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Clonazepam Disease Interactions

There are 10 disease interactions with clonazepam:

Benzodiazepines (Includes Clonazepam) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication, Alcoholism

The use of benzodiazepines is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  3. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
View all 13 references

Benzodiazepines (Includes Clonazepam) ↔ Closed-Angle Glaucoma

Severe Potential Hazard, Low plausibility

Applies to: Glaucoma/Intraocular Hypertension

The manufacturers consider the use of benzodiazepines to be contraindicated in patients with acute angle-closure glaucoma or untreated open-angle glaucoma. These agents do not possess anticholinergic activity but have very rarely been associated with increased intraocular pressure.

References

  1. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
View all 14 references

Benzodiazepines (Includes Clonazepam) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, Drug Abuse/Dependence

Benzodiazepines have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use and/or excessive dosages. However, abrupt cessation following continual use of as few as 6 weeks at therapeutic levels has occasionally precipitated withdrawal symptoms. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance when treated with benzodiazepines. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of benzodiazepine therapy should be undertaken gradually using a dosage-tapering schedule. If withdrawal symptoms occur, temporary reinstitution of benzodiazepines may be necessary.

References

  1. Specht U, Boenigk HE, Wolf P "Discontinuation of clonazepam after long-term treatment." Epilepsia 30 (1989): 458-63
  2. Pecknold JC "Discontinuation reactions to alprazolam in panic disorder." J Psychiatr Res 27 (1993): 155-70
  3. Wilbur R, Kulik AV "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 298-300
View all 48 references

Benzodiazepines (Includes Clonazepam) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Asphyxia, Pulmonary Impairment, Sleep Apnea, Respiratory Arrest

Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.

References

  1. Cohen S, Khan A "Respiratory distress with use of lorazepam in mania." J Clin Psychopharmacol 7 (1987): 199-200
  2. Eldridge PR, Punt JA "Risks associated with giving benzodiazepines to patients with acute neurological injuries." Br Med J 300 (1990): 1189-90
  3. Iber FL, Livak A, Kruss DM "Apnea and cardiopulmonary arrest during and after endoscopy." J Clin Gastroenterol 14 (1992): 109-13
View all 30 references

Benzodiazepines (Includes Clonazepam) ↔ Seizures

Severe Potential Hazard, High plausibility

Applies to: Seizures

Abrupt cessation of benzodiazepine therapy may precipitate seizures and other withdrawal symptoms, particularly after prolonged use and/or excessive dosages. Status epilepticus may occur in patients with a history of seizures withdrawn rapidly from benzodiazepine therapy. Following chronic administration, cessation of benzodiazepine therapy should occur gradually with incrementally reduced dosages. Patients should be advised not to discontinue medication without first consulting with the physician.

References

  1. Berlin RM, Conell LJ "Withdrawal symptoms after long-term treatment with therapeutic doses of flurazepam: a case report." Am J Psychiatry 140 (1983): 488-90
  2. Tien AY, Gujavarty KS "Seizure following withdrawal from triazolam." Am J Psychiatry 142 (1985): 1516-7
  3. Schneider LS, Syapin PJ, Pawluczyk S "Seizures following triazolam withdrawal despite benzodiazepine treatment." J Clin Psychiatry 48 (1987): 418-9
View all 36 references

Clonazepam (Includes Clonazepam) ↔ Renal/Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

The use of clonazepam is considered by the manufacturer to be contraindicated in patients with clinical or biochemical evidence of significant liver disease. Clonazepam is primarily metabolized by the liver, and the metabolites are eliminated by the kidney. Due to the possibility of excess accumulation of metabolites and the unknown effects of such accumulation, therapy with clonazepam should also be administered cautiously in patients with renal impairment.

References

  1. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.

Antiepileptics (Includes Clonazepam) ↔ Suicidal Tendency

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis, Depression

Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs across multiple indications in either monotherapy or adjunctive therapy for a median treatment duration of 12 weeks (up to a maximum of 24 weeks) showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. The estimated rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% for 16,029 placebo-treated patients, representing an increase of approximately one case for every 530 patients treated. There were four suicides in AED-treated patients and none in placebo-treated patients, although the number is too small to establish any causal relationship. The increased risk of suicidal thoughts or behavior was observed as early as one week after starting AEDs and persisted for the duration of treatment assessed. The risk did not vary substantially by age (5 to 100 years) in the clinical trials analyzed. Therapy with AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. For clinically significant or persistent symptoms, a dosage reduction or treatment withdrawal should be considered. If patients have symptoms of suicidal ideation or behavior, treatment should be discontinued.

Benzodiazepines (Includes Clonazepam) ↔ Depression

Moderate Potential Hazard, High plausibility

Applies to: Depression

Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or suicidal tendencies. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  3. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
View all 12 references

Benzodiazepines (Includes Clonazepam) ↔ Obesity

Moderate Potential Hazard, Moderate plausibility

Applies to: Obesity

The plasma half-lives of benzodiazepines may be prolonged in obese patients, presumably due to increased distribution into fat. Marked increases in distribution (> 100%) have been reported for diazepam and midazolam, and moderate increases (25% to 100%) for alprazolam, lorazepam, and oxazepam. Therapy with benzodiazepines should be administered cautiously in obese patients, with careful monitoring of CNS status. Longer dosing intervals may be appropriate. When dosing by weight, loading doses should be based on actual body weight, while maintenance dose should be based on ideal body weight to avoid toxicity.

References

  1. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 14 references

Benzodiazepines (Includes Clonazepam) ↔ Paradoxical Reactions

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperkinetic Syndrome of Childhood, Psychosis

Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.

References

  1. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  2. Marchevsky S, Isaacs G, Nitzan I "Behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 10 (1988): 447
  3. Fava M, Borofsky GF "Sexual disinhibition during treatment with a benzodiazepine: a case report." Int J Psychiatry Med 21 (1991): 99-104
View all 35 references

You should also know about...

clonazepam drug Interactions

There are 838 drug interactions with clonazepam

clonazepam alcohol/food Interactions

There are 2 alcohol/food interactions with clonazepam

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2014 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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