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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Oxazepam and clonazepam are benzodiazepine tranquilizers. Among 89 infants born to women who used oxazepam during the first trimester, there were no congenital anomalies (Ornoy et al., 1998). Small numbers of first-trimester exposure to clonazepam are published in clinical case series, but they are confounded by concomitant use of other known teratogens (anticonvulsants), as well as small sample sizes and sample selection bias (Friedman and Polifka, 2006).
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Clonazepam in dosages of 100 mcg/kg has been used successfully in neonates. Recently, Sheth and co-workers [50] reported administration of midazolam (loading dose of 150 mcg/kg followed by maintenance doses of 100–400 meg/kg/h IV) to six neonates.
Prescribing for a first episode of affective psychosis
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
The use of lorazepam and clonazepam in acute mania is supported by some small double-blind studies.205 Indeed, Chouinard reported that clonazepam had some advantages over lithium in such adjunctive treatment of acute mania in a double-blind, crossover study.206 Lorazepam has a shorter half-life and may be more effective than clonazepam in very acute disturbance or severe agitation;207,208 it can be given as 1—4 mg orally or IM, repeated every 2-6 hours as required to a maximum of 4 mg daily. Clonazepam may be given as 0.5-2 mg orally every 2-6 hours up to 6 mg. After brief courses (2-6 weeks) of benzodiazepines, most patients tolerate gradual dose reduction without exhibiting signs of dependency.
Sublingual dexmedetomidine (BXCL501) reduces opioid withdrawal symptoms: findings from a multi-site, phase 1b/2, randomized, double-blind, placebo-controlled trial
Published in The American Journal of Drug and Alcohol Abuse, 2023
Jermaine D. Jones, Lavanya Rajachandran, Frank Yocca, Robert Risinger, Michael De Vivo, Jeff Sabados, Frances R. Levin, Sandra D. Comer
On the day of admission to the inpatient unit (Day 1), participants began maintenance on oral morphine [30 mg, Q.I.D: 8 am, 1 pm, 6 pm, and 11 pm (±30 minutes)], an additional 30 mg rescue dose was also made available each day, as needed (i.e., up to 150 mg/day). The morphine stabilization protocol was based on a trial of lofexidine that also utilized medically supervised opioid withdrawal (33). Throughout Days 1–5 participants were also administered a blinded placebo BXCL501 sublingual film at 8 am and 8 pm. During the stabilization phase participants had access to concomitant medications for: anxiety/restlessness, nausea, upset stomach, diarrhea, insomnia, muscle pain, and general discomfort (See Supplementary Table S1). The use of benzodiazepines was limited to an as-needed standardized clonazepam taper. On Day 1: 0.5 mg of clonazepam was available every 3–4 hrs, up to 2.0 mg total. Using this same schedule of availability, on Day 2, a total of 1.5 mg was available, Day 3, 1.0 mg total, and on Day 4, only one 0.5 mg dose was available. On Day 5, no clonazepam was available.
Intravenous esketamine leads to an increase in impulsive and suicidal behaviour in a patient with recurrent major depression and borderline personality disorder
Published in The World Journal of Biological Psychiatry, 2022
Thomas Vanicek, Jakob Unterholzner, Rupert Lanzenberger, Angela Naderi-Heiden, Siegfried Kasper, Nicole Praschak-Rieder
After admission bupropion was continued and augmented with escitalopram up to 30 mg p.o.q.d., and trazodone (retard preparation) 150 mg p.o.q.d. in the evening. Non-selective GABA-A receptor positive allosteric modulators (lorazepam and clonazepam) were given as a continuous medication to reduce anxiety, inner tension, and agitation. Zolpidem 10 mg was administered only once since the drug-induced visual and auditory illusions. After all, the patient was severely depressed and reported to suffer from impulsive suicidal thoughts she felt unable to control. Therefore, she was restrained against her will (according to the Austrian Hospitalisation Act). After obtaining informed consent, electroconvulsive therapy (ECT) was started and bupropion XR was discontinued. The patient received a total of seven unilateral ECT treatments with a final stimulation dose of 70% (350 mC). Due to occurrence of side effects in the form of severe headache and cognitive impairment ECT was discontinued, while depressive symptoms and suicidality attenuated during ECT.
Therapeutic approach to difficult-to-treat typical absences and related epilepsy syndromes
Published in Expert Review of Clinical Pharmacology, 2021
Giovanni Mastroianni, Michele Ascoli, Sara Gasparini, Francesco Brigo, Vittoria Cianci, Sabrina Neri, Emilio Russo, Umberto Aguglia, Edoardo Ferlazzo
Clonazepam (CLN) acts by binding to the benzodiazepine site of the GABA receptors, resulting in an increased influx of chloride ions into the neurons with an inhibition of synaptic transmission across the central nervous system. CLN is probably the most effective benzodiazepine for the treatment of TAs. It is also effective for the treatment of myoclonic jerks [29,30]. In a small-sample, controlled, single-blind clinical trial [31]. CLN (3–6 mg/day) was added to one or more ASMs (including phenobarbital, phenytoin, ESX, primidone) in 10 patients with refractory TAs. During CLN treatment, 8 patients became free from TAs and one had more than 75% reduction. In the National Institute for Health and Care Excellence (NICE) guidelines for epilepsy treatment, another benzodiazepine, clobazam (CLB), is considered as an adjunctive treatment in children, young people, and adults with TAs if a first add-on is not effective [32]. Clobazam may also be useful to treat absence SE [33–35]. Common side effects of CLN and CLB are sedation, lack of concentration and ataxia. Sedation is more serious with CLN than with CLB.