Hegstad et al. 65044. In most cases, other drugs were also present. Version 2.73 51776-37-Aminoclonazepam [Mass/volume] in Urine by Confirmatory methodActive Part Description LP28541-8 7-Aminoclonazepam 7-Aminoclonazepam is a metabolite of clonazepam, a benzdiazepine drug used to treat or control seizures, panic attacks, and akathisia. Epub 2010 Feb 8. The .gov means its official. Vomiting and diarrhea can disrupt normal absorption and metabolism of medications and reduce excreted amounts to undetectable levels. 2013 Jan-Feb;37(1):25-9. doi: 10.1093/jat/bks080. Brand names: KlonoPIN, KlonoPIN Wafer and phenytoin. 7-aminoclonazepam is superior to clonazepam for detection of - PubMed It may also be used to treat panic attacks, insomnia, and generalized anxiety. In the case of improper storage, drug degradation contributing to unexpected negative results may be possible. The range of concentrations detected was from 73.0 pg x mL(-1) to 183.2 ng x mL(-1). Patients who drink a lot of water, consume caffeine, take diuretic medications, have disorders of antidiuretic hormone, or other physiologic disturbances affecting urinary concentration may produce less concentrated urine. Following a single dose of 2009 Apr 28;9:5. doi: 10.1186/1471-227X-9-5. Some long-term trials have suggested a benefit of clonazepam for up to three years without the development of tolerance but these trials were not placebo-controlled. medicines that don't need a prescription and any illegal drugs you may use. Our series on interpreting unexpected results concludes with a discussion on the interpretation of benzodiazepine results from Aegis Sciences Corporation. False negative immunoassay results may also occur due to failure of the assay to react to drug-specific markers such as alpha-OH-alprazolam, 7-aminoclonazepam, 2-hydroxyethylflurazepam, and lorazepam glucuronide.6,11,12,16,18-21. If the patient reports a recent hospitalization or emergency department visit, follow-up with the hospital may be necessary to determine what medications were administered to the patient. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide. Comparison of Clonazepam Compliance by Measurement of Urinary 8600 Rockville Pike Taking other antiseizure medicines may affect your results. Clonazepam, marketed as Klonopin and Rivotril, is a long-acting benzodiazepine with anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties. Eur J Drug Metab Pharmacokinet. Any level over 0.08 mcg/mL is considered toxic. Other names, such as Antelepsin, Clonoten, Ravotril, Rivotril, Iktorivil, Clonex (Israel), Paxam, Petril, Naze, Zilepam and Kriadex, are used throughout the world. Methods: Millennium Laboratories performed measurements on the urinary excretion of pain patients prescribed clonazepam as the indicator test. MeSH Alprazolam Detection Using an Electrochemical Nanobiosensor Based on AuNUs/Fe-Ni@rGO Nanocomposite. [129], Clonazepam has plasma protein binding of 85%. Swallow the regular tablet whole, with a full glass of water. Ask a doctor if it is safe to breastfeed while using this medicine. MeSH Cook JD, Caplan YH, LoDico CP, et al. 0000000016 00000 n official website and that any information you provide is encrypted It may also be used to treat Accessibility MeSH Clonazepam, sold under the brand names Klonopin and Rivotril, is a medication used to prevent and treat seizures, panic disorder, anxiety disorders, and the movement disorder known as akathisia. This is not a complete list of side effects and others may occur. Clonazepam does, however, affect glutamate decarboxylase activity. 2013:416:80-58. [87], Clonazepam and 7-aminoclonazepam may be quantified in plasma, serum, or whole blood in order to monitor compliance in those receiving the drug therapeutically. [96], Clonazepam decreases the levels of carbamazepine,[97][98] and, likewise, clonazepam's level is reduced by carbamazepine. official website and that any information you provide is encrypted The central nervous system depressing effects of the drug can be intensified by alcohol consumption, and therefore alcohol should be avoided while taking this medication. Methods: In these cases, the claimed sensitivity is inadequate to detect the presence of the drug in urine even after an overdose. 2004 Oct 29;145(2-3):123-30. doi: 10.1016/j.forsciint.2004.04.066. Dizziness or drowsiness can cause falls, accidents, or severe injuries. 7-Aminoclonazepam 1.0 mg/mL in Acetonitrile | . Principles of Forensic Toxicology. [21] As a result, clonazepam is sometimes used for certain rare childhood epilepsies; however, it has been found to be ineffective in the control of infantile spasms. [133], A 2006 US government study of hospital emergency department (ED) visits found that sedative-hypnotics were the most frequently implicated pharmaceutical drug in visits, with benzodiazepines accounting for the majority of these. [Benzodiazepine (clonazepam, nitrazepam, diazepam)]. Version 2.73 28073-57-Aminoclonazepam [Mass/volume] in UrineActive Part Description LP28541-8 7-Aminoclonazepam 7-Aminoclonazepam is a metabolite of clonazepam, a benzdiazepine drug used to treat or control seizures, panic attacks, and akathisia. The comprehensive drug screen was designed to rapidly detect the presence of a broad array of compounds in patients presenting with a possible overdose. Generic name: clonazepam [kloe-NAZ-e-pam] Clonazepam in particular is more prone to stability issues. Chze M, Muckensturm A, Hoizey G, Ppin G, Deveaux M. Forensic Sci Int. 7-Aminoflunitrazepam. A gradual reduction in dosage reduces the severity of the benzodiazepine withdrawal syndrome. 2010 Mar 20;196(1-3):14-7. doi: 10.1016/j.forsciint.2009.12.037. Prolonged excretion of 7-aminoclonazepam in urine after repeated ingestion of clonazepam: a case report. Clonazepam is a benzodiazepine prescription drug and is classified by the DEA as Schedule IV controlled substance under the federal Controlled Substances Act. Bioanalysis. Your results Drug classes: Benzodiazepine anticonvulsants, Benzodiazepines. Careers. Benzodiazepines do not replace GABA, but instead enhance the effect of GABA at the GABAA receptor by increasing the opening frequency of chloride ion channels, which leads to an increase in GABA's inhibitory effects and resultant central nervous system depression. trailer Would you like email updates of new search results? [89] Clonazepam is generally not recommended for use in elderly people for insomnia due to its high potency relative to other benzodiazepines. have a problem. 2013 Nov;5(22):2803-20. doi: 10.4155/bio.13.244. Disclaimer. 215 0 obj <> endobj Background: sharing sensitive information, make sure youre on a federal Plasma levels of clonazepam can vary as much as tenfold between different patients. 0000002060 00000 n 2010;13(3):273-81.20. Neonatal withdrawal syndrome associated with benzodiazepines include hypertonia, hyperreflexia, restlessness, irritability, abnormal sleep patterns, inconsolable crying, tremors, or jerking of the extremities, bradycardia, cyanosis, suckling difficulties, apnea, risk of aspiration of feeds, diarrhea and vomiting, and growth retardation. Moosmann B, Link LA, Auwarter V. Designer benzodiazepines: a new challenge. PDF DRUG FACT SHEET - phoenix.gov Clipboard, Search History, and several other advanced features are temporarily unavailable. 11th ed. Using molecular similarity to highlight the challenges of routine immunoassay-based drug of abuse/toxicology screening in emergency medicine. %%EOF [8], Common side effects include sleepiness, poor coordination, and agitation. Selling or giving away this medicine is against the law. Six of the volunteers had urine concentrations of 7-ACLO that peaked at 1 day after administration. J Anal Toxicol. Some withdrawal symptoms may last up to 12 months or longer. [22] Clonazepam is mainly prescribed for the acute management of epilepsies. 7-Aminoclonazepam 100 ug/mL in Acetonitrile | Certified Reference Material This certified Snap-N-Spike solution is suitable for use as a starting material in calibrators and controls for numerous GC/MS or LC/MS applications in forensic analysis, clinical toxicology and urine drug testing. We investigated the effects of ACZP on the GABA A receptor-mediated currents (I GABA ) in neurons from the nucleus reticularis thalami (NRT) of the . Your healthcare provider may also order other tests, including: 7-aminoclonazepam. doi: 10.1097/MD.0000000000002881. Results: Immunoassay. and transmitted securely. It produces pharmacological effects (depression, amnesia) similar to other compounds from the same therapeutic class, and in combination with alcohol, its CNS-depressant action can be significantly potentiated. In the case of unexpected positive benzodiazepine results, consider the following drug exposures:Chlordiazepoxide (Librax, Librium), Clorazepate (Gen-xene, Tranxene), Diazepam (Valium), Oxazepam, and/or Temazepam (Restoril). [9] Clonazepam may affect levels of phenytoin (diphenylhydantoin). 41782. Simultaneous analysis of 14 benzodiazepines in oral fluid by solid-phase extraction and LC-MS-MS. Follow the directions on your prescription label and read all medication guides. [80] Many studies have found that tolerance develops to the anticonvulsant properties of clonazepam with chronic use, which limits its long-term effectiveness as an anticonvulsant. Federal government websites often end in .gov or .mil. J Anal Toxicol. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Clonazepam increases the levels of primidone[100] and phenobarbital. 4th ed. Clin Chim Acta. [29], Restless legs syndrome can be treated using clonazepam as a third-line treatment option as the use of clonazepam is still investigational. Stay alert to changes in your mood or symptoms. Clonazepam (CLO) is an anticonvulsant benzodiazepine approved by the Food and Drug Administration for use in the treatment of seizures. 2007 Mar 2;166(2-3):209-17. doi: 10.1016/j.forsciint.2006.05.040. [32] Rapid eye movement sleep behavior disorder responds well to low doses of clonazepam. The site is secure. Key words: Clonazepam, 7-aminoclonazepam, pain management, LC-MS/MS, immunoassay, patient compliance [125] Clonazepam is metabolized extensively via nitroreduction by cytochrome P450 enzymes, including CYP3A4. [106] It acts by binding to the benzodiazepine site of the GABA receptors, which enhances the electric effect of GABA binding on neurons, resulting in an increased influx of chloride ions into the neurons. Your doctor may occasionally change your dose. In addition, BZ are highly protein bound, reducing the free fraction of . Your test results may be different depending on the lab used. The https:// ensures that you are connecting to the 0000006281 00000 n Benzodiazepines also require special precaution if used by individuals that may be pregnant, alcohol- or drug-dependent, or may have comorbid psychiatric disorders. Stability of pain-related medications, metabolites, and illicit substances in urine. 0000009216 00000 n Comprehensive Drug Screen Limits of Detection - University of Washington Version: 10.01. gabapentin, sertraline, alprazolam, fluoxetine, lamotrigine, Zoloft, Xanax, pregabalin, diazepam, Prozac. However, negative results do not necessarily indicate the absence of the drug in question. [74], Like all benzodiazepines, clonazepam is a GABA-positive allosteric modulator. This site needs JavaScript to work properly. In: Levine B, ed. 0000009460 00000 n Is the patient on dialysis?If testing a dialysis patient, testing prior to dialysis is recommended or at least on a non-dialysis day to reduce the possibility of unexpected negative results. Selling or giving away this medicine is against the law. Therapeutic medicine levels Curr Drug Metab. Of anticonvulsant drugs, behavioural disturbances occur most frequently with clonazepam and phenobarbital. PUGVIEW FETCH ERROR: 503 National Center for Biotechnology Information 8600 Rockville Pike, Bethesda, MD, 20894 USA Contact Policies FOIA HHS Vulnerability Disclosure National Library of Medicine National Institutes of Health [9], Clonazepam was patented in 1960 and went on sale in 1975 in the United States from Roche. Bioanalysis. A highly sensitive NCI-GC-MS method for the simultaneous quantitation of CLO and its major metabolite 7-ACLO in urine was developed and validated. Application to forensic cases of drug facilitated crimes. [12][13] It is available as a generic medication. 7-Aminoclonazepam | Certified Solutions Standards | Certified Reference It consists of screening immunoassays for several drugs or drug classes, a quantitative enzymatic assay for ethanol and a gas chromatography-mass spectrometry (GC/MS) assay for a wide variety of therapeutic and abused drugs, as listed below. Disposition of toxic drugs and chemicals in man. 3494-2. The screening immunoassays cutoffs given are the concentrations above which the assay is reported as positive; note that a drug present below the cutoff will be reported as negative on an immunoassay screen even though it is present. [124][8], Clonazepam is lipid-soluble, rapidly crosses the bloodbrain barrier, and penetrates the placenta. It can cause side effects such as . bruising, or feeling dizzy. Contact the laboratory with any questions about the cross-reactivity of any specific drug with this assay. PMC data for clonazepam and 7-aminoclonazepam. [95], Clonazepam has similar effectiveness to other benzodiazepines at often a lower dose. Although the impact of urine pH would not likely be so significant to cause unexpected negative results, providers may consider that an elevated urine pH may be a natural physiologic response to regulate the bodys acid-base balance, or it may also be elevated if the urine was not stored properly prior to shipment. Further information regarding specimen tampering is available in the Aegis Clinical Reference Guide at https://www.aegislabs.com/resources/clinical-reference-guide/. Epub 2012 Nov 10. Mayo Clin Proc.2008;83(1):66-76.7. Clipboard, Search History, and several other advanced features are temporarily unavailable. Copyright 1996-2023 Cerner Multum, Inc. Clonazepam: Drug Uses, Dosage, Side Effects - Drugs.com Prescription: Benzodiazepines are controlled substances, and legitimate prescriptions would show up on the prescription drug monitoring program (PDMP) in most cases. Drug class: benzodiazepine anticonvulsants. 0000001057 00000 n Clonazepam's mode of action is to decrease abnormal electrical energy in the brain. Because of the intended primary use of the comprehensive drug screen, the GC/MS assay was designed for rapid detection of a wide range of drugs when present at overdose concentrations, rather than for high sensitivity for any specific drug. To make sure this medicine is safe for you, tell your doctor if you have ever had: depression, mood problems, or suicidal thoughts or behavior; or. Avoid driving or hazardous activity until you know how clonazepam will affect you. It is typically taken by mouth. Coloring the toilet water blue prior to sample collection and assessing the urine temperature within 4 minutes of collection (should be between 90F and 100F) are additional measures to check for sample tampering.5-6. Intermolecular Interactions between Eosin Y and Caffeine Using. Stopping suddenly may cause increased seizures or unpleasant withdrawal symptoms. The data are also inconclusive on whether benzodiazepines such as clonazepam cause developmental deficits or decreases in IQ in the developing fetus when taken by the mother during pregnancy. 7-aminoclonazepam is superior to clonazepam for detection of clonazepam use in oral fluid by LC-MS/MS 7AC should be the analyte measured in OF for the detection of CLON use. 2009;31(6):746-8.19. Please note that the interpretation of benzodiazepine results differs when using presumptive vs. definitive testing methods, and may differ among laboratories. You should not take clonazepam if you allergic to it or if you have: a history of allergic reaction to any benzodiazepine (including alprazolam, diazepam, lorazepam, Valium, Xanax, Versed, and others). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [103], Combined use of clonazepam with certain antidepressants, anticonvulsants (such as phenobarbital, phenytoin, and carbamazepine), sedative antihistamines, opiates, and antipsychotics, nonbenzodiazepines (such as zolpidem), and alcohol may result in enhanced sedative effects. National Library of Medicine Long-acting benzodiazepines such as clonazepam are not generally recommended for the elderly due to the risk of drug accumulation. Nordal K, iestad EL, Enger A, Christophersen AS, Vindenes V. Ther Drug Monit. Valium, Xanax Prescriptions Could Raise Overdose Risk in Youth. [33], In September 2020, the U.S. Food and Drug Administration (FDA) required the boxed warning be updated for all benzodiazepine medicines to describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class. Federal government websites often end in .gov or .mil. Providers may also consider recent GI illness in the interpretation of unexpected negative results. 0000003040 00000 n This is a substance your body makes from clonazepam. Negrusz A, Bowen AM, Moore CM, Dowd SM, Strong MJ, Janicak PG. Before arm. 2010;67:1344-50.14. Trends in drug use from urine drug testing of addiction treatment clients. This site needs JavaScript to work properly. Remove an orally disintegrating tablet from the package only when you are ready to take the medicine. WARNING This product is not for human or veterinary use. [105], Clonazepam enhances the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the central nervous system to give its anticonvulsant, skeletal muscle relaxant, and anxiolytic effects. Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. 7-aminoclonazepam is superior to clonazepam for detection of clonazepam use in oral fluid by LC-MS/MS Due to the risks of tolerance and withdrawal seizures, clonazepam is generally not recommended for the long-term management of epilepsies. Commonly prescribed medications and potential false-positive urine drug screens. [24], Abrupt or over-rapid withdrawal from clonazepam may result in the development of the benzodiazepine withdrawal syndrome, causing psychosis characterised by dysphoric manifestations, irritability, aggressiveness, anxiety, and hallucinations. A patient taking alprazolam, clonazepam, flurazepam, or lorazepam will not test positive for benzodiazepine metabolites on an Aegis report. It can cause side effects such as drowsiness, problems with . -7-Aminoclonazepam (metabolite of clonazepam)-Diazepam (separate prescribable drug and . It differs from other anticonvulsant drugs it was compared to in a study. It is not a diagnostic device. [9] In addition, clonazepam decreases the utilization of 5-HT (serotonin) by neurons[111][112] and has been shown to bind tightly to central-type benzodiazepine receptors. Read and carefully follow any Instructions for Use provided with your medicine. This has been conjectured as a mechanism for high-dose effects on seizures in the study. Any questions about how to list medications as prescribed on an Aegis laboratory requisition may be directed to the Aegis Client Services department at 1-800-533-7052. Bookshelf Copyright 2016 Elsevier B.V. All rights reserved. Residual effect of a 7-amino metabolite of clonazepam on GABAA - PubMed [9] Peak blood concentrations of 6.513.5ng/mL were usually reached within 12 hours following a single 2mg oral dose of micronized clonazepam in healthy adults. The concentrations were thus similar among the groups, although the median value was highest in the postmortem group. Elimination of 7-aminoclonazepam in urine after a single dose of Keep the medication in a place where others cannot get to it. [62] Carbamazepine has been tested in the treatment of clonazepam withdrawal but was found to be ineffective in preventing clonazepam withdrawal-induced status epilepticus from occurring. Caution is also required if clonazepam is used during breastfeeding. 0000003638 00000 n LC-MS/MS extends the range of drug analysis in pain patients. LP28541-8 7-Aminoclonazepam 7-Aminoclonazepam is a metabolite of clonazepam, a benzdiazepine drug used to treat or control seizures, panic attacks, and akathisia. CLO was not detected in any of the samples. Bethesda, MD 20894, Web Policies One hundred samples were presumptive-positive for 7AC and/or CLON. 0000010374 00000 n Mikel C, Pesce AJ, Rosenthal M, West C. Therapeutic monitoring of benzodiazepines in the management of pain: current limitations of point of care immunoassays suggest testing by mass spectrometry to assure accuracy and improve safety. Some people have thoughts about suicide while taking clonazepam. 0000011260 00000 n LOINC 61030-3 7-Aminoclonazepam [Presence] in Urine In general, the following guidance may be helpful: Positive for alprazolam and alpha-OH-alprazolam, Write in Other field(Paper Requisition). Extraction and analysis of clonazepam and 7-aminoclonazepam in whole blood using a dual internal standard methodology. Do not stop using clonazepam without asking your doctor. Drugs of abuse in oral fluid collected by two different sample kitsstability testing and validation sing ultra performance tandem mass spectrometry. Clonazepam. If there is a particular scenario involving unexpected results, the Aegis Clinical Team is happy to review available literature to examine possible causes of such results. Click on the title Drug Stability and Toxicology Testing to download a copy of this chapter. Withdrawal seizures and psychosis can occur in severe cases of withdrawal, and anxiety and insomnia can occur in less severe cases of withdrawal. [9], The elderly are especially susceptible to increased risk of harm from motor impairments and drug accumulation side effects. Patients dependent on clonazepam should be slowly titrated off under the supervision of a qualified healthcare professional to reduce the intensity of withdrawal or rebound symptoms. 91 (91.0%) confirmed positive for 7AC (median, range: 4.2, 0.5-316.7 ng/ml) using the ion ratio test, while only 44 of the 100 (44.0%) samples confirmed positive for CLON (median, range: 3.7, 0.5-217.2 ng/ml) using the ion ratio test. Urinary analyses of the metabolite 7-aminoclonazepam (7-AC) can be helpful in monitoring drug abuse and in the context of suspected drug-facilitated sexual assaults (DFSA). [113] Because clonazepam is effective in low milligram doses (0.5mg clonazepam = 10mg diazepam),[114][115] it is said to be among the class of "highly potent" benzodiazepines. Seal Beach, CA: Biomedical Publications; 2017.2. Do not stop using clonazepam suddenly, even if you feel fine. eCollection 2019. Careers. Epub 2012 Oct 16. Tell your doctor right away if you become pregnant. Blood concentrations of clonazepam and 7-aminoclonazepam in - PubMed In OF the levels of 7AC were approximately 2.4-fold higher than CLON. In many cases, non-pharmacological treatments, such as relaxation therapy, psychotherapy, and avoidance of caffeine, can be an effective and safer alternative to the use of benzodiazepines for anxiety in pregnant women. Clipboard, Search History, and several other advanced features are temporarily unavailable. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. 2015;11(1):618.17. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use clonazepam only for the indication prescribed. Your family or caregivers should also watch for sudden changes in your behavior. [110], Clonazepam's primary mechanism of action is the modulation of GABA function in the brain, by the benzodiazepine receptor, located on GABAA receptors, which, in turn, leads to enhanced GABAergic inhibition of neuronal firing. sharing sensitive information, make sure youre on a federal Call your doctor if this medicine seems to stop working as well in treating your seizures or panic attacks. Providers should use their independent medical judgment based on the clinical needs of the patient when making determinations of who to test, what medications to test, testing frequency, and the type of testing to conduct. These include valproate BZ are weakly acidic and are therefore excluded from OF, resulting in low OF concentrations [7]. Clonazepam is a medicine used to treat seizures. Urinary analyses of the metabolite 7-aminoclonazepam (7-AC) can be helpful in monitoring drug abuse and in the context of suspected drug-facilitated sexual assaults (DFSA). Clonazepam was approved in the United States as a generic drug in 1997 and is now manufactured and marketed by several companies. Using LC-MS/MS, clonazepam was detected in 297 traffic cases, 92 criminal cases (perpetrators or victims of a crime) and in 140 postmortem cases. J Opioid Manag. 2009;1(5):937-52.13. 0 Bookshelf Keywords: [84], Coma can be cyclic, with the individual alternating from a comatose state to a hyper-alert state of consciousness, which occurred in a four-year-old boy who overdosed on clonazepam. Forensic Sci Int. Other drugs may interact with clonazepam, including prescription and over-the-counter medicines, vitamins, and herbal products. [88], The elderly metabolize benzodiazepines more slowly than younger people and are also more sensitive to the effects of benzodiazepines, even at similar blood plasma levels. Ther Drug Monit. What Did My Patient Actually Take? An Overview of Benzodiazepine [102] [1][135] In August 2021, Roche Australia transferred Rivotril to Pharmaco Australia Ltd.[138], Clonazepam orally disintegrating tablet, 0.25mg. On this Wikipedia the language links are at the top of the page across from the article title. Test results may vary depending on your age, gender, health history, and other things. PMC Benzodiazepine Multi-Component Mixture-8, 250 g/mL of each component, A-916 / A-916-1ML, A-917 / A-917-1ML, A-924 / A-924-1ML, B-033 / B-033-1ML, C-905 / C-905-1ML, C-906 / C-906-1ML, C-907 / C-907-1ML, F-043 / F-043-1ML, H-113 / H-113-1ML, P-093 / P-093-1ML, read more about ordering regulated substances. Flurazepam is detected as the metabolite hydroxyethyl-flurazepam. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. [104], The safety profile of clonazepam during pregnancy is less clear than that of other benzodiazepines, and if benzodiazepines are indicated during pregnancy, chlordiazepoxide and diazepam may be a safer choice. Do not take two doses at one time. 2023 Jan 23:1-13. doi: 10.1007/s40264-022-01269-x. Do not change your doses or medication schedule without your doctor's advice. Taking a blood sample with a needle carries risks that include bleeding, infection, [92], Clonazepam may aggravate hepatic porphyria.
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