Brand Name: Rivotril.Disopen,Epiclone,Epita,Leptic,Clontril etc.(BD)
Clonazepam is the generic name (non-brand name) of the seizure medicine
Klonopin used in the United States, Canada, the UK and some other
countries. In Canada and the UK, the brand name Rivotril is used for
clonazepam.in Bangladesh Rivotril.Disopen,Epiclone,Epita,Leptic,Clontril etcClonazepam belongs to a group of medications called the benzodiazepines (BEN-zo-di-AZ-ah-peens).
The use of benzodiazepines to treat epilepsy over a long period of time
is controversial because tolerance often develops within weeks.
Tolerance occurs when a person has to take larger and larger doses of a
medication to achieve the same result Such as:-
Some people with epilepsy find that over time they have to take
larger and larger doses of their seizure medicine to achieve the same
result. This effect is known as tolerance. Studies in both humans and
animals have shown that tolerance is not much of a problem for most of
the standard antiepileptic drugs. That is, most patients continue to
enjoy good seizure control while taking the same dose and maintaining
the same blood levels of medication.
There are two circumstances in which tolerance can be an important
issue in the care of people with epilepsy, however. The first is when
patients take certain antiepileptic drugs that commonly have high
degrees of tolerance. The most commonly used medications of this kind
are benzodiazepines: clobazam (Frisium, not sold in the U.S.),
clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). These
are very effective in stopping seizures in the emergency setting,
especially when they are given intravenously, rectally, or under the
tongue so that they are rapidly absorbed into the blood. But usually
they are not used for the long-term treatment of epilepsy because of
tolerance. Although they work extremely well for brief periods, their
effectiveness diminishes over weeks, months, or years while their side
effects continue. In many cases the side effects increase, since the
dosage must be increased to maintain the same degree of seizure control.
Patients who rely on benzodiazepines often get caught in a vicious
cycle. The medication is introduced at a very low dose, seizures are
greatly reduced or completely controlled, and both the patient and
doctor are extremely happy. But after a week or a month passes, the
seizures slowly start to re-emerge. The dose is increased and again
seizure control is achieved. This cycle repeats itself and side effects
gradually become more prominent. These often include tiredness,
irritability, decreased attention, decreased short-term memory, changes
in mood, or changes in sleep pattern. At last the problem of the cycle
is recognized, either by the patient or a physician. Then the challenge
begins—lowering the dose. The only way to avoid a major increase in
seizure frequency or severity is to reduce the benzodiazepine dosage
very slowly, but some increase in seizure activity may occur even with
gradual reductions. Ultimately, once things have stabilized, most
patients enjoy a similar degree of seizure control off of the
benzodiazepine, with a marked reduction in side effects. Avoiding the
cycle is the best medicine.
The other circumstance in which tolerance can be important in the
care of patients with epilepsy is what many refer to as the "honeymoon
effect." For some individuals, the effectiveness of medication tends to
wear off over time much more than for most other people, either because
of the particular way in which their bodies function or because of the
nature of their epilepsy and its underlying causes. These individuals
often do very well with a new medication for some weeks or, more often,
some months. Then the effectiveness of the medication begins to decrease
and seizure control gradually may be lost. Many patients who are said
to have "medically refractory epilepsy" are those for whom the honeymoon
effect is most prominent. These patients often do well at first with a
new medication, an increased dose, a change or adjustment in the
distribution and timing of medicines during the day, or a new
combination of antiepileptic drugs. But after a relatively brief
period-as little as a few weeks or occasionally as long as 6 months or a
year-their excellent seizure control has deserted them.
Besides tolerance, the honeymoon effect probably also involves some
adaptation by the epilepsy process itself. How this process works is
still speculation. One theory involves the way abnormal brain activity
spreads. Seizure activity originates in a core area of abnormal brain
tissue, called the seizure focus. Sometimes the abnormality is
structural, as in the case of a scar from a head injury, an area of
prior surgery, or an abnormal cell pattern that developed before birth.
Even a seizure focus without an apparent structural difference will be
marked by some disorder of chemical and electrical function. The
abnormal electrical activity that the seizure focus generates needs to
be dispersed or spread. In an ideal world, antiepileptic drugs would
restore the normal balance and quiet the seizure focus so that no
abnormal electrical activity is produced. In reality, however, it is
likely that in many cases antiepileptic drugs are simply keeping the
abnormal electrical activity from spreading out of the seizure focus, so
that other areas of the brain are not affected. In some of these cases,
the abnormal activity never disappears but instead is always there,
trying to find a way out. One theory about the honeymoon effect is that
if the abnormal seizure waves keep pushing over and over against the
walls of resistance raised by natural brain processes and the beneficial
effects of antiepileptic drugs, eventually they may find a way (or
create one) through which they can spread beyond the seizure focus. Thus
after some time, the seizures return —the honeymoon effect.
What can be done to prevent tolerance or the honeymoon effect?
Unfortunately, our answers are limited. One important strategy is to
avoid the long-term use of medications that have high rates of
tolerance, such as the benzodiazepines. Those patients who gradually
develop tolerance to the more standard antiepileptic drugs present a
more difficult problem. One proposed strategy is for them to change
antiepileptic drugs on a regular basis to prevent long-term tolerance
from building up. Usually this idea does not work very well. For one
thing, with each change in medication, the patient may need to adjust to
new short-term side effects. SEE NEXT >>
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