Patients being treated for epilepsy may need to be
maintained on a specific manufacturer’s branded or
generic oral clonazepam product.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Clonazepam for preventing
seizureswww.medicinesforchildren.org.uk/clonazepam-
preventing-seizures- 0lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: orodispersible tablet, oral suspension,
oral solution, oral drops
Tablet
CAUTIONARY AND ADVISORY LABELS2, 8
▶Clonazepam (Non-proprietary)
Clonazepam 500 microgramClonazepam 500 microgram tablets|
100 tabletP£ 27. 70 DT = £ 27. 70 d
Clonazepam 2 mgClonazepam 2 mg tablets| 100 tabletP
£ 30. 75 DT = £ 29. 79 d
Oral solution
CAUTIONARY AND ADVISORY LABELS2, 8
EXCIPIENTS:May contain Ethanol
▶Clonazepam (Non-proprietary)
Clonazepam 100 microgram per 1 mlClonazepam
500 micrograms/ 5 ml oral solution sugar free sugar-free|
150 mlP£ 69. 50 DT = £ 69. 50 d
Clonazepam 400 microgram per 1 mlClonazepam 2 mg/ 5 ml oral
solution sugar free sugar-free| 150 mlP£ 108. 36 DT =
£ 108. 36 deiiiiF 218Diazepam 21-Nov-2016
lINDICATIONS AND DOSE
Tetanus
▶BY INTRAVENOUS INJECTION
▶Child: 100 – 300 micrograms/kg every 1 – 4 hours
▶BY INTRAVENOUS INFUSION, OR BY NASODUODENAL TUBE
▶Child: 3 – 10 mg/kg, adjusted according to response, to
be given over 24 hours
Muscle spasm in cerebral spasticity or in postoperative
skeletal muscle spasm
▶BY MOUTH
▶Child 1–11 months:Initially 250 micrograms/kg twice
daily
▶Child 1–4 years:Initially 2. 5 mg twice daily
▶Child 5–11 years:Initially 5 mg twice daily
▶Child 12–17 years:Initially 10 mg twice daily; maximum
40 mg per day
Status epilepticus|Febrile convulsions|Convulsions due
to poisoning
▶BY INTRAVENOUS INJECTION
▶Neonate: 300 – 400 micrograms/kg, then
300 – 400 micrograms/kg after 10 minutes if required, to
be given over 3 – 5 minutes.▶Child 1 month–11 years: 300 – 400 micrograms/kg (max.
per dose 10 mg), then 300 – 400 micrograms/kg after
10 minutes if required, to be given over 3 – 5 minutes
▶Child 12–17 years: 10 mg, then 10 mg after 10 minutes if
required, to be given over 3 – 5 minutes
▶BY RECTUM
▶Neonate: 1. 25 – 2. 5 mg, then 1. 25 – 2. 5 mg after
10 minutes if required.▶Child 1 month–1 year: 5 mg, then 5 mg after 10 minutes if
required
▶Child 2–11 years: 5 – 10 mg, then 5 – 10 mg after
10 minutes if required
▶Child 12–17 years: 10 – 20 mg, then 10 – 20 mg after
10 minutes if requiredLife-threatening acute drug-induced dystonic reactions
▶BY INTRAVENOUS INJECTION
▶Child 1 month–11 years: 100 micrograms/kg, repeated if
necessary, to be given over 3 – 5 minutes
▶Child 12–17 years: 5 – 10 mg, repeated if necessary, to be
given over 3 – 5 minuteslUNLICENSED USE
▶With rectal useDiazepam Desitin®,Diazepam Rectubes®,
andStesolid Rectal Tubes®not licensed for use in children
under 1 year.IMPORTANT SAFETY INFORMATION
ANAESTHESIA
Benzodiazepines should only be administered for
anaesthesia by, or under the direct supervision of,
personnel experienced in their use, with adequate
training in anaesthesia and airway management.lCONTRA-INDICATIONSAvoid injections containing benzyl
alcohol in neonates.CNS depression.compromised
airway.hyperkinesis.obsessional states.phobic states.
respiratory depression
lCAUTIONS
GENERAL CAUTIONSMuscle weakness.organic brain
changes.parenteral administration (close observation
required until full recovery from sedation)
SPECIFIC CAUTIONS
▶With intravenous useHigh risk of venous thrombophlebitis
with intravenous use (reduced by using an emulsion
formulation)
CAUTIONS, FURTHER INFORMATION
▶Special precautions for intravenous injectionWhen given
intravenously facilities for reversing respiratory
depression with mechanical ventilation must be
immediately available.
lINTERACTIONS→Appendix 1 : diazepam
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonAppetite abnormal.movement
disorders.muscle spasms.palpitations.sensory disorder
▶UncommonConcentration impaired.constipation.
diarrhoea.hypersalivation.skin reactions.speech slurred
.vomiting
▶Rare or very rareBradycardia.bronchial secretion
increased.cardiac arrest.dry mouth.gynaecomastia.
heart failure.leucopenia.loss of consciousness.memory
loss.psychiatric disorder.respiratory arrest.sexual
dysfunction.syncope
▶Frequency not knownApnoea.nystagmus.vision blurred
lPREGNANCYWomen who have seizures in the second half
of pregnancy should be assessed for eclampsia before any
change is made to antiepileptic treatment. Status
epilepticus should be treated according to the standard
protocol.
Epilepsy and Pregnancy RegisterAll pregnant women with
epilepsy, whether taking medication or not, should be
encouraged to notify the UK Epilepsy and Pregnancy
Register (Tel:0800 389 1248).
lBREAST FEEDINGPresent in milk, and should be avoided if
possible during breast-feeding.
lHEPATIC IMPAIRMENTCan precipitate coma. If treatment
is necessary, benzodiazepines with shorter half lives are
safer, such as temazepam or oxazepam. Avoid in severe
impairment.
Dose adjustmentsStart with smaller initial doses or reduce
dose.
lRENAL IMPAIRMENT
Dose adjustmentsStart with small doses in severe
impairment.220 Epilepsy and other seizure disorders BNFC 2018 – 2019
Nervous system4