Open pouch and peel back foil on the blister; do not push tablet through foil. Use dry hands to remove tablet and place in mouth. May be swallowed with or without water. Use immediately after removing from package. Swallow whole with water. Monitor therapy Azelastine Nasal: Consider therapy modification Bosentan: Monitor therapy Brimonidine Topical: Consider therapy modification Cannabis: Use of ceritinib with a narrow therapeutic index CYP3A substrate eg, alfentanil, cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, tacrolimus should be avoided when possible.
Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification Chlorphenesin Carbamate: Consider decreasing the dose of or possibly discontinuing benzodiazepines prior to initiating clozapine.
Consider therapy modification CNS Depressants: May increase the serum concentration of ClonazePAM. May enhance the hepatotoxic effect of ClonazePAM. Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification Dabrafenib: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely particularly therapeutic effects.
Consider therapy modification Dasatinib: Monitor therapy Dimethindene Topical: Consider dose reductions of droperidol or of other CNS agents e. Consider therapy modification Enzalutamide: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Consider therapy modification Flunitrazepam: Consider therapy modification Fosaprepitant: May decrease the serum concentration of ClonazePAM.
Clonazepam may also alter concentrations of Phenytoin active metabolite of Fosphenytoin. Monitor therapy Fusidic Acid Systemic: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification HydrOXYzine: Avoid combination Kava Kava: Monitor therapy Magnesium Sulfate: May enhance the sedative effect of Benzodiazepines.
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. But thinking of how it works I would say headache-no, pain-no, tension, maybe as it is a tranquilizer.
Benzodiazepines are also known as minor tranquilizers, anti-psychotics are sometimes called major tranquilizers, but have far more severe potential side effects. I was not warned of the side effects or checked on while taking it. I went back to the dr.
I couldn't get an apt with the dr. People are amazed at the change in my behavior and attitude. I talked to the pharmacist and she said not one pharmacist she knows approves of this med or any ending in "pam". I will be off it in several weeks. The specific considerations addressed above regarding the use of anticonvulsants for epilepsy in women of childbearing potential should be weighed in treating or counseling these women.
Because of experience with other members of the benzodiazepine class, Clonazepam is assumed to be capable of causing an increased risk of congenital abnormalities when administered to a pregnant woman during the first trimester.
Because use of these drugs is rarely a matter of urgency in the treatment of panic disorder, their use during the first trimester should almost always be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Patients should also be advised that if they become pregnant during therapy or intend to become pregnant, they should communicate with their physician about the desirability of discontinuing the drug.
When used in patients in whom several different types of seizure disorders coexist, Clonazepam may increase the incidence or precipitate the onset of generalized tonic-clonic seizures grand mal.
This may require the addition of appropriate anticonvulsants or an increase in their dosages. The concomitant use of valproic acid and Clonazepam may produce absence status.
Periodic blood counts and liver function tests are advisable during long-term therapy with Clonazepam. Risks of Abrupt Withdrawal: The abrupt withdrawal of Clonazepam, particularly in those patients on long-term, high-dose therapy, may precipitate status epilepticus.
Therefore, when discontinuing Clonazepam, gradual withdrawal is essential. While Clonazepam is being gradually withdrawn, the simultaneous substitution of another anticonvulsant may be indicated. Caution in Renally Impaired Patients: Metabolites of Clonazepam 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.
Clonazepam may produce an increase in salivation. This should be considered before giving the drug to patients who have difficulty handling secretions. Diazepam and clonazepam, like all benzodiazepine drugs, were found to have five therapeutic actions, i. Any drug with similar therapeutic spectrum to the above will be both cross tolerate and cross dependent with the benzodiazepines and in principle will be of some help in benzodiazepine withdrawal.
As well as the therapeutic actions, drugs with long half-lives are essential to prevent interdose withdrawals and to produce a helpful accumulation of the parent drug. In a few benzodiazepines the metabolites of the parent drug are also therapeutically active with the same five therapeutic actions.
Of these only diazepam and chlordiazepoxide Librium have long half-lives for the parent drug and for the active metabolites. Librium is most commonly used for alcohol withdrawal and diazepam for a range of drug withdrawal problems.
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