What Causes Anxiety And Seizure Disorders?

Rivotril is the brand name for Clonazepam. Clonazepam is a long acting 1,4-benzodiazepine .It is primarily used as an anti-epileptic. It acts on the CNS and produces sedation, sleep, and inhibition of anxiety. It is also used for involuntary muscle spasms and seizures. It is also sometimes used for restless legs syndrome. Benzodiazepines are the most widely used anxiolytic drugs and have replaced barbiturates and meprobamate because of their efficacy and safety.

Common side effects are agitation, sleepiness, and lack of coordination. Prolonged use of this can cause tolerance, dependence, and withdrawal effects if stopped abruptly. It should not be used in pregnancy and lactation as it can cause harmful side effects. Benzodiazepines act by binding to a specific site on GABA receptors and increase the frequency of Cl- channels which in turn lead to membrane hyperpolarization and CNS depression.

History:

Sedatives and Narcotics have long been used for medication and leisure, starting with alcohol which is the foremost and original sedative in history. Paraldehyde, bromides, chloral hydrates were created during the 1800s, trailed by barbiturates and meprobamate in the early twenties. These substances are restricted by their high potential for misuse and reliance and their possibly deadly results of overdose.

Clonazepam was licensed in 1964 by the Hoffman La Roche organization when benzodiazepines overall were supplanting barbiturates as medication of choice for sedation. It went on sale and was first promoted as a treatment for epileptic seizures in 1975. It can treat all types of epilepsies but is predominantly used for myoclonic and absent seizures.

However, with time it came to attention that due to its high efficacy, it can be abused. The study named “misuse of clonazepam” favors the potential of abuse and dependence of clonazepam and emphasizes reinforcement of monitoring for this medication. This medication is categorized as SCHEDULE IV by the Drug Enforcement Authority (DEA), which means it is a controlled substance but is comparatively less addictive. This data needs to be transferred to health professionals.

Despite the risk of abuse, a very important specification of this drug is its relative safety in comparison to other tranquilizers because the lethal dose is over 1000 folds greater than the typical therapeutic dose. This proves that it is rarely fatal when taken alone but can lead to severe consequences when used alongside certain medications.

FDA approved the drug in 1975 and after fluctuation in prescription ranking; it was ranked 47th in the year 2018 with 7 million prescriptions.

Uses:

Rivotril is primarily used in all forms of epilepsy, petit mall (absence seizures). It acts on the CNS and produces sedation, sleep, and inhibition of anxiety. It is also used for involuntary muscular spasms, Bipolar affective disorder, bipolar disorder, choreiform movements, and drug-induced dyskinesia. It is also sometimes used for restless legs syndrome and Lennox-gastaut syndrome. It effectively treats the symptoms of akathisia that often occur due to the usage of antipsychotic drugs and for the treatment of catatonic reactions. Benzodiazepines are the most widely used anxiolytic drugs and have replaced barbiturates and meprobamate because of their efficacy and safety.

Anti-epileptic:

Rivotril (Clonazepam) is used for all forms of epilepsy . Epilepsy is the sudden, excessive, and synchronous discharge of cerebral neurons. This abnormal electrical activity may result in a variety of events, including loss of consciousness, abnormal movements, atypical or odd behavior, and distorted perceptions that are of limited duration but recur if untreated. Epilepsy is the 3ysr most common neurological disorder. Rivotril is more frequently used for Petit mall seizures and Myoclonic seizures in clinical settings. Petit mall (absence seizures) is characterized by sudden onset of unconsciousness and starring with momentary loss of consciousness.

According to a study “EXPERIENCES WITH RIVOTRIL in TREATMENT OF EPILEPSY—PARTICULARLY MINOR MOTOR EPILEPSY—IN MENTALLY RETARDED CHILDREN” states that Rivotril is the best anti-convulsant available as compared to other benzodiazepines. Myoclonic seizures consist of single or multiple sudden, brief, shock-like contractions.

According to another study, Clonazepam had an especially decent impact on central epilepsies both when given alone and with different anticonvulsants. Consideration is attracted to the two patients with Epilepsia partialis continua who turned out to be liberated from attacks under clonazepam treatment.

For Epilepsy in adults:

The initial dose is 1mg taken at night followed by 4mg to 8mg over 2 to 4 weeks.

Epilepsy in children:

The dose varies depending on their age. It is enhanced gradually over 2 to 4 weeks.

Anti-anxiety:

Rivotril (Clonazepam) is used for anxiety and panic disorders. Anxiety is an upsetting condition of strain, worry, or uneasiness (a dread that appears to emerge from an obscure source). Anxiety disorders are the most common mental disturbances. Anxiety causes both psychological symptoms and physical symptoms. The physical symptoms of severe anxiety include Tachycardia, sweating, trembling, palpitations, muscular tension, tightness in the abdominal region, restlessness, fatigue, inability to catch one's breath. It involves sympathetic activation. Episodes of mild anxiety are common life experiences and do not require any treatment. However, the symptoms of severe, persistent, debilitating anxiety may be treated with anti-anxiety drugs such as benzodiazepines which include Clonazepam.

Caution: It should not be used to alleviate the normal stress of everyday life. They should be reserved for continued severe anxiety, and should only be used for short periods because of their potential of causing addiction.

As Clonazepam is long acting, it is often preferred in those patients with anxiety who may require treatment for prolonged periods.

Panic attacks are sudden episodes of severe fear that have physical manifestations when there is no danger. For Panic attacks, It is given in the dose of 1 mg to 2 mg daily depending on the severity of symptoms.

OFF-Label Uses:

For Tardive dyskinesia:

The use of clonazepam for the short-term treatment of tardive dyskinesia is included in The American Academy of Neurology Guidelines.

It is given in the dose of 1 mg per day. The dose should be adjusted based on tolerability but should not exceed 4.5 mg.

Akathisia and catatonic movements:

Clonazepam is also used to treat symptoms of akathisia () that may occur as a side effect of treatment with antipsychotic medications (medications for mental illness) and to treat acute catatonic reactions. Akathisia is the restlessness and a strong urge for a constant movement that mainly involves the legs and catatonic movements are a state in which a person does not move or speak at all or moves or speaks abnormally.

Restless leg Syndrome:

Restless leg syndrome is the continuous uncontrollable urge to move your legs. It usually occurs in the evening or at night time. Rivotril is also very effective for this.

It is given in the dose of 500 micrograms to 2mg each day

It is also used for sleepwalking and social phobias.

Routes of administration:

Oral (Tablets and liquid form)

Intravenous (IV)

Intramuscular (IM)

Sublingual

Rivotril v/s Valium:

Rivotril is clonazepam and Valium is diazepam. Both are benzodiazepines and act by enhancing GABA receptors. According to a study “Clinical experience with clonazepam (Rivotril) in the treatment of epilepsies in infancy and childhood”, the spectrum of action of Rivotril is as broad as valium for Status epilepticus while Rivotril is more effective and have less tolerance as compared to valium. For Petit mall and myoclonic seizures, it is effective even in patients not responding to other medications.

For anxiety, Rivotril (clonazepam) can be used for treatment of panic attacks and seizures but is not proposed for long-term management of anxiety. However, it is also used for that in some settings. Valium (diazepam) is effective for occasional or short-term use for anxiety and muscle spasms but not for minor anxiety every day.

Both cause dependence and are equally addictive controlled substances and are categorized as Schedule IV medications by the Drug Enforcement Administration (DEA).

Rivotril v/s Tegretol:

Rivotril is clonazepam and tegretol is carbamazepine. Carbamazepine binds to voltage-dependent Na+ channels (prolongs the inactivated state) and prevents further entry of Na+ Ions into the neuron.

According to the study “Clonazepam (Rivotril®) and carbamazepine (Tegretol®) in psychomotor epilepsy”, there is no significant difference in the efficacy of treatment during 6 months period. Rivotril causes dependence and has the potential for abuse while no evidence of abuse is found for Tegretol. It cannot cause physical or psychological dependence. Also, Tegretol is well tolerated as compared to Rivotril. So, it is equally effective in psychomotor epilepsy with comparatively fewer side effects.

Rivotril v/s Ativan(lorazepam):

Ativan is lorazepam.Both rivotril and Ativan are benzodiazepines. Both are used for anxiety and epilepsy. Rivotril (clonazepam) can be used for status epilepticus but Ativan is the first-line drug according to treatment guidelines for status epilepticus. However, according to the study “Practice Variability and Efficacy of Clonazepam, Lorazepam, and Midazolam in Status Epilepticus: A Multicenter Comparison.”, Rivotril(clonazepam) has many attributes that make it an excellent alternative for initial treatment of Status Eoilepticus.

For anxiety, Rivotril can be used for treatment of panic attacks and seizures but is not proposed for long-term management of anxiety. However, it is used for anxiety in some settings. Ativan (lorazepam) is an effective medicine for occasional or short-term anxiety.

Rivotril v/s Epilim:

Epilim (Sodium valproate) is a broad spectrum anti-epileptic. It acts by delaying the inactivation of Na+ channels in the neuron thus preventing the spread of seizure discharges.

According to the study “Sodium valproate and clonazepam in the treatment of intractable epilepsy", Both Clonazepam and sodium valproate are used for all forms of epilepsy but Clonazepam is better than valproate for temporal lobe and other partial (focal) epilepsies, while valproate is better for grand mal seizures and atonic attacks.

Depression of Central Nervous system:

It can cause a decrease in motor skills, drowsiness, and decrease in cognition. Cognitive activities that require learning and recalling previous knowledge are impaired. It can also affect the decision-making power of a person. Routine work can be severely affected. Ataxia can also occur in higher doses. Activities requiring fine motor functions can be impaired.

The dosage of clonazepam should be reduced in the elderly, as they are more susceptible to drugs that cause psychomotor dysfunctions.

Withdrawal effects:

When used for a prolonged period, clonazepam can cause dependence. In such cases, withdrawal effects can occur when the drug is suddenly stopped. As clonazepam is a long-acting drug so withdrawal symptoms occur slowly within three weeks and are less lethal. Withdrawal effects include

• irritability
• sweating
• headache
• unpleasant dreams
• tremors, anorexia
• sleep abnormalities
• dizziness
• fatigue
• Convulsions can occur, in severe cases.

Addiction to clonazepam is more common in people with personality disorder and previous history of sedative or alcohol abuse.

Tolerance:

Tolerance can occur with chronic use of clonazepam. Tolerance is the decrease in responsiveness, which occurs when drugs are used chronically. Thus to maintain the pharmacological action of the drug, the dose of the drug has to be increased over time.

Long term use of benzodiazepines for insomnia is not recommended because of tolerance, dependency, and hangover effects, but these drugs are ideal for occasional use by air travelers, shift workers, etc

Hangover Effects:

Hangover effects are headache and residual drowsiness on waking. Due to the prolonged effect of clonazepam, it has a strong hangover effect, so their long term use should be discouraged

Floppy baby syndrome:

Usage of benzodiazepines during labor may cause respiratory depression and hypotonia known as a floppy baby syndrome in newborns and even the withdrawal effects can occur in newborns.

Overdose:

Overdose of clonazepam can seldom occur and can cause respiratory and cardiovascular depression. Coma can occur. Other symptoms may include:

• Depression
• Dizziness
• Bluish-colored lips and fingernails.
• Rashes
• Tremors

Overdose can be reversed effectively by a Benzodiazepine antagonist named flumazenil. It can reverse the Central Nervous system depression produced but overdose but is not efficacious against respiratory depression.

It can be given intravenously in the dose of 200micro gram initially in 15 seconds, then 100 micrograms at 1-minute intervals.

Blood dyscrasias

Skin Rashes

Allergic Reaction:

It should be used with caution in patients with aspirin hypersensitivity as it may induce an allergic reaction

Other SIDE EFFECTS

Other symptoms include:

• Mental confusion
• Light-headed ness
• Lassitude
• Motor-incoordination
• Anterograde amnesia(memory loss for a short time) during effect.
• Disorganization of thoughts
• Dysarthria
• Dry mouth
• Bitter taste
• Headache
• Disorientation
• confusion
• Vertigo
• Weakness
• Blurring of vision
• Giddiness
• Nausea
• Vomiting
• Epigastric pain
• Diarrhea

Phlebitis, changes in libido, pain at the injection site poor appetite, constipation, and hematuria are some other side effects.

Precaution:

Clonazepam should be used with caution in patients with respiratory diseases and patients with hypersensitivity. In patients with depression, give the least amount of drug.

It should be used with caution in patients with myasthenia Gravis.

Can I take Clonazepam if I am pregnant or breastfeeding?

No, Clonazepam is harmful to the baby both during pregnancy and breastfeeding. Clonazepam is classified in FDA pregnancy category D, which means there is a possible risk to the fetus. It has the potential to cross the placental barrier in pregnancy. For lactation, it is categorized as L3, which means a breastfeeding child can be at risk. So it should be avoided.

It can cause lethal effects in the newborn such as respiratory depression which can lead to mortality of the newborn. It can also cause hypotonia known as Floppy baby syndrome, in which the baby doesn't have any tone and feel limp, like a rag doll. It can also cause other symptoms of CNS depression and withdrawal effects even in the newborn. It can lead to congenital malformations such as cleft palate.

How quickly does the treatment work?

Rivotril generally has an intermediate onset of action. When administered, it acts within 1 hour to 4 hours of treatment.

Is it safe to take Rivotril?

Yes, it’s highly safe to use Rivotril due to its wide therapeutic index.

How long does a dose of Rivotril last?

As Rivotril is a long-acting benzodiazepine so its dose lasts for 8 to 12 hours so its dose for adults is 2-3 times a day.

Are there any side effects of the treatment?

Yes, therapeutic doses of Rivotril have side effects but these are less likely to be lethal.

Do I require a prescription for taking Rivotril?

Yes, you should have the prescription for taking Rivotril because it is only available on prescription by a certified doctor only. This is due to its fatal effects if misused. Having diazepam without a prescription is illegal.

Why is it not safe to buy Rivotril online?

It is not safe because this drug may be fake. FDA strongly discourages consumers from buying online because of the issue of counterfeit. Counterfeited drug can be lethal if used.

I cannot swallow tablets, what should I take?

You can take Oral Clonazepam liquid. You can also crush or dissolve the tablet in your mouth with water and then swallow. Always use a calibrated dropper with this product for accurate dosage
You can also use Clonazepam sublingually.

Is this treatment a safe option for children?

Do not give clonazepam to your child without consultation from a health care professional. It is not approved for the treatment of panic attacks in anyone age less than 18 years. For epilepsy, clonazepam can be used. Your child should take clonazepam regularly so that they have fewer seizures. They may also get slurred speech and double vision which usually get better after a week.

How long do I have to take Clonazepam?

This depends on your medical condition and response to the medication. The doctor may stop the medication to check whether there is improvement in symptoms and whether the medication is still needed. You need to adhere to the directions of your primary care physician cautiously.

Can I take Clonazepam with other medication?

Certain drugs shouldn't be used alongside Clonazepam because some drugs decrease their efficacy and interaction of some drugs with it, can cause lethal effects. Severe interaction of Clonazepam can be caused by sodium oxalates.
Serious interactions of diazepam include:

• Anti-psychotics
• Opioids
• Anti-epileptic such as carbamazepine
• Cimetidine
• Itraconazole
• ketoconazole
• rifampin
• erythromycin lactobionate
• erythromycin base
• erythromycin stearate
• benzodiazepines

Rivotril causes moderate interactions with at least 238 different drugs. Concomitant use of opioids and benzodiazepines may result in respiratory depression, severe sedation, coma, and death

Can I use Rivotril with alcohol?

No. Combining Rivotril with alcohol is dangerous and can cause respiratory depression (slowed breathing, not getting enough oxygen), extreme sedation, coma, or even death.

Is Clonazepam hard on the liver and kidney?

Clinically, liver injury from clonazepam is rare. However, it should be used with caution in patients with liver diseases. It is eliminated by the kidney; the metabolites can be accumulated in the kidney so it should be cautiously used.

Is it true that Rivotril should not be used in glaucoma?

Yes, it is contraindicated in narrow-angle glaucoma.

Is Rivotril a muscle relaxant?

Rivotril is not indicated for use as a muscle relaxant. Valium is used for muscle relaxation due to its effect on neurons in the spinal cord. Occasionally, Rivotril may be used off-label for muscle spasms, but it is not a first-line or common treatment for muscle spasms.