Rivotril belongs to the medicaments known as benzodiazepine. This group includes diazepam or Valium and flurazepam. Rivotril enhances the effects of the GABA neurotransmitter, inhibiting brain activity.
Patients with seizures, such as akinetic, petit mal, and myoclonus seizure, may take Rivotril. This medicament is also effective for relieving short-term anxiety symptoms. Rivotril can be used to complement other medicaments for seizure disorders.
Rivotril can result in physical dependence, which is typical with benzodiazepines. Patients who suddenly stop taking the medicament may experience side effects that include insomnia and agitation. Patients taking Rivotril for a longer period than prescribed may experience muscle cramping, seizure, vomiting, tremors, and sweating.
Rivotril tablets and injection both contain clonazepam, which a type of medicine called a benzodiazepine. (Clonazepam tablets are also available without a brand name, ie as the generic medicine.) Clonazepam acts on nerve cells in the brain.
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 HPPD
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-term Rapid 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.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Fatigue.
Drowsiness.
Confusion.
Muscle weakness.
Restlessness.
Dizziness.
Shaky movements and unsteady walk (ataxia).
Concentration difficulties.
Decreased co-ordination.
Loss of memory following an epileptic seizure (anterograde amnesia).
Changes in behaviour such as aggression, anxiety, agitation, nervousness.
Abnormal dreams.
Difficulty with speech.
Increased saliva or phlegm production (in infants and young children only).
Skin reactions such as rash, itching, changes in pigmentation.
Hair loss (reversible if treatment is stopped).
Urinary incontinence.
Heart failure.
Slow, shallow breathing (respiratory depression).
Visual disturbances (after long-term use only).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
You must not use Clonazepam (Rivotril) during pregnancy or if you are trying to become pregnant due to possible harm to the unborn baby and interference with normal labor/delivery.
Talk to your doctor or healthcare provider before using this drug. Clonazepam (Rivotril) is excreted into human milk in small amounts. No adverse effects have been reported in nursing infants, but experience is quite limited. The American Academy of Pediatrics has no position on the use of clonazepam during breast-feeding but describes other benzodiazepines as drugs "whose effect on nursing infants is unknown but may be of concern".
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
There may be an increased risk of drowsiness and sedation if clonazepam is taken with any of the following (which can also cause drowsiness):
alcohol
antipsychotics, eg chlorpromazine, clozapine
barbiturates, eg phenobarbital
other benzodiazepines, eg temazepam
MAOI antidepressants, eg phenelzine
sedating antihistamines, eg chlorphenamine
sleeping tablets, eg zopiclone
strong opioid painkillers, eg morphine, codeine, dihydrocodeine
tricyclic antidepressants, eg amitriptyline.
The following medicines may prevent the breakdown of clonazepam in the body. As this could increase the blood level of clonazepam and its sedative effects, as well as the risk of its side effects, your doctor may need to prescribe you a lower than normal dose of clonazepam if you are taking any of these medicines:
cimetidine, disulfiram, fluvoxamine, isoniazid
protease inhibitors for HIV infection, such as ritonavir or fosamprenavir.
The following medicines may decrease the blood level of clonazepam. As this could make it less effective, your doctor may need to prescribe you a larger than normal dose of clonazepam if you are taking any of these medicines:
carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, sodium valproate.
There may be an increased risk of side effects if this medicine is taken in combination with lithium.
Usual Clonazepam Adult Dose for Seizure Prophylaxis:
Initial dose: Should not exceed 1.5 mg/day divided into three doses.
Dosage may be increased in increments of 0.5 to 1 mg every 3 days until seizures are adequately controlled or until side effects preclude any further increase.
Maintenance dose: Individualized for each patient depending upon response.
Maximum Daily Dose: 20 mg.
Usual Adult Clonazepam Dose for Bipolar Disorder:
Initial dose: Should not exceed 1.5 mg/day divided into three doses.
Dosage may be increased in increments of 0.5 to 1 mg every 3 days until seizures are adequately controlled or until side effects preclude any further increase.
Maintenance dose: Individualized for each patient depending upon response.
Maximum Daily Dose: 20 mg.
Usual Adult Clonazepam Dose for Panic Disorder:
Initial dose: 0.25 mg bid.
Maintenance dose: An increase to the target dose for most patients of 1 mg/day may be made after 3 days.
The dose may be increased in increments of 0.125 to 0.25 mg bid every 3 days until panic disorder is controlled or until side effects make further increases undesired. To reduce the inconvenience of somnolence, administration of one dose at bedtime may be desirable.
Maximum Dose: 4 mg/day
Treatment should be discontinued gradually, with a decrease of 0.125 mg bid every 3 days, until the drug is completely withdrawn.
Usual Pediatric Clonazepam Dose for Seizure Prophylaxis:
<= 10 years or < 30 kg of body weight:
Initial Dose: Orally:
In order to minimize drowsiness, the initial dose should be between 0.01 and 0.03 mg/kg/day but not to exceed 0.05 mg/kg/day given in two or three divided doses.
Dosage should be increased by no more than 0.25 to 0.5 mg every third day until a daily maintenance dose of 0.1 to 0.2 mg/kg of body weight has been reached, unless seizures are controlled or side effects preclude further increase. Whenever possible, the daily dose should be divided into three equal doses. If doses are not equally divided, the largest dose should be given before retiring.
>10 years and >30 kg of body weight:
The initial dose should not exceed 1.5 mg/day divided into three doses.
Dosage may be increased in increments of 0.5 to 1 mg every 3 days until seizures are adequately controlled or until side effects preclude any further increase.
The maintenance dosage should be individualized for each patient depending upon response.
Maximum Daily Dose: 20 mg.
Clonazepam review by 57 year old female patient:
Rating
Overall rating:
Effectiveness: Marginally Effective
Side effects: Mild Side Effects
Treatment Info
Condition / reason: Blepharospasm
Dosage & duration: 1 mg taken 1/day for the period of 3 months - still taking it
Other conditions: none
Other drugs taken: none
Reported Results
Benefits: Very slight reduction in muscle spasms around eyes. Ended up also getting light Botox injections in eyelid muscles. This combo therapy has not resulted in a total cessation of eyelid spasms, but has reduced them enough so that I can drive again (the main disability caused by the blepharospasm). Taking the clonazepam at night also helps me get a better night's rest than before I took it.
Side effects: The first few days I took it I was dizzy and very sleepy. However, those side effects have now subsided.
Comments: Take 1 MG tab at night before bed. As mentioned above, also got Botox injections to reduce eyelid spasmx.
Clonazepam review by 52 year old female patient:
Rating
Overall rating:
Effectiveness: Considerably Effective
Side effects: Mild Side Effects
Treatment Info
Condition / reason: agoraphobia, panic disorder
Dosage & duration: 2 mg at night taken every night for the period of since 1988
Other conditions: none
Other drugs taken: valium 5 mg as needed
Reported Results
Benefits: Taking the rivotril made me sleepy at first but then it just calmed me down enough to be able to cope with life. I was constantly anxious and scared and the rivotril made it possible for me to come down to relatively normal anxiety levels in "safe" situations, whereas before I didn't have any situations I considered safe. It helped me sleep and made me feel more rested and in control. ... I started confronting situations that were uncomfortable to me before and was able to live a reasonably normal life, even though I have become housebound. I feel the rivotril got me through a very tough time in my life.
Side effects: The Rivotril didn't have any side effects in the long run, it made me a bit sluggish at first. However after taking it for a few years and feeling I no longer needed it, I found it impossible to stop taking it as the withdrawal symptoms were so bad. I have cut the dosage down considerably, from 5 mg at night to one, then I became nervous again and started taking 2 again. I have tried several times to come off the drug completely but the results have been tremors and feeling sick along with high anxiety to the point of hardly being able to speak. ...
Comments: I was told that panic attacks were caused by a chemical imbalance in the brain in the same area that caused epileptic fits. As Rivotril is a sedative and is given to people with epilepsy they had found that it also helped alleviate panic attacks. I was prescribed it for this reason. I am unable to take anti-depressants which also stop panic attacks because of strong side effects so this was a better choice for me at the time. I feel that it did the job...
Clonazepam review by 19 year old female patient:
Rating
Overall rating:
Effectiveness: Highly Effective
Side effects: Mild Side Effects
Treatment Info
Condition / reason: anxiety/ panic attacks/ insomnia
Dosage & duration: 1mg twice daily (2mg daily total) taken as perscribed twice daily for the period of 1 year
Other conditions: depression
Other drugs taken: None that would sugnificantly interact
Reported Results
Benefits: The drug was taken for my daily anxiety caused by stress and also insomnia to help relax my body before bed. The drug is mainly intended for anxiety and works great at relieving those systems such as irregular heart beat, nervousness and other anxiety causing symptoms. I give it a 9 out of 10 for its performance.
Side effects: The only thing i didnt like about this drug is that with taking it overtime I felt as if my body built tolerance to the drug as well as became more dependent on it. I still am until this day and have managed to ween off the drug. Then again every ones body is different, Just do your research before taking benzodiazepines long term.
Comments: The treatment overall treated my anxiety quickly and effectively. No regrets. The drug overall has treated me effectively despite the minor drawbacks.