How to use clonotril (clonazepam) mouth dissolving tablets?

How to Use Clonotril (Clonazepam) Mouth Dissolving Tablets

Critical Safety Warning: Do NOT Use Mouth Dissolving Tablets After a Seizure

Nothing should be given by mouth to a patient who has just had a seizure due to decreased responsiveness and aspiration risk in the immediate postictal period. 1 The American Academy of Pediatrics explicitly states that oral formulations, including mouth dissolving tablets, are NOT appropriate for acute post-seizure management—intravenous or intramuscular routes are the standard of care for seizure emergencies. 1

Standard Administration Method for Clonazepam Tablets

Clonazepam tablets should be administered with water by swallowing the tablet whole. 2 This is the FDA-approved method of administration for standard clonazepam tablets. 2

Key Administration Points:

• Take with water and swallow whole - this is the primary instruction from the FDA drug label 2
• Do not crush, chew, or allow to dissolve in the mouth unless specifically prescribed an orally disintegrating formulation designed for that purpose 2
• Take exactly as prescribed by your healthcare provider - do not adjust doses without medical guidance 2

Dosing Guidelines

For Seizure Disorders:

• Adults: Initial dose should not exceed 1.5 mg/day divided into three doses, with increases of 0.5-1 mg every 3 days until seizures are controlled (maximum 20 mg/day) 2
• Pediatric patients (up to 10 years or 30 kg): Initial dose 0.01-0.03 mg/kg/day (not exceeding 0.05 mg/kg/day) in 2-3 divided doses, with increases of 0.25-0.5 mg every third day to maintenance of 0.1-0.2 mg/kg/day 2
• Largest dose should be given before bedtime when doses are not equally divided 2

For Panic Disorder:

• Adults: Initial dose 0.25 mg twice daily, increasing to target dose of 1 mg/day after 3 days (maximum 4 mg/day) 2
• One dose at bedtime may reduce daytime somnolence 2

Critical Safety Considerations

Respiratory Monitoring:

• Monitor oxygen saturation continuously when using clonazepam, especially with other sedatives 1
• Be prepared to provide respiratory support due to increased risk of apnea 1
• Risk is particularly high when combined with other sedative agents 3, 1

Discontinuation Warning:

• Never stop clonazepam suddenly - this can cause seizures that do not stop, hallucinations, shaking, and severe withdrawal symptoms 2
• Gradual withdrawal is essential - decrease by 0.125 mg twice daily every 3 days for panic disorder 2
• Consult your physician before changing doses 2

Drug Interactions:

• Avoid alcohol completely - it potentiates CNS depression and increases drowsiness/dizziness 2
• CNS depressants (narcotics, barbiturates, other benzodiazepines) significantly increase sedation risk 2
• Oral antifungal agents should be used cautiously as they inhibit clonazepam metabolism 2

Common Side Effects to Monitor

The most common side effects include drowsiness, problems with walking and coordination, dizziness, depression, fatigue, and memory problems. 2 These effects tend to be dose-related and occur early in therapy, potentially subsiding with chronic administration. 4

When to Seek Immediate Medical Attention:

• Seizures worsen or increase in frequency 2
• Severe respiratory depression or difficulty breathing 1
• Suicidal thoughts or unusual mood changes 2
• Signs of allergic reaction 2

Special Populations

Pregnancy:

• Clonazepam is Pregnancy Category D - birth defects can occur as early as the first month of pregnancy 2
• Do not breastfeed while taking clonazepam - the drug passes into breast milk 2
• Enroll in the North American Antiepileptic Drug Pregnancy Registry by calling 1-888-233-2334 if you become pregnant 2

Elderly Patients:

• Start on low doses and observe closely - elderly patients require careful monitoring 2

Renal Impairment:

• Use with caution - metabolites are excreted by kidneys and can accumulate 2