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클로나제팜

Clonazepam

5-(2-chlorophenyl)-7-nitro-1,3-dihydro-1,4-benzodiazepin-2-one

벤조디아제핀계 항경련제 / 항불안제PO개고양이

다른 이름: Klonopin · Antelepsin · Clonagin · Clonapam · Clonax · Clonex · Diocam · Epitril · Iktorivil · Kenoket · Kriadex · Neuryl · Paxam · Rivatril · Rivotril · Solfidin · Linotril · clonazepamum · Ro-5-4023

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

1-2 mg/kg PO q12hPO· q12h
— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증용량경로빈도기간지역
Adjunctive medication in the treatment of seizures1-2 mg/kg PO q12hPOq12h—🌎 NA
Adjunctive medication in the treatment of seizures0.5 mg/kg PO two to three times a dayPOq8-12h—🌎 NA
Anxiolytic0.05-0.25 mg/kg PO q12-24hPOq12-24h—🌎 NA
Anxiolytic0.1-1 mg/kg PO two to three times a dayPOq8-12h—🌎 NA
Muscular hypertonicity (episodic falling) / Anxiolytic0.5 mg/kgPOq8-12h—🌍 EU
  • Adjunctive medication in the treatment of seizures: May need to lower phenobarbital dose by 10-20%
  • Muscular hypertonicity (episodic falling) / Anxiolytic: Suggested starting dose but there is a wide range of recommendations.

고양이

적응증용량경로빈도기간지역
Anxiolytic0.05-0.25 mg/kg PO q12-24hPOq12-24h—🌎 NA
Anxiolytic0.02-0.2 mg/kg PO once to two times a dayPOq12-24h—🌎 NA
Anxiolytic0.1-0.2 mg/kg PO as needed or up to two times a dayPOPRN or q12h—🌎 NA
Adjunctive medication in the treatment of seizuresStarting dose is 0.5 mg (total dose) PO q12-24hPOq12-24h—🌎 NA
Adjunctive medication in the treatment of seizures1/8th to 1/4 of a 0.5 mg tablet PO two to three times dailyPOq8-12h—🌎 NA
Anxiolytic / Hyperaesthesia / Epilepsy0.5 mg/catPOq12-24h—🌍 EU
  • Adjunctive medication in the treatment of seizures: Anecdotally more effective for maintenance and to decrease cluster seizures; acute hepatic necrosis possible
  • Anxiolytic / Hyperaesthesia / Epilepsy: Suggested starting dose but there is a wide range of recommendations.

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

클로나제팜은 강력하고 지속 시간이 긴 ​벤조디아제핀계​ 약물로, 수의학에서는 주로 보조 항경련제 및 항불안제로 사용됩니다.

​임상 요점:​ 개에서는 항경련 효과에 대한 내성이 빠르게(보통 1~4주 이내) 발생하기 때문에 장기 유지 항경련제로서의 유용성이 매우 제한적입니다. 이는 수용체 하향 조절 및 약동학적 변화 때문입니다. 따라서 단기 펄스 요법이나 군발 발작 관리에 훨씬 더 적합합니다.

  • 고양이의 경우 뇌전증이나 불안증의 장기 보조 치료에 사용할 수 있습니다. 고양이에서 경구용 벤조디아제핀(가장 대표적으로 디아제팜)은 특이체질성 급성 간괴사를 유발할 위험이 있는 것으로 알려져 있으나, 클로나제팜은 그 가능성이 더 낮은 것으로 간주됩니다. 하지만 여전히 모니터링이 필요합니다.
  • 클로나제팜은 오남용 및 의존성 위험으로 인해 ​제4군(C-IV) 향정신성의약품​으로 분류됩니다.

작용 기전

Clonazepam acts as a positive allosteric modulator at the GABA-A receptor complex in the central nervous system.

  • It binds to specific benzodiazepine receptors (located primarily in the limbic, thalamic, and hypothalamic regions) → enhances the affinity of the receptor for the inhibitory neurotransmitter ​gamma-aminobutyric acid (GABA)​.
  • This increases the frequency of chloride channel opening → influx of chloride ions → cellular hyperpolarization → decreased neuronal excitability.
  • Additional postulated mechanisms include antagonism of serotonin and diminished release or turnover of acetylcholine in the CNS.

안전성·주의사항

금기사항

  • Hypersensitivity to clonazepam or other benzodiazepines
  • Significant liver disease or dysfunction
  • Acute narrow-angle glaucoma
  • Myasthenia gravis (may exacerbate weakness)
  • Marked CNS depression
  • Respiratory depression
  • Severe muscle weakness
  • Hepatic impairment (may worsen hepatic encephalopathy)

부작용

  • Sedation and lethargy
  • Ataxia (incoordination)
  • Paradoxical excitement, hyperactivity, or vocalization
  • Increased salivation
  • Gastrointestinal upset (vomiting, diarrhea, constipation)
  • Dogs: Rapid tolerance to anticonvulsant effects
  • Cats: Polyphagia, potential for acute hepatic necrosis (rare)
  • Respiratory suppression (at higher doses)
  • Acute hepatic necrosis (idiosyncratic in cats)
  • Tolerance development

주의

Do not discontinue therapy abruptly, especially in patients on chronic or high-dose therapy, as this may precipitate withdrawal signs or status epilepticus; taper the dose gradually. Use with caution in nursing dams, as benzodiazepines can enter milk and accumulate to toxic levels in neonates. Monitor cats closely for signs of hepatotoxicity.

약물 상호작용

Azole Antifungals (itraconazole, ketoconazole)

May increase clonazepam levels by inhibiting its metabolism.

Cimetidine

May decrease the metabolism of benzodiazepines, increasing their effects.

CNS Depressants (barbiturates, narcotics, anesthetics)

Additive CNS depression; may cause profound sedation or respiratory depression.

Erythromycin

May decrease the metabolism of benzodiazepines.

PhenobarbitalModerate

May decrease clonazepam concentrations via hepatic enzyme induction.

PhenytoinModerate

May decrease clonazepam concentrations.

Propantheline

May decrease clonazepam concentrations.

Rifampin

May induce hepatic microsomal enzymes and decrease the pharmacologic effects of benzodiazepines.

Antifungal imidazoles (e.g., Ketoconazole, Itraconazole)Moderate

Inhibition of CYP450 enzymes may decrease clonazepam clearance, increasing its plasma levels and risk of toxicity.

Other CNS DepressantsMajor

Additive sedation and respiratory depression.

모니터링

  • Clinical efficacy (seizure frequency, anxiety levels)
  • Adverse effects (sedation, ataxia, paradoxical excitement)
  • Therapeutic blood levels (reported target: 0.015-0.07 mcg/mL)
  • Cats: Baseline and periodic liver function tests
  • Degree of sedation and ataxia
  • Respiratory rate and effort
  • Hepatic function panel (especially in cats)
  • Clinical response (seizure frequency, muscle tone, or behavioral changes)

약동학

반감기

고양이Variable개Dose-dependent (saturation kinetics)

흡수

In dogs, oral bioavailability is variable (20-60%) but absorption is rapid. In humans, it is well absorbed from the GI tract with peak serum levels occurring about 3 hours after oral dosing.

분포

Highly lipophilic; rapidly crosses the blood-brain barrier and placenta. Protein binding in dogs is approximately 82%.

대사

Metabolized in the liver to several metabolites. In dogs, clonazepam exhibits saturation kinetics, meaning elimination rates are dose-dependent.

배설

Metabolites are excreted primarily in the urine.

과다투여

Overdoses commonly cause profound sedation, depression, and ataxia.

  • ​Paradoxical Reactions:​ Some animals may exhibit paradoxical signs such as hyperactivity, disorientation, agitation, and vocalization. Paradoxical excitation can be treated with a mild sedative, such as diphenhydramine.
  • ​Management:​ Emesis is generally NOT indicated due to the risk of rapid CNS depression and aspiration. Mild to moderate overdoses can often be monitored at home if the animal is rousable and not showing paradoxical signs. Keep the animal confined and minimize stimulation.
  • ​Severe Toxicity:​ Massive overdoses can lead to respiratory depression or hypotension. Flumazenil (a specific benzodiazepine antagonist) can be used to reverse severe respiratory or CNS depression. Because flumazenil has a short half-life, multiple doses may be required.

제품

제형

  • Oral tablets
  • Orally disintegrating tablets (ODT)
  • Compounded oral suspension
  • 0.25 mg tablet
  • 0.5 mg tablet
  • 1.0 mg tablet
  • 2 mg tablet
  • 500 mcg tablet
  • 500 mcg/5 ml oral solution
  • 2 mg/5 ml oral solution

인용의약품

  • Clonazepam Oral Tablets: 0.5 mg, 1 mg, & 2 mg (Klonopin, generic)
  • Clonazepam Orally Disintegrating Tablets: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg & 2 mg (Klonopin Wafers, generic)
  • Linotril
  • Rivotril

규제 현황

European Union✗ 미승인처방전의약품 · Controlled DrugEMA

POM (Prescription Only Medicine). Subject to national controlled drug regulations.

United Kingdom✗ 미승인처방전의약품 · Schedule 3 (CD No Register)VMD

POM. Prescriptions are subject to controlled drug requirements.

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Tablets should be stored in airtight, light-resistant containers at room temperature. Compounded oral suspensions (0.1 mg/mL in Ora-Plus/Ora-Sweet) retain >90% potency for 60 days when stored at 5°C or 25°C, but must be protected from light.

보호자 정보

  • ​규칙적인 투약이 핵심:​ 항경련제 치료 실패의 주요 원인은 처방된 치료를 제대로 따르지 않는 것입니다. 정해진 시간에 규칙적으로 약을 먹이는 것이 매우 중요합니다.
  • ​갑자기 중단하지 마세요:​ 수의사의 지시 없이 이 약을 갑자기 중단하지 마십시오. 갑작스러운 중단은 생명을 위협하는 심각한 지속성 발작(간질 중첩증)을 유발할 수 있습니다. 약을 중단해야 하는 경우 수의사가 점진적인 감량 일정을 안내할 것입니다.
  • ​부작용:​ 약을 처음 시작할 때 가벼운 졸음과 비틀거림이 흔하게 나타나지만 대개 호전됩니다. 반려동물이 비정상적으로 과잉 행동을 하거나 불안해하면 수의사에게 연락하십시오.
  • ​고양이 보호자 주의사항:​ 고양이가 식욕 부진, 구토를 보이거나 눈의 흰자위나 잇몸이 노랗게 변하는지(황달) 주의 깊게 관찰하십시오. 이는 드물지만 심각한 간 문제의 징후일 수 있습니다. 이러한 증상을 발견하면 즉시 수의사에게 연락하십시오.

VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.