IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

29 April 2022
Medically reviewed by
Sumayya Salam
Pharm D
Clonazepam Vs Lorazepam
Table of Contents

A seizure is an abnormal electrical activity in the brain cells that causes temporary alterations in the activity of muscles leading to muscle stiffness, twitching, loss of muscle tone, and may also lead to loss of consciousness. Repeated occurrence of seizures is known as epilepsy. It is one of the most common neurological disorders in the world. The World Health Organisation(WHO) estimates that around 50 million people suffer from epilepsy worldwide.

The various causes of epilepsy are as follows:

  1. Head injury following an accident, or trauma to the head during birth
  2. Infections in the brain such as encephalitis, meningitis
  3. Congenital abnormalities, congenital syndromes
  4. Stroke
  5. Tumor in the brain

The maximum burden of epilepsy is seen in low and middle-income countries. When diagnosed and treated early, 70% of the people suffering from this condition can be seizure-free. The symptoms of epilepsy can be focal (limited to one part of the body), or generalized(involving the whole body). They consist of muscle twitching, stiffness, biting of the tongue, aura, involuntary urination, and defecation, loss of muscle tone, and loss of consciousness.

The patients of epilepsy also face social stigma along with financial and economic loss due to their physical condition. Hence it is necessary to treat such patients not only for the betterment of their health but also for their upliftment and sustainable living in society.

Pharmacotherapy is the mainstay for the treatment of epilepsy.  One of the important class of medications for the treatment of epilepsy are the Benzodiazepines(BZDs). This class contains drugs such as Diazepam, Lorazepam, Clonazepam, etc.

The maximum burden of epilepsy is seen in low and middle-income countries. When diagnosed and treated early, 70% of the people suffering from this condition can be seizure-free. The symptoms of epilepsy can be focal (limited to one part of the body), or generalized (involving the whole body). Pharmacotherapy is the mainstay for the treatment of epilepsy. 

One of the important class of medications for the treatment of epilepsy are the Benzodiazepines(BZDs). This class contains drugs such as Diazepam, Lorazepam, Clonazepam, etc. They can be used to treat various disorders such as epilepsy, anxiety, panic disorder, insomnia, as pre - anaesthetic medication, catatonia, and alcohol withdrawal syndrome.

What is Klonopin (Clonazepam)?

Clonazepam is a an anti-epileptic drug(AED) drug that is used to treat and prevent seizures. An anticonvulsant or antiepileptic medicine is what this medication is called. It's also used to help people who are having It is additionally used to treat panic attacks. Clonazepam It relieves anxiety by calming the brain and nerves. It belongs to the benzodiazepine family of medicines.

Klonopin is the a brand name for clonazepam oral tablets and it is a prescription medicine only, that which means you will need a prescription to buy Klonopin (clonazepam). 

Clonazepam is available as an oral tablet and an oral dissolving tablet.

What is Ativan (Lorazepam)?

Lorazepam belongs to the benzodiazepine class of medicines, which have a calming effect on the brain and nerves. Anxiety is treated using this drug. This medication works by amplifying the impact of a natural substance in the body (GABA). 

Lorazepam is used in the treatment of epilepsy, as well as anxiety. It is available in oral as well as injectable formulations. As it belongs to the BZD class of drugs, it is also available as a prescription-only medicine.

Lorazepam is used in the treatment of anxiety, and insomnia due to anxiety. Injectable form of Lorazepam is also used to terminate an acute attack of seizure.

Lorazepam is a prescription drug and has been approved by the Food and Drug Administration (FDA) to

  •       Treat sleep problems caused by anxiety or stress
  •       Treat certain seizures
  •       Treat anxiety
  •       Make you fall asleep before surgery  

Take precautions with the use of lorazepam as it is a controlled substance and prescription will be required to buy Lorazepam.

How Clonazepam and Lorazepam Works?

These drugs act by increasing the levels of gamma-aminobutyric acid(GABA) which is a neurotransmitter in the brain that blocks the impulses between brain cells, decreases the stimulation of nerve cells and hence produces calming effects.

Low levels of GABA lead to increased excitability within the brain cells leading to anxiety, panic attacks, restlessness, sleep disturbances, and seizures. BZD drugs like Clonazepam and Lorazepam reduce these symptoms by increasing GABA.

Clonazepam

Clonazepam works by boosting gamma-aminobutyric acid activity (GABA). This is a molecule that transmits messages throughout the neural system of a person. A person's body may be aroused if they don't have enough GABA.

They may get panic episodes or seizures as a result of this. When a person takes this medication, their body produces more GABA. They will experience fewer panic attacks and seizures as a result of this. 

Lorazepam

It works by boosting the amounts of a relaxing chemical in your brain called gamma-amino-butyric acid (GABA). This may help you feel calmer, ease anxiety, or stop a seizure or fit, depending on your health condition.  

Mechanism Of Action

Clonazepam

Clonazepam is a 1,4-benzodiazepine with anticonvulsant properties that can be and is primarily used to treat some kinds of myoclonus absence seizures. It is also used as an adjuvant in the treatment of myoclonic and akinetic epilepsy, and infantile spasms.

Its primary mechanism of action is to help GABAergic transmission in the brain by acting directly on benzodiazepine receptors. GABA receptors are found on the cell bodies of dorsal raphe neurons, and GABA inhibits raphe cell activity, which benzodiazepines enhance. Clonazepam does not affect 5-HT production. 

However, it does reduce 5-HT use in the brain and prevents 5-HIAA from leaving the brain. It's It is unclear if Clonazepam's effects actions on 5-HT binding sites function are is responsible for its anti-myoclonic properties, which are only detected at high doses.

Furthermore, Clonazepam's effects are the polar opposite of those anticipated by 5-HTP's therapeutic effects in human myoclonic diseases. 

Lorazepam

Lorazepam interacts with benzodiazepine receptors on postsynaptic GABA-A ligand-gated chloride channel neuron benzodiazepine receptors at various places throughout the central nervous system (CNS). It increases the conductance of chloride ions in the cell by enhancing the inhibitory effects of GABA. 

The cellular plasma membrane is hyperpolarized and stabilised due to the shift in chloride ions. Its inhibitory action in the amygdala aids anxiety disorders, while its inhibitory activity in the cerebral cortex aids seizures.  

There are no dietary restrictions required unless mentioned by the physician.
The medication should be stored in a tightly closed container, at room temperature, and out of reach of children.
Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to compensate for the missed one.

How Much Should You Take: Dosages

Clonazepam

It's important to take Clonazepam precisely as prescribed by the doctor. Typically, you'll begin with a low dose and gradually raise it over 2 to 4 weeks until your doctor determines that the dose is appropriate.

 A doctor may prescribe you whether you should take Clonazepam in one dose or break it into three doses throughout the day. If you're not sure how to take it, consult a doctor or pharmacist.  

Usual Dose For;

  • Epilepsy in Adults:  1mg given at night is the initial dose (increasing to 4mg to 8mg over 2 to 4 weeks.
  • Epilepsy in Children: The dosage is determined by their age. It will be gradually raised over the next 2 to 4 weeks.
  • Adults with involuntary muscle spasms:  Should start with 1mg given at night (increasing to 4mg to 8mg over 2 to 4 weeks)
  • Panic Disorder: 1mg to 2mg each day.
  • Restless Legs Syndrome:  5mg to 2mg each day.

A doctor may prescribe a lesser dose if the patient is over 65 years of age or have suffers from any kidney or liver disease, or severe breathing problems. 

Lorazepam

Always take Lorazepam as prescribed by the doctor. Lorazepam tablets are available in strengths of 0.5mg, 1mg, and 2.5mg. Each In the injectable form, 1ml of the liquid contains 1mg of lorazepam.

Usual Dosage For:

  • Anxiety: 1 to 4 mg per day; your doctor will advise you on how often to take it.
  • Sleep Problem:  Sleep disturbances: 1mg to 2mg before bedtime (Lorazepam starts to work in 20-30 mins)
  • A Pre-Med for Adults Before surgery: 2 to 3 mg the night before the surgery, then 2 to 4 mg 1 to 2 hours before the procedure
  • A Pre-Med Before surgery for Children Aged 1Month to 11 Years: The child's weight will determine the dosage.
  • A Pre-Med Before surgery for Children Aged 12 to 17 Years and Above: 1 to 4 mg the night before or 1 hour before the operation.

A doctor may prescribe a lesser dose if the patient is over 65 years old or have liver or kidney problems. 

Side-Effects Of Clonazepam and Lorazepam

Common side-effects of Clonazepam

Common side-effects of Lorazepam

drowsiness

Drowsiness

dizziness

Dizziness

weakness

Tiredness

unsteadiness

Muscle weakness

depression

Headache

loss of orientation,

Blurred vision

headache

Insomnia 

Difference And Similarities Between Clonazepam And Lorazepam

Particular

Clonazepam

Lorazepam

Drug Class

Benzodiazepine

Benzodiazepine

Brand Name

Klonopin

Ativan

Form of Drug

Oral Tablet

Oral Tablet and injection

Standard Dosage

0.25 mg twice per day, depending upon the doctor's prescription

1 mg twice per day, depending upon the doctor's prescription

Medication Prescribed for

Panic disorder: Adults 18 years and older     

Seizures: Adults or children 10 years and older

Anxiety: Adults or children 12 years and older

Which Is More Effective Clonazepam or Lorazepam?

Both Clonazepam and Lorazepam are effective drugs for treatment equally effective. Depending on the condition being treated, their effectiveness can vary because they have been studied for different purposes. 

In multicenter research, the active components of clonazepam and Lorazepam were equally effective in treating anxiety disorders. There were no significant differences between these medicines when it came to anxiety and sleep improvement. Clonazepam has fewer negative effects in the study. 

Another study evaluated the effects of clonazepam and Lorazepam in treating status epilepticus, a form of a severe seizure. Clonazepam is a more effective alternative to Lorazepam for status epilepticus, even though Lorazepam is more extensively utilized. Clonazepam is sometimes used for treatment, off-label.

Warning: Clonazepam And Lorazepam

Taking Benzodiazepines and opioids together can cause a greater risk of respiratory depression, coma, and death. They have the potential to be abused and become addicted. As a result, they usually are only recommended for short-term use.

Both the drugs should be avoided on in the elderly or those who may be at risk of falls. Patients on these drugs should be monitored regularly with liver disease liver function tests, as both affect the liver. as lower doses may be required in patients with liver disease.

Clonazepam and Lorazepam should be avoided during pregnancy or if planning pregnancy. It should also be kept away a while, breastfeeding. It should also be avoided during breastfeeding.

Bottom Line From Practical Anxiety Solutions

Both Clonazepam and Lorazepam are benzodiazepines with an intermediate action; as a result, their effects may endure longer than those of comparable medications. Both medications can treat anxiety disorder, and epilepsy which binds to GABA receptors in the brain. 

While both these medications function in similar ways, the way they are administered differs, their route of administration, dosage form, and indications may differ.like in dosage, form in which they are available, and for whom it is suitable. They should not be taken together as the combination may lead to excessive drowsiness, and confusion.

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