Clorazepate (Oral Route)

Prescribed to patients suffering from anxiety, alcohol withdrawal or seizures, Clorazepate is a benzodiazepine and a central nervous system depressant.

Overview:

As a benzodiazepine, Clorazepate has a tranquilizing effect on patients. In addition to this, the medicine can also be given as an anticonvulsant, anxiolytic or a sedative. By affecting the neurotransmitter gamma-aminobutyric acid (GABA), Clorazepate slows down the nerve signals which are dispatched from the brain.

As a result, Clorazepate can help to reduce the frequency of seizures and it can also produce a calming effect. If patients suffer from anxiety and/or panic attacks, Clorazepate can significantly reduce their distress and can relieve symptoms associated with these conditions.

When people experience alcohol withdrawal, the sudden drop in their alcohol intake can affect the gamma-aminobutyric acid in their brain and they can develop a number of symptoms. These may include palpitations, shakiness, increased heartrate, sweating and/or anxiety. By reducing the rate at which nerve signals are sent from the brain, Clorazepate can significantly reduce these symptoms or eliminate them completely.

Although Clorazepate may be taken on a long-term basis if it is used for seizure control, it may only be prescribed for a relatively short time if patients are being treated for anxiety and/or alcohol withdrawal.

With a half-life of approximately 20-179 hours, Clorazepate can provide significantly relief from symptoms for a relatively long period of time. Due to this, it is a particularly popular medication for treating patients with on-going anxiety problems. Whilst Clorazepate can be taken as a standard dose, it is also available in an extended release format. This means that patients can benefit from a staggered yet controlled release of the active ingredient and should, therefore, notice that their symptoms are significantly reduced over a longer period of time.

As many patients struggle to deal with the physical and emotional impact of alcohol withdrawal, Clorazepate can help them to manage their symptoms and enable them to reduce their alcohol intake. As a result, Clorazepate can help patients to avoid developing future alcohol-related health problems.

Currently, Clorazepate is used to treat patients who are suffering from seizures, anxiety or alcohol withdrawal. Due to its various uses, Clorazepate is commonly prescribed and has been found to be extremely effective in treating patients with these conditions.

Conditions Treated:

  • Seizure Management
  • Alcohol Withdrawal
  • Anxiety

Type of Medicine:

  • Benzodiazepine
  • Anticonvulsant
  • Anxiolytic
  • Sedative

Side Effects:

When taking Clorazepate, patients may experience some adverse effects. Not all side-effects require medical intervention but, if patients experience the following symptoms when taking Clorazepate, they should seek medical help:

• Bladder pain
• Cloudy or bloody urine
• Painful urination
• Increased urination
• Pain in side or lower back
• Burning urination
• Unsteady or shaky walk
• Painful urination
• Slurred speech
• Shaking or trembling of the hands and/or feet
• Trembling, unsteadiness or problems with muscle coordination or control

The following side-effects can also occur when patients are taking Clorazepate. In most instances, these effects are relatively mild and patients should find that they are lessened as they become used to the medication. These side-effects may include:

• Blurry vision
• Diarrhea
• Feeling empty or sad
• Discouragement
• Headache
• Dizziness
• Indigestion
• Double vision
• Irritability
• Dry mouth
• Lack of appetite
• Mental confusion
• Loss of pleasure or interest
• Vomiting or nausea
• Nervousness
• Inability to sleep
• Passing of gas
• Rash on skin
• Seeing double
• Insomnia or sleeplessness
• Pain in stomach, fullness or discomfort
• Trouble concentrating
• Difficulty sleeping
• Unusual weakness or tiredness

Although these side-effects may not automatically require medical attention, patients should always seek medical help if they are concerned about adverse effects when taking Clorazepate.

On occasion, patients may experience other side-effects when taking Clorazepate. As well as seeking medical help for them, patients may wish to notify the Food and Drug Administration. If so, patients can contact the FDA on 1-800-FDA-1088 to inform them of any other side-effects which have occurred whilst taking this medication.

Furthermore, patients should be aware of the symptoms an overdose of Clorazepate can cause. These can include:

• Change in level of consciousness
• Sleepiness
• Drowsiness
• Extreme relaxation or calmness
• Loss of consciousness

If patients believe they have taken too much Clorazepate or if they exhibit signs of an overdose, they will require immediate medical help. Patients should treat this as a medical emergency and seek assistance straight away.

Dosage:

When patients are prescribed Clorazepate, their dose will depend on why they’re given the medication, their medical history and their current symptoms. A standard dose of Clorazepate for anxiety is likely to be 30mg per day, for example. If older patients are given Clorazepate for anxiety, however, they are likely to start on a slightly lower dose of 7.5-15mg per day. In many cases, patients will be advised to take their dose throughout the day, rather than at once.

If patients are prescribed Clorazepate alcohol withdrawal, the starting dose is likely to be different. In most instances, patients will be given 30mg initially, with follow up doses of 30-60mg per day. The maximum dose of Clorazepate for alcohol withdrawal will not usually exceed 90mg per day. As the patient’s symptoms start to dissipate, physicians are likely to reduce their dose accordingly.

When Clorazepate is prescribed for seizure control, patients may be given a starting dose of 7.5mg to be taken three times daily. Although the dose can be increased, patients are not normally given more than 90mg of Clorazepate per day. For children between the ages of 9-12, a maximum dose of 60mg per day is normally applied.

Currently, there are no studies to determine whether Clorazepate is safe for children under the age of 9. If physicians believe that the benefits of treatment with Clorazepate outweigh the potential risks, this should be discussed with the patient’s parent or guardians before treatment commences.

Although there are standard dosing regimes for Clorazepate, they apply to standard Clorazepate tablets and capsules. If patients are prescribed an extended release version of Clorazepate, their dose is likely to vary.

Furthermore, every patient should be given individual instructions. It’s important that patients adhere to their doctor’s advice when taking Clorazepate and that they do not take too little or too much of the medication.

If patients accidentally miss a dose of Clorazepate, they should take it as soon as they remember to do so. However, if their next dose of medication is almost due, they should avoid the missed dose altogether. If patients are unsure how to continue with their treatment, they should seek advice from their physician or pharmacist.

Potential Drug Interactions:

As medicines can interact with each other, it may not be appropriate for Clorazepate to be prescribed in conjunction with other medications. Patients who are taking Flumazenil, for example, will not normally be given Clorazepate because of the drug interactions which may occur.

In most circumstances, treatment with Clorazepate is not recommended is patients are taking the following medications:

• Alfentanil
• Fentanyl
• Amobarbital
• Carbinoxamine
• Anileridine
• Chloral Hydrate
• Bromazepam
• Doxylamine
• Bromopride
• Dihydrocodeine
• Buprenorphine
• Ethchlorvynol
• Butabarbital
• Dantrolene
• Butalbital
• Flibanserin
• Butorphanol
• Fospropofol
• Calcifediol
• Methadone
• Carisoprodol
• Meperidine
• Chlorzoxazone
• Meclizine
• Codeine
• Metaxalone
• Hydrocodone
• Meprobamate
• Hydromorphone
• Methohexital
• Levorphanol
• Mephenesin
• Secobarbital
• Mephobarbital
• Omeprazole
• Phenobarbital
• Methocarbamol
• Oxymorphone
• Mirtazapine
• Propoxyphene
• Morphine
• Pentobarbital
• Morphine Sulfate Liposome
• Sodium Oxybate
• Orlistat
• Pentazocine
• Oxycodone
• Periciazine
• Tapentadol
• Remifentanil
• Thiopental
• Primidone
• Propofol
• Tramadol
• Zolpidem
• Sufentanil

However, if doctors believe that the risks of taking Clorazepate with the above medications are outweighed by the benefits, they may be prepared to prescribe the medication. In such cases, modifying the dose and the time the patient takes their medication can help to reduce interactions occurring.

Taking Clorazepate with some other medications and supplements may also increase the risk of side-effects occurring. If patients are taking any of the following medications whilst they are also taking Clorazepate, they should be aware that they may suffer from increased side-effects:

• Ginkgo
• Amprenavir
• Theophylline
• St John's Wort

If patients are concerned about side-effects whilst taking Clorazepate, they should seek medical advice. Often, adverse effects can be reduced by altering their treatment or dose. In addition to this, physicians may be able to prescribe additional medication to reduce specific side-effects.

Although Clorazepate may interact with other prescription medications, it could also interact with other substances. Due to this, patients should inform their doctor if they use any over-the-counter medications, herbal supplements and/or vitamins before taking Clorazepate.

Similarly, once patients are taking Clorazepate, they should seek medical advice before using any supplements, vitamins and/or over-the-counter medicines.

Warnings:

In some cases, the presence of other medical conditions can prevent Clorazepate from being prescribed. If patients have any of the following conditions, they should inform their physician before beginning treatment:

• Narrow angle glaucoma
• History of drug dependence or drug abuse
• Depression or mental illness
• Breathing problems or lung conditions
• Liver Disease
• Kidney Disease

Although the presence of these conditions may not prevent Clorazepate from being prescribed, doctors may modify the patient’s treatment so that any existing conditions are not worsened.

Clorazepate can be prescribed to older patients but they will normally be given a smaller starting dose of the medication. Side-effects, such as dizziness, drowsiness, confusion, unsteadiness and/or confusion, appear to be more prevalent in older patients. Doctors may increase the patient’s dose once their response to the medication has been assessed.

When taken regularly, benzodiazepines can be habit-forming. Patients should not take more medication than their physician has advised them to. If patients feel that the medication is not working as well as it did, they should seek medical advice.

As Clorazepate can cause blurred vision, dizziness and confusion, patients should determine how the medication affects them before driving and/or operating heavy machinery. If they are affected by side-effects when taking Clorazepate, patients should avoid driving or operating heavy machinery.

When receiving treatment with Clorazepate, patients should have regular consultations with their doctor. In addition to this, blood tests may be carried out at regular intervals. This will enable physicians to assess the patient’s symptoms and ensure that the medication is not having any unwanted effects.

Clorazepate will increase the effects of alcohol and patients should discuss this with their doctor before taking the medication. Although patients who are taking Clorazepate due to alcohol withdrawal are unlikely to be consuming any alcohol, patients who are taking Clorazepate for anxiety and/or seizure management may feel able to consume small amounts of alcohol. However, it is important that patients seek advice from their physician before consuming alcohol whilst taking Clorazepate.

Clorazepate can also increase the effects of other central nervous system depressants. These may include, muscle relaxants, sedatives, antihistamines, cold and flu medications, pain medication, insomnia medication, narcotics, hay fever and allergy medicines, seizure-control medications, other benzodiazepines and/or anesthetics.

If patients are due to undergo any surgical procedures, they should inform the relevant medical professional that they are taking Clorazepate in advance. This includes any dental procedures which the patient may be due to undergo.

Unless patients are advised to stop taking the medication immediately, patients should not stop taking Clorazepate suddenly. If they do so, they may experience withdrawal symptoms, such as nausea, convulsions, hallucinations, vomiting, muscle and stomach cramps, tremors and patients may exhibit unusual behavior. In addition to this, stopping Clorazepate suddenly may cause the patient’s original condition to worsen.

When Clorazepate is discontinued, patients may be advised to reduce their dose gradually as this can help to avoid withdrawal symptoms occurring.

If the patient displays any behavioral changes or has strange or unusual thoughts while taking Clorazepate, their doctor should be notified. In some cases, Clorazepate can cause patients to experience depression, suicidal thoughts and/or hallucinations. Sudden feelings of excitement, irritability and/or nervousness can also occur when taking Clorazepate and these should also be reported to the patient’s physician. If the patient’s mental state changes drastically or if their behavior is a cause for concern, medical help should be obtained immediately.

Clorazepate is not normally recommended for use in patients who are pregnant. If Clorazepate is taken by pregnant patients, it may present a risk to the unborn fetus. It should, therefore, only prescribed to pregnant patients if there is no suitable alternative and if physicians believe the benefits outweigh the risks.

If patients become pregnant when taking Clorazepate, they should seek medical advice from their doctor.

If patients take medication while breastfeeding, the drug may be passed on to the infant. Patients should not, therefore, continue breastfeeding whilst taking Clorazepate as it may cause harm to the infant. As Clorazepate may remain in the patient’s system for some time, they should not begin breastfeeding until a significant period of time after taking their last dose of medication. If patients are breastfeeding and treatment with Clorazepate is recommended, they should discuss the risks and alternatives with their doctor.

Before taking any medication, including Clorazepate, patients should ensure their doctor is aware of any allergies they have. If patients develop an allergic reaction when taking Clorazepate, they may show signs of labored breathing, wheezing, swelling of the throat and/or face and they may also suffer from itching and hives. Allergic reactions can be life-threatening in some cases and should always be treated as a medical emergency. Patients are advised to call 911 and seek urgent medical help if they suspect that they are experiencing an allergic reaction to Clorazepate.

Storage

As patients are normally advised to take Clorazepate every day, they will need to store their medication at home. When doing so, patients should find an appropriate location and keep their medicine away from children and/or pets.

In most situations, Clorazepate should be kept at room temperature and the medicine should not be exposed to extreme temperature. It is also important to keep Clorazepate out of direct sunlight and away from moisture.

If patients are advised to stop taking Clorazepate, they will need to dispose of the medicine safely. Instead of throwing Clorazepate out with regular household waste, patients should contact their pharmacist or physician so that a safe disposal method can be used.

Summary

As Clorazepate can be used to treat different conditions, it is prescribed to a significant number of patients each year. Patients suffering with ongoing seizures or convulsions may be prescribed Clorazepate on a long-term basis as the medicine is effective in reducing the frequency of seizures.

For patients taking Clorazepate for anxiety and/or alcohol withdrawal, short term treatment with Clorazepate is normally appropriate. Whilst Clorazepate can help with the short-term symptoms of anxiety and alcohol withdrawal, it may be used in conjunction with other therapies so that the long-term effects of alcohol dependency and anxiety can be addressed and treated as well.

Able to deliver numerous therapeutic benefits, Clorazepate is a first-line treatment for a number of conditions and enables patients to achieve an increased level of calmness, as well as helping them to combat nervousness, anxiety and tension.