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Rivotril 2mg by Roche

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Product Description

Clonazepam

is a benzodiazepine drug having anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties.It is marketed by Roche under the trade name Klonopin in the United States and Rivotril in Australia, Brazil, Canada, Mexico and the European Union (and in countries like Serbia, Macedonia, Croatia and Montenegro). Other names such as Ravotril, Rivatril, Clonex, Paxam, or Kriadex are known throughout the rest of the world.[citation needed] Clonazepam has an unusually long elimination half-life of 18–50 hours, making it generally considered to be among the long-acting benzodiazepines.Clonazepam is a chlorinated derivative of nitrazepamand therefore a chloro-nitrobenzodiazepine.

Benzodiazepines such as clonazepam have a fast onset of action and high effectiveness rate and low toxicity in overdose but have drawbacks due to adverse reactions including paradoxical effects, drowsiness, and cognitive impairment. Cognitive impairments can persist for at least six months after withdrawal of clonazepam; it is unclear whether full recovery of memory functions occurs. Other long-term effects of benzodiazepines include tolerance, benzodiazepine dependence, and benzodiazepine withdrawal syndrome, which occurs in a third of people treated with clonazepam for longer than four weeks.

Clonazepam is classified as a high potency benzodiazepine and is sometimes used as a second-line treatment of epilepsy. Clonazepam, like other benzodiazepines, while being a first-line treatment for acute seizures, is not suitable for the long-term treatment of seizures due to the development of tolerance to the anticonvulsant effects. The benzodiazepine clorazepate may be preferred over clonazepam due to a slower onset of tolerance and availability in slow-release formulation to counter fluctuations in blood levels. Clonazepam is also used for the treatment of panic disorder. The pharmacological property of clonazepam as with other benzodiazepines is the enhancement of the neurotransmitter GABA via modulation of the GABAA receptor.

Medical uses

Clonazepam may be prescribed for the following:

  • Epilepsy
  • Anxiety disorders
  • Panic disorder
  • Initial treatment of mania or acute psychosis together with firstline drugs such as lithium, haloperidol or risperidone
  • For the management of the visual effects of
  • Hyperekplexia
  • Many forms of parasomnia are sometimes treated with clonazepam.Restless legs syndrome can be treated using clonazepam as a third line treatment option as the use of clonazepam is still investigational.Bruxism also responds to clonazepam in the short-termRapid eye movement behavior disorder responds well to low doses of clonazepam.
  • The treatment of acute and chronic akathisia induced by neuroleptics also called antipsychotics.
  • Spasticity related to amyotrophic lateral sclerosis

The effectiveness of clonazepam in the short-term treatment of panic disorder has been demonstrated in controlled clinical trials. Some long-term trials have suggested a benefit of clonazepam for up to three years without the development of tolerance but these trials were not placebo controlled. Clonazepam is also effective in the management of acute mania.

Clonazepam is sometimes used for certain rare childhood epilepsies and for refractory epilepsies; however, long-term prophylactic treatment of epilepsy has considerable limitations, the most notable ones being the loss of antiepileptic effects due to tolerance, which renders the drug ineffective with long term use which is why clonazepam and benzodiazepines as a class are, in general, to be prescribed only for the acute management of epilepsies. However, a subgroup of people with treatment resistant epilepsy may benefit from long-term use of clonazepam; the benzodiazepine clorazepate may be preferred however, due to its slower onset of tolerance.

Clonazepam or diazepam has been found to be effective in the acute control of nonconvulsive status epilepticus. However, the benefits tended to be transient in many of the patients, and the addition of phenytoin for lasting control was required in these patients.

In general, clonazepam has been found to be ineffective in the control of infantile spasms.Clonazepam is less effective and potent as an anticonvulsant in bringing infantile seizures under control compared with nitrazepam in the treatment of West syndrome, which is an age-dependent epilepsy affecting the very young. However, as with other epilepsies treated with benzodiazepines, long-term therapy becomes ineffective with prolonged therapy, and the side effects of hypotonia and drowsiness are troublesome with clonazepam therapy; other antiepileptic agents are, therefore, recommended for long-term therapy, possibly Corticotropin (ACTH) or vigabatrin. Furthermore, clonazepam is not recommended for widespread use in the management of seizures related to West syndrome.

Clonazepam has shown itself to be highly effective as a short-term (3 weeks) adjunct to SSRI treatment in obsessive-compulsive disorder and clinical depression in reducing SSRI side effects with the combination being superior to SSRI treatment alone in a study funded by the manufacturers of clonazepam, Hoffman LaRoche Inc.

Side effects

Very common

  • Drowsiness
  • Interference with cognitive and motor performance
  • Euphoria

Less common

  • Irritability and aggression
  • Psychomotor agitation
  • Lack of motivation
  • Loss of libido
  • Impaired motor function
    • Impaired coordination
    • Impaired balance
    • Dizziness
  • Cognitive impairments
    • Hallucinations
    • Short-term memory loss
    • Anterograde amnesia (common with higher doses)
  • Some users report hangover-like symptoms of being drowsy, having a headache, being sluggish, and being irritable after waking up if the medication is taken before sleep. This is likely the result of the medication's long half-life, which continues to affect the user after waking up.
  • The "hangover effect" some experience not only results from clonazepam's considerably long half-life. Like many other benzodiazepines, when taken as a sleep-aid, clonazepam disrupts or interferes with the brain's delta waves. Delta waves signify the brain's slowest waves (~4 Hz) and occur during Stage 4 sleep, which represents humans' deepest sleep state (our muscles are the most relaxed; breathing slows and becomes shallow), and the stage right before R.E.M. sleep and dreaming (Stage 5). Therefore, upon waking, this disruption of Stage 4 delta wave sleep causes a failure for an adequate brain/body rest or "recharge".

While benzodiazepines induce sleep, they tend to produce a poorer quality sleep than natural sleep. Benzodiazepines such as clonazepam suppress REM sleep.After regular use rebound insomnia can occur when discontinuing clonazepam.

  • Benzodiazepines may cause or worsen depression.

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