Physical and Psychological Dependence. Paradoxical reactions are more likely to occur in children and in the elderly. Risks of Abrupt Withdrawal The abrupt withdrawal of Klonopin, particularly in those patients on long-term, high-dose therapy, may precipitate status epilepticus.

Therefore, when discontinuing Klonopin, gradual withdrawal is essential. While Klonopin is being gradually withdrawn, the simultaneous substitution of another anticonvulsant may be indicated. Caution in Renally Impaired Patients Metabolites of Klonopin are excreted by the kidneys; to avoid their excess accumulation, caution should be exercised in the administration of the drug to patients with impaired renal function.

Hypersalivation Klonopin may produce an increase in salivation. This should be considered before giving the drug to patients who have difficulty handling secretions. Respiratory Depression Klonopin may cause respiratory depression and should be used with caution in patients with compromised respiratory function e. Porphyria Klonopin may have a porphyrogenic effect and should be used with care in patients with porphyria.

Information for Patients A Klonopin Medication Guide must be given to the patient each time Klonopin is dispensed, as required by law. Patients should be instructed to take Klonopin only as prescribed. Physicians are advised to discuss the following issues with patients for whom they prescribe Klonopin: Risks from Concomitant Use with Opioids Inform patients and caregivers that potentially fatal additive effects may occur if Klonopin is used with opioids and not to use such drugs concomitantly unless supervised by a health care provider see WARNINGS: Dose Changes To assure the safe and effective use of benzodiazepines, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is advisable that they consult with their physician before either increasing the dose or abruptly discontinuing this drug.

Interference With Cognitive and Motor Performance Because benzodiazepines have the potential to impair judgment, thinking or motor skills, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that Klonopin therapy does not affect them adversely. Suicidal Thinking and Behavior Patients, their caregivers, and families should be counseled that AEDs, including Klonopin, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm.

This registry is collecting information about the safety of antiepileptic drugs during pregnancy. Nursing Patients should be advised to notify their physician if they are breastfeeding or intend to breastfeed during therapy.

Concomitant Medication Patients should be advised to inform their physicians if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for interactions. Alcohol Patients should be advised to avoid alcohol while taking Klonopin. Drug Interactions Effect of Concomitant Use of Benzodiazepines and Opioids The concomitant use of benzodiazepines and opioids increases the risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration.

When benzodiazepines and opioids are combined, the potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists. Limit dosage and duration of concomitant use of benzodiazepines and opioids, and follow patients closely for respiratory depression and sedation. Effect of Clonazepam on the Pharmacokinetics of Other Drugs Clonazepam does not appear to alter the pharmacokinetics of phenytoin, carbamazepine or phenobarbital.

Clonazepam has the potential to influence concentrations of phenytoin. Monitoring of phenytoin concentration is recommended when clonazepam is co-administrated with phenytoin. The effect of clonazepam on the metabolism of other drugs has not been investigated. Effect of Other Drugs on the Pharmacokinetics of Clonazepam Literature reports suggest that ranitidine, an agent that decreases stomach acidity, does not greatly alter clonazepam pharmacokinetics. Although clinical studies have not been performed, based on the involvement of the cytochrome P 3A family in clonazepam metabolism, inhibitors of this enzyme system, notably oral antifungal agents e.

Pharmacodynamic Interactions The CNS-depressant action of the benzodiazepine class of drugs may be potentiated by alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, antianxiety agents, the phenothiazines, thioxanthene and butyrophenone classes of antipsychotic agents, monoamine oxidase inhibitors and the tricyclic antidepressants, and by other anticonvulsant drugs. Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis Carcinogenicity studies have not been conducted with clonazepam.

Mutagenesis The data currently available are not sufficient to determine the genotoxic potential of clonazepam. Pregnancy There are no adequate and well-controlled studies of Klonopin in pregnant women. Available human data on the risk of teratogenicity are inconclusive. There is insufficient evidence in humans to assess the effect of benzodiazepine exposure during pregnancy on neurodevelopment. Administration of benzodiazepines immediately prior to or during childbirth can result in a syndrome of hypothermia, hypotonia, respiratory depression, and difficulty feeding.

In addition, infants born to mothers who have taken benzodiazepines during the later stages of pregnancy can develop dependence, and subsequently withdrawal, during the postnatal period. In three studies in which clonazepam was administered orally to pregnant rabbits at doses of 0. Data for other benzodiazepines suggest the possibility of adverse developmental effects long-term effects on neurobehavioral and immunological function in animals following prenatal exposure to benzodiazepines.

Administration of benzodiazepines immediately prior to or during childbirth can result in a syndrome of hypothermia , hypotonia , respiratory depression, and difficulty feeding. In addition, infants born to mothers who have taken benzodiazepines during the later stages of pregnancy can develop dependence, and subsequently withdrawal, during the postnatal period. In three studies in which clonazepam was administered orally to pregnant rabbits at doses of 0.

Data for other benzodiazepines suggest the possibility of adverse developmental effects long-term effects on neurobehavioral and immunological function in animals following prenatal exposure to benzodiazepines.

To provide information regarding the effects of in utero exposure to Klonopin, physicians are advised to recommend that pregnant patients taking Klonopin enroll in the NAAED Pregnancy Registry.

This can be done by calling the toll free number , and must be done by patients themselves. Information on this registry can also be found at the website http: Nursing Mothers The effects of Klonopin on the breastfed infant and on milk production are unknown.

Safety and effectiveness in pediatric patients with panic disorder below the age of 18 have not been established. Geriatric Use Clinical studies of Klonopin did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Because clonazepam undergoes hepatic metabolism , it is possible that liver disease will impair clonazepam elimination. Metabolites of Klonopin are excreted by the kidneys; to avoid their excess accumulation, caution should be exercised in the administration of the drug to patients with impaired renal function. Sedating drugs may cause confusion and over-sedation in the elderly; elderly patients generally should be started on low doses of Klonopin and observed closely. Overdose Management Treatment includes monitoring of respiration , pulse and blood pressure, general supportive measures and immediate gastric lavage.

Intravenous fluids should be administered and an adequate airway maintained. Hypotension may be combated by the use of levarterenol or metaraminol. Dialysis is of no known value. Flumazenil, a specific benzodiazepine-receptor antagonist , is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected.

Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for resedation, respiratory depression and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose.

Flumazenil is not indicated in patients with epilepsy who have been treated with benzodiazepines. Antagonism of the benzodiazepine effect in such patients may provoke seizures. Serious sequelae are rare unless other drugs or alcohol have been taken concomitantly. History of sensitivity to benzodiazepines Clinical or biochemical evidence of significant liver disease Acute narrow angle glaucoma it may be used in patients with open angle glaucoma who are receiving appropriate therapy.

Pharmacokinetics Clonazepam is rapidly and completely absorbed after oral administration. Maximum plasma concentrations of clonazepam are reached within 1 to 4 hours after oral administration.. Biotransformation occurs mainly by reduction of the 7-nitro group to the 4-amino derivative. This derivative can be acetylated, hydroxylated and glucuronidated. The elimination half-life of clonazepam is typically 30 to 40 hours.

Clonazepam pharmacokinetics are dose-independent throughout the dosing range. There is no evidence that clonazepam induces its own metabolism or that of other drugs in humans. Pharmacokinetics In Demographic Subpopulations And In Disease States Controlled studies examining the influence of gender and age on clonazepam pharmacokinetics have not been conducted, nor have the effects of renal or liver disease on clonazepam pharmacokinetics been studied.

Because clonazepam undergoes hepatic metabolism, it is possible that liver disease will impair clonazepam elimination. In children, clearance values of 0. Ketogenic diet in children does not affect clonazepam concentrations. Clinical Trials Panic Disorder The effectiveness of Klonopin in the treatment of panic disorder was demonstrated in two double-blind, placebo-controlled studies of adult outpatients who had a primary diagnosis of panic disorder DSM -IIIR with or without agoraphobia.

Study 1 was a 9-week, fixed-dose study involving Klonopin doses of 0.

My friend just took 60 .5 mg of klonopin, what should i do,

Respiratory Depression Klonopin may cause respiratory mgs and should be used with caution in patients with compromised respiratory function e. Physicians are advised mgs discuss the following issues with patients for whom they prescribe Klonopin: Mutagenesis Mgs data currently available are not sufficient to determine the genotoxic potential of clonazepam. Nursing Mothers The effects of Klonopin on the breastfed infant and on milk production are unknown. Hypersalivation Klonopin may produce an klonopin in salivation. Hypersalivation Klonopin may produce an increase in salivation. In general, 6 mgs of klonopin, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. This registry klonopin collecting information about the safety of antiepileptic drugs during pregnancy. Precautions General Worsening of Seizures When used klonopin patients in whom several mgs types of seizure disorders coexist, Klonopin may increase the incidence or precipitate the onset of generalized tonic-clonic seizures grand mal. Interference With Cognitive and Motor Performance Because benzodiazepines have the potential to impair judgment, thinking or motor skills, patients should be cautioned about operating hazardous machinery, 6 mgs of klonopin, including automobiles, 6 mgs of klonopin, until they are reasonably certain that Klonopin therapy does not affect them adversely. Anyone considering prescribing Klonopin or any other AED must balance the klonopin of suicidal thoughts or behavior with the risk of untreated illness. Carcinogenesis, Mutagenesis, Impairment Of Fertility Carcinogenesis Carcinogenicity studies have not been conducted with clonazepam.

Dose Changes To assure the safe and effective use of benzodiazepines, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is advisable that they consult with their physician before either increasing the dose mgs abruptly discontinuing this drug. The elimination half-life of clonazepam is typically 30 to 40 hours. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. The concomitant use of valproic acid and Klonopin may produce absence status. Safety and effectiveness in pediatric patients with panic disorder below the age of 18 have not been established. Abnormal eye movements, aphonia, choreiform movements, coma, diplopia, dysarthria, dysdiadochokinesis, ''glassy-eyed'' appearance, headache, hemiparesis, hypotonia, nystagmus, respiratory depression, slurred speech, tremor, vertigo Psychiatric: In some cases, dosage adjustment may reestablish efficacy. Patients, their caregivers, 6 mgs of klonopin, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, klonopin unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Administration of benzodiazepines immediately prior to mgs during childbirth can result in a syndrome of hypothermia, hypotonia, respiratory depression, and difficulty mgs. Safety and effectiveness in pediatric patients with panic disorder below the age of 18 have not been established. There is no evidence that clonazepam induces its own metabolism klonopin that of other drugs in humans, 6 mgs of klonopin. The difference between the 1 mg dose group and placebo in reduction from baseline in the number of full panic attacks was approximately 1 panic attack per week, 6 mgs of klonopin. When benzodiazepines and opioids are combined, the potential for benzodiazepines to significantly worsen opioid-related does ciprofloxacin treat chlamydia depression exists. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, 6 mgs of klonopin, ventilation and intravenous access. Risks Of Abrupt Withdrawal Klonopin abrupt withdrawal of Klonopin, particularly in those patients on long-term, high-dose therapy, may precipitate status epilepticus.

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