Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Clonazepam is an anti-anxiety medication in the
benzodiazepine family, the same family that includes diazepam (Valium),
alprazolam (Xanax), lorazepam (Ativan), flurazepam (Dalmane), and others.
Clonazepam and other benzodiazepines act by enhancing the effects of
gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter (a
chemical that nerve cells use to communicate with each other) that inhibits
brain activity. It is believed that excessive activity in the brain may lead to
anxiety or other psychiatric disorders. Clonazepam also is used to prevent
certain types of seizures.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 0.5, 1, and 2 mg. Disintegrating tablets: 0.125, 0.25,
0.5, 1, and 2 mg.
STORAGE: Tablets should be kept at room temperature, between 15° and 30°C
(59-86°F).
PRESCRIBED FOR: Clonazepam is used for the short-term relief of symptoms of
anxiety. It is used for certain types of seizures, specifically petit mal
seizures, akinetic seizures, and myoclonus, as well as Lennox-Gastaut syndrome.
Clonazepam maybe used alone or together with other medications for these seizure
disorders.
DOSING: The dose of clonazepam is tailored to the patient's needs. For
seizures in adults the initial dose is 1.5 mg daily in 3 divided doses. Dosage
may be increased by 0.5 to 1 mg daily every 3 days until seizures are controlled
or side effects preclude further increases in dose. The maximum dose is 20 mg
daily. The initial dose for panic disorders is 0.25 mg twice daily. The dose may
be increased to the target dose of 1 mg daily after 3 days.
DRUG INTERACTIONS: Clonazepam, like all other benzodiazepines, accentuates
the effects of other drugs that slow the brain's processes, such as alcohol,
barbiturates, and narcotics and leads to increased sedation.
PREGNANCY: Clonazepam and other benzodiazepines have been associated with
fetal damage, including congenital malformations, when taken by pregnant women
in their first trimester. Clonazepam is best avoided in the first trimester and
probably throughout pregnancy.
NURSING MOTHERS: Benzodiazepines are secreted in breast milk. Mothers who are
breastfeeding should not take clonazepam.
SIDE EFFECTS: The most commonly noted side effects associated with clonazepam
are sedation, which is reported in approximately half of patients, dizziness
which is reported in one-third of patients, weakness, and unsteadiness. Other
side effects include a feeling of depression, loss of orientation, headache, and
sleep disturbance.
Like all benzodiazepines, clonazepam can cause physical dependence. Suddenly
stopping therapy after a few months of daily therapy may be associated with a
feeling of loss of self-worth, agitation, and insomnia. If clonazepam is taken
continuously for longer than a few months, stopping therapy suddenly may produce
seizures, tremors,
muscle cramping,
vomiting, and/or sweating. Therefore,
discontinuation usually is accomplished by reducing the dose gradually.
Antiepileptic medications have been associated with an increased risk of
suicidal thinking and behavior. Anyone considering the use of
antiepileptic drugs must balance this risk of suicide with the clinical need for
the antiepileptic drug. Patients who begin antiepileptic therapy should be
closely observed for clinical worsening, suicidal thoughts or unusual changes in
behavior.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Huntington's disease is the result of degeneration of neurons in areas of the brain. Huntington's disease is an inherited disorder. Early symptoms include mood swings, apathy, depression, and anger uncharacteristic of the individual. Judgement, memory, and other cognitive functions may become impaired. Presymptomatic testing is available for individuals who have a family history of Huntington's disease. Treatment includes medication and therapy for symptoms.
Phobias are unrelenting fears of activities (social phobias), situations (agoraphobia), and specific items (arachnophobia). There is thought to be a hereditary component to phobias, though there may be a cultural influence or they may be triggered by life events. Symptoms and signs of phobias include having a panic attack, shaking, breathing troubles, rapid heart beat, and a strong desire to escape the situation. Treatment of phobias typically involves desensitization, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors and beta blockers.
Agoraphobia is a fear of being outside or of being in a situation from which escape would be impossible. Symptoms include anxiety, fear, disorientation, rapid heartbeat, diarrhea, or dizziness. Treatment may incorporate psychotherapy, self-exposure to the anxiety-causing situation, and medications such as SSRIs, benzodiazepines, and beta blockers.
Separation anxiety disorder is a common childhood anxiety disorder that has many causes. Infants, children, older kids and adults can suffer from symptoms of separation anxiety disorder. Common treatment methods include therapy and medications.
Dystonia disorders cause involuntary movements and prolonged muscle contraction, resulting in twisting body motions, tremor, and abnormal posture. There are many forms of dystonia. Some types of dystonia respond to dopamine, or can be controlled with dedative-type medications, or surgery.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Sleepwalking is a condition in which an individual walks or does other activities while asleep. Factors associated with sleepwalking include genetic, environmental, and physiological. Episodes of sleepwalking may include quiet walking to agitated running. Conditions that may have similar symptoms of sleepwalking, but are not include night terrors, confusional arousals, and nocturnal seizures. Treatment of sleepwalking generally include preventative measures. Medication may be prescribed if necessary.
The majority of epileptic seizures are controlled through drug therapy, particularly anticonvulsant drugs. The type of treatment prescribed will depend on several factors including the frequency and severity of the seizures as well as the person's age, overall health, and medical history. An accurate diagnosis of the type of epilepsy is also critical to choosing the best treatment.
Drug Therapy
Many drugs are available to treat epilepsy, several of which have only recently been released.
Older, classic medications used to treat epilepsy include:
Dilantin or Phenytek
Phenobarbital
Tegretol or Carbatrol
Mysoline
Zarontin
Depakene
Depakote, Depakote ER
Valium and similar tranquilizers such as Tranxene and Klonopin