Healthy Living

C 1 Round Pill

C 1 Round Pill

Round Pill C1

This pill has a "C 1" imprint. It is also round and blue in color. It has been identified as clonazepam 1 mg. It is used to treat anxiety, panic disorder, benzodiazepine withdrawal, and borderline personality disorder. It belongs to the drug class benzodiazepine anticonvulsants and is also used to treat insomnia. Accord Healthcare, Inc. supplies the medicine.

Evidence shows that taking this medicine during pregnancy can put the fetus at risk. Thus, it is put in pregnancy category D. Under the Controlled Substances Act, it has been classified as schedule 4 controlled substance. The strength of the medication is 1 mg. It is available only by prescription. The inactive ingredients present in this medicine are:

  • Lactose anhydrous
  • Magnesium stearate
  • Lactose monohydrate
  • Corn starch
  • Microcrystalline cellulose
  • FD&C Blue No.2

Clonazepam is available under the brand name Klonopin. It is an oral tablet available only by prescription. Its generic form is also available, which usually costs less. It is a controlled substance drug.

Clonazepam is also called as an anti-epileptic or anticonvulsant drug. The unbalanced chemicals in the brain are affected by the medicine. It also calms the brain and nerves.

Anticonvulsant drugs are used for several types of seizures such as atonic, photosensitive, myoclonic, epilepsy, and absence seizures. It is seldom effective in partial or generalized tonic-clonic seizures. It is believed to enhance gamma-aminobutyric acid receptor responses.

Generally, benzodiazepine relieves tension, nervousness, symptoms of anxiety, and some types of seizure by slowing the central nervous system. The FDA has approved the use of this drug for epilepsy and panic disorders, but in some cases, it is also used to treat social phobia, post-traumatic stress disorder, and mania. Benzodiazepines help relieve tension, anxiety, and nervousness since it is a sedative-hypnotic drug. The medicine blocks the effects of certain chemicals that are involved in the transmission of nerve impulses. Thus, the excitement level of the nerve cells is decreased.

Clonazepam has a more sedating effect than alprazolam when it comes to treating panic disorders. In patients with a previous history of depression, clonazepam may trigger episodes of depression, unlike other benzodiazepines drugs. The rate of depression is reduced in people using clonazepam for social phobia, although its use, in this case, is off-label.

Uses

Clonazepam is used to stop seizures and treat panic disorders. It may be used as a part of combination therapy, which means that it can be taken along with other medications. This medication is used as an anticonvulsant in the treatment of Lennox-Gastaut syndrome. It is also used to treat akinetic and myoclonic seizures.

Recommended Dosage

The initial recommended dose is twice daily at 0.25 mg for panic disorders. It can be taken twice daily in increments of 0.125-0.25 every three days. For panic disorder, the target dose per day is 1.0 mg. However, some individuals may take a maximum dose of 4 mg per day.

The drug should be gradually discontinued when a person decides to stop taking the medication. The drug can be decreased to twice daily every three days at 0.125 mg. Although clonazepam is not FDA-approved for the treatment of post-traumatic stress disorder, it has been observed that if the dose is taken in the range of 0.25-3.0 mg, it may help treat the symptoms. For social phobia, the daily dosage may range from 1.0-2.5 mg. The dose can be as high as 10 mg per day for the treatment of mania.

How Clonazepam Works

Clonazepam belongs to the class of drugs known as benzodiazepines. Medications belonging to the same class of drugs work in a similar manner and usually are used to treat similar conditions. The activity of gamma-aminobutyric acid is increased by clonazepam.

GABA is actually a chemical that sends signals through the brain. Your body will be in an excited state if you do not have an adequate amount of GABA. It will cause seizures and panic attacks. Taking this drug increases GABA production, thereby reducing panic attacks and seizures.

You can tell that the medicine is working if you experience fewer seizures or panic attacks. 

Pharmacodynamics

Primarily, clonazepam is used in the treatment of absence seizure, akinetic and myoclonic seizure, petit mal variant seizure, and nocturnal myoclonus as an anticonvulsant. In the central nervous system, GABA is a major inhibitory neurotransmitter whose activity is enhanced by clonazepam.

In humans, the spike and wave discharge in absence seizure is suppressed by clonazepam. Moreover, the frequency, duration, amplitude, and minor motor seizures are decreased.

How to take this medicine?

Treatment usually depends on the patient's age, medical condition and its severity, reaction to the first dose, and other medical conditions present. Clonazepam can be taken with or without food. The tablet can be crushed or cut. There is no need to ask for a new prescription for this medicine since it is refillable. The doctor will indicate the number of refills on your prescription. 

The medicine is taken for short-term treatment only. Do not suddenly stop taking the drug to avoid having withdrawal symptoms, which may include anxiety, trouble sleeping, or irritability. Withdrawal symptoms may also be experienced if you miss a dose. An overdose may cause symptoms such as confusion, sleepiness, drowsiness, poor coordination, slow reflexes, and coma.

Make sure that you always carry this medication with you when traveling. Keep this medicine in your carry-on bag when flying. 

Mechanism of Action

Between GABA and the central benzodiazepine receptors, allosteric interaction occurs and can potentiate the effects of GABA. An increased inhibition of ascending reticular activating system is caused since GABA is an inhibitory neurotransmitter. It also blocks cortical and limbic arousal after reticular pathway stimulation.

Side Effects

The most common side effect of the drug is drowsiness. By interfering with the activities of the brain such as thinking, judgment and reaction time, it can slow down the activity of the brain. Thus, any heavy work that requires mental alertness such as operating heavy machinery or driving should be avoided. Other side effects include:

  • Problems with walking or coordination
  • Drowsiness
  • Depression
  • Fatigue
  • Dizziness
  • Memory problems
  • Changes in sexual desire
  • Weakness
  • Headache
  • Sleep disturbances
  • Rash

Mild side effects may go away within a few days or weeks. However, consult your doctor if the symptoms still persist. 

Serious Side Effects

The following side effects can be life-threatening and considered as a medical emergency:

  • Suicidal thoughts
  • Depressed mood
  • Seizures 
  • Hypoventilation (respiratory depression)
  • Fainting
  • Withdrawal symptoms (when suddenly stopped)
  • Low blood pressure
  • Tachycardia (fast heart rate)
  • Hepatomegaly (enlarged liver)
  • Blood disorders

While taking clonazepam, some people may develop an upper respiratory tract infection or asthma. Increased salivation is one of the side effects of this drug. While taking this drug, some people may start coughing. It may also cause dry mouth and anorexia.

Clonazepam may also cause diarrhea or constipation. In a few cases, clonazepam may cause blurred vision or menstrual irregularities.

Drug Interaction

Clonazepam can interact with other medications, herbs, and vitamin supplements. Make a list of all medications that you are taking and inform your doctor about them. The following drugs may interact and increase the risk of side effects:

  • Benzodiazepines - Make people feel sedated or drowsy. They include lorazepam, triazolam, and midazolam.
  • Opioids - Increase the risk of slowed breathing, severe drowsiness, coma, or death. They include hydroquinone and codeine.
  • Barbiturate and nonbarbiturate - May interact and make people feel drowsy and sedated. They include amobarbital, eszopiclone, zolpidem, pentobarbital, butabarbital, and zaleplon.
  • Anxiolytics - Drugs used to treat anxiety may make the person feel sedated and drowsy. This includes hydroxyzine and buspirone.
  • Drugs that treat alcoholism - Disulfiram is a medication that is used to treat alcohol dependence. The effect of clonazepam increases due to the interaction of both drugs. Carbamazepine, phenobarbital, theophylline, rifabutin, rifampin, and phenytoin can make clonazepam ineffective.
  • Seizure medications - pregabalin and gabapentin.

Precautions

  • Alcohol intake - The risk of sedative effects with this drug may increase if it is taken along with alcohol. It can also cause poor judgment, slowed reflexes, and sleepiness.
  • Allergies - Severe allergic reactions may be caused by this drug, which includes trouble breathing and swelling of the tongue or throat. Call your doctor if you have any allergic reactions.
  • Depression - If you are on this drug then it may make depression worse. Inform your doctor if you have suicidal thoughts or when your depression becomes worse.
  • Acute narrow-angle glaucoma - The drug may worsen this condition.
  • Liver disease - Your body will not be able to clear this drug if you have liver problems. The drug may accumulate in the body and increases the risk of side effects.
  • Pregnant women - Clonazepam has been put in category D. It means that when the mother takes the drug, the fetus is at risk of adverse side effects. Thus, this drug should not be used during pregnancy. It should be only used in serious cases and when needed.
  • Breastfeeding - Clonazepam may cause side effects to the breastfed child since it passes into the mother's breast milk. You can decide either to stop the medication or stop breastfeeding. Ask your doctor about breastfeeding and the effects of clonazepam. Drowsiness and developmental milestones of babies should be monitored. If excessive sedation occurs, then the infant’s serum concentration should be monitored. Rather than clonazepam, a drug that is short-acting should be used since clonazepam has a long half-life. However, according to experts during lactation, for refractory restless legs syndrome, an accepted choice would be taking clonazepam in lower doses.
  • Seniors - In older adults, their kidneys may not function as well as they do when they were younger. For this reason, drugs tend to be slowly processed. The drug may remain for a longer time in the body and increases the risks of side effects.

People who have previous allergic reactions to the drug or any other drug belonging to the class of benzodiazepines such as valium should not take clonazepam. People with an impaired gag reflex or respiratory distress should be careful while using this medication since it can increase saliva production.

If taken, then it should be taken only under close supervision. The medicine should not be taken with other sedatives, alcohol, tranquilizers, or sleeping pills since clonazepam is a nervous system depressant. At first, a person may feel mentally sluggish and drowsy after taking the medicine. After a short time, the sedation usually goes away. When patients have an underlying depression and are taking clonazepam, they should be carefully monitored since they are more prone to suicide attempts.

Clinical Monitoring

  • Kidney function - To determine the overall function of your kidneys, the doctor may order certain blood tests. If your kidney is not functioning properly, a lower dose is generally recommended.
  • Mental health and behavioral problems - If there are any unusual changes in the mood or behavior of the person, then it should be made note of. New mental and behavioral changes may be caused by the drug, which could get worse.
  • Seizures - The number of seizures should be noted after starting clonazepam treatment.

Absorption

Clonazepam tends to be rapidly and completely absorbed after oral administration. About 90 percent is the absolute bioavailability of clonazepam.

Route of Elimination

Kidneys excrete the metabolites of clonazepam. Most of the drug is metabolized and only less than 2 percent may be eliminated as unchanged. It is excreted in the urine. 

Toxicity

The major toxic effects of the drug are somnolence, coma, confusion, and diminished reflexes. For seizure disorders, CNS depression is the most commonly reported adverse effect when clonazepam is used. 

Missed Dose

If you miss a dose, take it as soon as you remember. However, if it is almost time for the next dose, then skip the missed dose and take the next dose as scheduled. Do not attempt to catch up by taking double doses at once to avoid dangerous consequences or side effects. 

Increased levels of this drug in your system can cause:

  • Slow reflexes or coordination trouble
  • Confusion
  • Drowsiness or sleepiness
  • Coma (a deep state of unconsciousness)