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Clonazepam Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

  • Lorazepam is favoured over clonazepam for the treatment of status epilepticus
  • Unlicensed preparation

Available preparations

Rivotril 1mg ampoule

Reconstitution

Water for Injections (supplied)

1ml to each 1mg vial

Draw up using a 5 micron filter needle

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Important: non-PVC containers must be used

Slow intravenous injection into a large vein

  • Administer dose of 1mg (or less) via a large vein over at least 2 minutes
  • Dilute with an equal volume of Water for Injection, immediately before administration (ref 1)
  • Rate of injection must not exceed 0.5mg per minute

Intravenous infusion (administer using an electronically controlled infusion pump) (ref 1)

  • Prepare an infusion with a maximum concentration of 12micrograms/ml: add 1mg to 100ml (10micrograms/ml), or 3mg to 250ml (12micrograms/ml)
  • Use non-PVC infusion bags (Ecoflac or Viaflo), and giving sets (Baxter VMC9606 or Braun 8700110SP), as the drug may be absorbed onto PVC containing bags/giving sets
  • Administer at a maximum rate of 0.5mg/minute- adjusted according to patient response

Dose in adults

Intravenous injection

  • Give 1 mg, repeated if necessary, to a total maximum of 10mg (one reference quotes a max of 20mg (ref 2))
  • Maximum rate of clonazepam administration is 0.5mg per minute
  • Administer via a large vein (ref 1) - can cause thrombophlebitis

Intravenous infusion

  • Give 1mg, repeated if necessary, to a total maximum of 10mg (one reference quotes a max of 20mg (ref 2))
  • Administer via a large vein (ref 1) - can cause thrombophlebitis
  • The manufacturers fail to mention over what time period the maximum dose applies to

Hepatic impairment

  • Avoid in severe liver impairment

Renal impairment

  • No dosage adjustment generally required, though some sources suggest starting with a low dose and adjusting according to response (ref 3)

Monitoring

  • Continuous monitoring of EEG, respiratory rate, and blood pressure is required
  • Facilities for reversing respiratory depression with mechanical ventilation must be at hand

Further information

  • The injection solution contains benzylalcohol, alcohol, glacial acetic acid and propylyene glycol

Storage

Store below 25°C

References

SPC 5th June 2017 (Australian SPC)

(1) Injectable Medicines Administration Guide downloaded from Medusa 6th NOv 2018

(2) Martindale - accessed online 8th Nov 2018

(3) Renal drug database- accessed online Nov 8th 2018

Therapeutic classification

Benzodiazepine