CLONAZEPAM

 (Rivotril)

Standard Prescription

clonazepam __mg PO ___(frequency) (__mg/kg/24 hr)

Dosages

Anticonvulsant:

< 30 kg or < 10 years old:
Initial: 0.005-0.01 mg/kg/dose PO BID (0.01-0.03 mg/kg/24 hr)
Increment: 0.01 mg/kg/24 hr every 3-7 days (Max: 0.25 mg)
Maintenance: 0.03 mg/kg/dose PO BID or TID (0.05-0.1 mg/kg/24 hr) Maximum: 0.2 mg/kg/24 hr

> 30 kg or >10 years old:
Initial: 0.5 mg PO BID
Increment: 0.25-0.5 mg/24 hr every 3-7 days
Maintenance: 0.5-1.5 mg PO BID or TID
Maximum: 5 mg/24 hr (In rare cases, may use higher maximum based on individual clinical response)

Anxiety:

< 30 kg or < 12 years old:
0.25 mg PO daily at HS or BID

> 30 kg or > 12 years old:
0.25-0.5 mg PO daily at HS or BID
May be increased by 0.5-1 mg q2-3 days to a maximum of 3 mg/24 hr (adolescents) or 4 mg/24 hr (adults)

Mechanism of Action

Benzodiazepine; anticonvulsant, Clonazepam acts by binding to the benzodiazepine site of the GABA receptors.

Forms Supplied

tablet: 0.5 mg, 2 mg (0.25 mg, 1 mg not stocked at BCCH)

oral suspension (BCCH): 0.1 mg/mL

Comments

For anxiety, benzodiazepines are for symptomatic treatment only, and alternative strategies to replace benzodiazepine use should be sought quickly.

Doses higher than those used as an anxiolytic may be required for treatment of catatonia consult specialist.

Dose should be increased gradually until seizures/anxiety controlled.

Adverse effects: drooling (common), sedation, paradoxical reactions, behavioural problems

Benzodiazepines are habit-forming, commonly abused, and have a significant street value.

Tolerance may develop over time; abrupt discontinuation may precipitate withdrawal reaction or seizures. Taper dose gradually after long-term use (> 4 weeks).

References

4, 32, 44, 83

Last Edited

2022-06-17 04:46:45