Clonazepam Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

• 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 (status epilepticus)

• Give 1 mg, repeated if necessary, to a total maximum of 20mg
• Maximum rate of clonazepam administration is 0.5mg per minute
• Administer via a large vein ^{(ref 1)} - can cause thrombophlebitis

Intravenous infusion (status epilepticus)

• Give 1mg, repeated if necessary, to a total maximum of 20mg
• 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 25⁰C

References

SPC January 2014

(1) Injectable Medicines Administration Guide downloaded from Medusa 20/01/2023

(2) Martindale - accessed online 20/01/2023 (max dose)

(3) Renal drug database- accessed online 26/01/2023

Therapeutic classification

Benzodiazepine