THERAPEUTICS

Brands

• Klonopin, Rivotril

Generic?

• Yes

Class

• Benzodiazepine, antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

• Seizure disorders. Used as monotherapy or adjunctive for the treatment of Lennox- Gastaut syndrome, akinetic, myoclonic, or absence seizures

• Panic disorder, with or without agoraphobia

• Periodic leg movements disorder (PLMD)

• Restless legs syndrome (RLS)

• Tic disorders

• Parkinsonian (hypokinetic) dysarthria

• Tardive dyskinesia

• Muscle relaxation

• Insomnia

• Burning mouth syndrome

• Generalized anxiety disorder

• Schizophrenia (adjunctive)

• Acute mania in bipolar disorder

How the Drug Works

• Benzodiazepines bind to and potentiate the effect of GABAA receptors, which are ligandgated chloride channels activated by GABA. It boosts chloride conductance across cell membranes, hyperpolarizes the membrane potential, and increases the threshold potential. There are at least 2 benzodiazepine receptors, 1 of which is associated with sleep mechanisms, the other with memory, sensory, and cognitive functions. Benzodiazepines act at spinal cord, brainstem, cerebellum, limbic, and cortical areas

• In petit mal seizures clonazepam suppresses spike and wave discharges, and in motor seizures decreases the frequency, amplitude, duration, and spread of discharge

How Long Until It Works

• There is often an immediate effect in treatment of epilepsy, PLMD, RLS, insomnia, and panic disorders, but usually weeks are required for optimal dose adjustments and maximal therapeutic benefit

If It Works

• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years seizure-free, depending on the type of epilepsy

• PLMD, RLS, tic disorders: continue to adjust dose to find the lowest dose that produces relief of symptoms with fewest AEs

• Anxiety: often used only on a short-term basis. Consider adding an SSRI or SNRI for long-term treatment

If It Doesn't Work

• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind