Accessibility Mandrioli R, Mercolini L, Raggi MA. Clonazepam may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Moosmann B, Link LA, Auwarter V. Designer benzodiazepines: a new challenge. Ask your healthcare provider what your test results mean for you. [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. Swallow the regular tablet whole, with a full glass of water. [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. Forensic Sci Int. Federal government websites often end in .gov or .mil. 4th ed. National Library of Medicine Disposition of toxic drugs and chemicals in man. An overdose of clonazepam can be fatal if you take it with alcohol, opioid medicine, or other drugs that cause drowsiness or slow your breathing. Clin Infect Dis. Hospitalization/Emergency Department Visit: Patients who arrive at the emergency room with a suspected poisoning or overdose may be given benzodiazepines depending on their presenting symptoms and the source of the toxicity. [10] Clonazepam binds to GABAA receptors, thus increasing the effect of the chief inhibitory neurotransmitter -aminobutyric acid (GABA). 7-Aminoflunitrazepam. NOTICE: The information above is intended as a resource for health care providers. All urine samples (1 mL) were extracted following addition of the internal standard (D(5)-diazepam) and enzymatic hydrolysis ( beta-glucuronidase) using solid-phase extraction columns. Bookshelf Schedule IV drugs have a lower potential for abuse relative to drugs in Schedule III (for example, codeine or buprenorphine) but can still be abused. Do not stop using clonazepam suddenly, even if you feel fine. [9] Clonazepam may affect levels of phenytoin (diphenylhydantoin). Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Ask your doctor or pharmacist if you do not understand these instructions. J Anal Toxicol. Your doctor will need to check your progress on a regular basis. Other drugs were present in all cases, with clonazepam judged to be the primary cause of death in five cases. Benzodiazepines may be detected for a longer period of time in urine compared to oral fluid and blood. <<5EF21C43C966E948A92DC807C389A0F0>]>> Key words: Clonazepam, 7-aminoclonazepam, pain management, LC-MS/MS, immunoassay, patient compliance [23], It is also approved for treatment of typical and atypical absences (seizures), infantile myoclonic, myoclonic, and akinetic seizures. 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. 2010 Mar 20;196(1-3):14-7. doi: 10.1016/j.forsciint.2009.12.037. [14][15] In many areas of the world it is commonly used as a recreational drug. [citation needed] Clonazepam is also effective in the management of acute mania. We comply with the HONcode standard for trustworthy health information. The objective of this paper was to determine how long after administration of benzodiazepine clonazepam (CLO), its major metabolite 7-aminoclonazepam (7-ACLO) could be detected in urine collected from 10 healthy volunteers who received a single 3-mg dose of Klonopin (clonazepam). Clonazepam is a medicine used to treat seizures. This limits the utility of the comprehensive drug screen for monitoring compliance or for confirming the results of screening immunoassays. Contact the laboratory with any questions about the cross-reactivity of any specific drug with this assay. Mikel C, West R, Crews B, et al. A considerable amount of 7-aminoclonazepam (ACZP), a major metabolite of clonazepam (CZP), is present in the brain during CZP treatment, yet the pharmacological properties of ACZP remain unknown. [102] Follow your doctor's instructions about tapering your dose. Unable to load your collection due to an error, Unable to load your delegates due to an error. Clonazepam's mode of action is to decrease abnormal electrical energy in the brain. Pain Physician. Our series on interpreting unexpected results concludes with a discussion on the interpretation of benzodiazepine results from Aegis Sciences Corporation. At Aegis, we understand your concerns as you evaluate definitive drug testing results. Copyright 1996-2023 Cerner Multum, Inc. Clonazepam was approved in the United States as a generic drug in 1997 and is now manufactured and marketed by several companies. As a major metabolite, 7-aminoclonazepam may be used to monitor use of the parent drug, clonazepam. A recurrence of symptoms of the underlying disease should be separated from withdrawal symptoms. 0 Bethesda, MD 20894, Web Policies If evaluating urine results, the sample pH may be an indicator of sample stability. and transmitted securely. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Lund HM, iestad El, Gjerde H, Christophersen AS. 1,2 This product is intended for research and forensic applications. Withdrawal symptoms from benzodiazepines in the neonate may include hypotonia, apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. Methods Find Exp Clin Pharmacol. In blood, especially, the period of detection is generally limited to very recent use. 1A Detection frequency NPS TID Prescription/OTC DSS P/A/I 27% 12% 55% 2% 4% Fig. Taking other antiseizure medicines may affect your results. 0000006281 00000 n 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. These medications share common metabolites, and distinguishing which compound was ingested may be impossible.1,2 Note the analytes in red boxes below that are both metabolites and drugs available as a prescription. Jang M, Chang H, Yang W, Choi H, Kim E, Yu BH, Oh Y, Chung H. J Pharm Biomed Anal. Copyright 2016 Elsevier B.V. All rights reserved. Clonazepam has been found to be effective in the acute control of non-convulsive status epilepticus; however, the benefits tended to be transient in many people, and the addition of phenytoin for lasting control was required in these patients. Urine drug screening: practical guide for clinicians. [73] Use of alcohol or other CNS depressants while taking clonazepam greatly intensifies the effects (and side effects) of the drug. Efavirenz treatment and false-positive results in benzodiazepine screening tests. 0000009216 00000 n Federal government websites often end in .gov or .mil. Last updated on Dec 13, 2021. A patient taking alprazolam, clonazepam, flurazepam, or lorazepam will not test positive for benzodiazepine metabolites on an Aegis report. Tell your doctor if you are pregnant or plan to become pregnant. Figure 1. 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. 2023 University of Rochester Medical CenterRochester, NY, Clinical and Translational Sciences Institute, Monroe County Community Health Improvement Plan. The benzodiazepine clonazepam is a prescription drug used to treat epilepsy and anxiety. Determination of bromazepam, clonazepam and metabolites after a single intake in urine and hair by LC-MS/MS. 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. 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. Providers may also consider recent GI illness in the interpretation of unexpected negative results. 0000009460 00000 n 2022 Oct 31;12(11):945. doi: 10.3390/bios12110945. 1988;10(1):21-6.9. [24] A subgroup of people with treatment resistant epilepsy may benefit from long-term use of clonazepam; the benzodiazepine clorazepate may be an alternative due to its slow onset of tolerance. Epub 2016 Mar 23. 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 But be sure your healthcare provider knows Clin Chim Acta. It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain. [125] Clonazepam is metabolized extensively via nitroreduction by cytochrome P450 enzymes, including CYP3A4. 0000000770 00000 n Baselt, RC. 2010;67:1344-50.14. PMC Illicit Exposure: Sources of illicit exposure may include use of another persons prescription drug, acquisition of counterfeit or other illicit drugs unknowingly laced with benzodiazepines, or exposure to illicitly manufactured benzodiazepines which may share metabolites with FDA-approved benzodiazepines.3. Pesce A, Rosenthal M, West R, et al. 2008;9(8):827-443. Please enable it to take advantage of the complete set of features! [109] Clonazepam has no effect on GABA levels and has no effect on gamma-aminobutyric acid transaminase. It is typically taken by mouth. Increasing the dose can overcome the effects of tolerance, but tolerance to the higher dose may occur and adverse effects may intensify. [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. Such data would be of great importance to law enforcement agencies trying to determine the best time interval for urine collection from a victim of drug-facilitated sexual assault in order to reveal drug use. Nordal K, iestad EL, Enger A, Christophersen AS, Vindenes V. Ther Drug Monit. [74], Like all benzodiazepines, clonazepam is a GABA-positive allosteric modulator. Unexpected benzodiazepine results may be indicative of noncompliance, drug misuse, or diversion, and we welcome your calls and e-mails for assistance in interpreting these results. The use of clonazepam during pregnancy should only occur if the clinical benefits are believed to outweigh the clinical risks to the fetus. 2019 Sep 5;2019:2035492. doi: 10.1155/2019/2035492. 65044. and transmitted securely. Okuom MO, Wilson MV, Jackson A, Holmes AE. Physiological dependence was demonstrated by flumazenil-precipitated withdrawal. [10] It is a tranquilizer of the benzodiazepine class. An official website of the United States government. Clonazepam's mode of action is to decrease abnormal electrical energy in the brain. Click on the title Drug Stability and Toxicology Testing to download a copy of this chapter. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. [126] It has an elimination half-life of 1960 hours. Accessibility The https:// ensures that you are connecting to the It can cause side effects such as drowsiness, problems with coordination, and . 2013 Nov;5(22):2803-20. doi: 10.4155/bio.13.244. 0000002060 00000 n [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. Keep track of your medicine. 0000000016 00000 n An official website of the United States government. The challenges of LC-MS/MS analysis of opiates and opioids in urine. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Your family or caregivers should also watch for sudden changes in your behavior. [131] The metabolites of clonazepam include 7-aminoclonazepam, 7-acetaminoclonazepam and 3-hydroxy clonazepam. The .gov means its official. Forensic Sci Int. benzodiazepine. The following urine samples were collected from each volunteer: one before CLO administration, and 6 h, and 1, 3, 5, 8, 10, 14, 21 and 28 days after. The stability of benzodiazepines in saliva. Such aberrant behavior should be considered in the context of the entire patient presentation with a provider using his or her clinical judgment to assess this possibility. Unauthorized use of these marks is strictly prohibited. [118][119] Clonazepam decreases release of acetylcholine in the feline brain[120] and decreases prolactin release in rats. Drug monitoring of benzodiazepines is often performed in toxicology and pain management settings. Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. Nihon Rinsho. We determined the optimal technical and clinical approach for the detection of CLON use using OF. [32] Rapid eye movement sleep behavior disorder responds well to low doses of clonazepam. published a procedure using LC/MS/MS for the detection of some benzodiazepines in urine, including 7-aminonitrazepam, 7-aminoclonazepam, 7-aminoflunitrazepam, alprazolam, alpha-hydroxyalprazolam, oxazepam, 3-OH-diazepam, and nordiazepam [4]. Analytical Methods Used for the Detection and Quantification of Benzodiazepines. [9], Tolerance to the anticonvulsant effects of clonazepam occurs in both animals and humans. Please note that chlordiazepoxide, when administered with clidinium (Librax), is not a controlled substance in many jurisdictions and may not show up on the PDMP in these states. These stability issues along with as-needed dosing and/or low doses may further increase the likelihood of unexpected negative results. You may have this test if it's possible you have taken an overdose of clonazepam. 2009;186:81-510. Simultaneous analysis of 14 benzodiazepines in oral fluid by solid-phase extraction and LC-MS-MS. Deposition of 7-aminoclonazepam and clonazepam in hair following a single dose of Klonopin. [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. [125], It is effective for 68 hours in children, and 612 in adults. Your doctor may occasionally change your dose. Clonazepam, when used late in pregnancy, may result in the development of a severe benzodiazepine withdrawal syndrome in the neonate. [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. Azole antifungals, such as ketoconazole, may inhibit the metabolism of clonazepam. WARNING This product is not for human or veterinary use. 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. Clonazepam is not approved to treat panic disorder in anyone younger than 18 years old. might be drooling, sleepiness, lack of muscle coordination, difficulty breathing, Possible adverse effects of use of benzodiazepines such as clonazepam during pregnancy include: miscarriage, malformation, intrauterine growth retardation, functional deficits, carcinogenesis, and mutagenesis. Please enable it to take advantage of the complete set of features! Alcohol alone was responsible for over twice as many ED visits as clonazepam in the same study. Caution is also required if clonazepam is used during breastfeeding. [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. 8600 Rockville Pike Prolonged accumulation of diazepam in obesity. Clipboard, Search History, and several other advanced features are temporarily unavailable. ", "[3H]Diazepam binding in mammalian central nervous system: a pharmacological characterization", "Micromolar-affinity benzodiazepine receptors regulate voltage-sensitive calcium channels in nerve terminal preparations", "Monograph - Clonazepam -- Pharmacokinetics", "Pharmacokinetics of antiepileptic drugs", "Improved micromethod for determination of underivatized clonazepam in serum by gas chromatography", "Drug Abuse Warning Network, 2006: National Estimates of Drug-Related Emergency Department Visits", Substance Abuse and Mental Health Services Administration, "Burundanga y Clonazepan. J Clin Pharmacol. 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. Commonly prescribed medications and potential false-positive urine drug screens. It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain. Do not take two doses at one time. This class of drug is also subject to misuse and is frequently included in urine drugs of abuse testing panels. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Prescription: Benzodiazepines are controlled substances, and legitimate prescriptions would show up on the prescription drug monitoring program (PDMP) in most cases. Opinion of Brazilian experts]", "Treatment of restless legs syndrome: an evidence-based review and implications for clinical practice", "Sleep and sex: what can go wrong? Stamford, CT: PharmaCom Group, Inc.; 2015:1-32.12. Because the exact drug ingested may not be distinguishable due to the overlapping metabolic pathways, positive results for Nordiazepam, Oxazepam, and/or Temazepam are reported by Aegis as Benzodiazepine Metabolites. Result LOINC Value. 2015 Aug;37(4):451-60. doi: 10.1097/FTD.0000000000000174. 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. 0000010374 00000 n In addition, it is frequently used to treat drug addicts and is itself a popular drug of abuse. Get medical help right away if you stop using clonazepam and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide. Negrusz A, Moore CM, Kern JL, Janicak PG, Strong MJ, Levy NA. [10] It possesses anxiolytic, anticonvulsant, sedative, hypnotic, and skeletal muscle relaxant properties. panic attacks, insomnia, and generalized anxiety. Keywords: Development of an LC-MS/MS method for the simultaneous determination of 25 benzodiazepines and zolpidem in oral fluid and its application to authentic samples from regular drug users. [10] Long-term use may result in tolerance, dependence, and withdrawal symptoms if stopped abruptly. [6][132] These metabolites are excreted by the kidney. A breakdown of the 1,358 total drug and metabolite confirmations demonstrated 128 different drugs, which consisted of 34 NPS, 16 TID, 70 prescription and OTC drugs, 3 DSS, and 5 P/A/I (Fig. 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). Alprazolam Detection Using an Electrochemical Nanobiosensor Based on AuNUs/Fe-Ni@rGO Nanocomposite. Urine samples with such a low creatinine level are less concentrated, and urine drug concentrations may fall below the reporting threshold in such samples. stinging sensation or pain. Available for Android and iOS devices. Fusaroli M, Pelletti G, Giunchi V, Pugliese C, Bartolucci M, Necibi EN, Raschi E, De Ponti F, Pelotti S, Poluzzi E. Drug Saf. Class/Isotype: IgG: Cross Reactivity: 7-aminoclonazepam, 7-aminoflunitrazepam, Delorazepam >10%; N-Desalkylflurazepam, Flunitrazepam >1%; Nitrazepam, Desmethyldiazepam, Diazepam : 1% Supplied In: . [135], In some countries, clonazepam is used by criminals to subdue their victims. Therefore many addiction clinics perform oral fluid (OF) testing, which unlike urine is not subject to adulteration, to monitor CLON compliance. Conclusions: 5-(2-Chlorophenyl)-7-nitro-1,3-dihydro-1,4-benzodiazepin-2-one, O=C1CN=C(c2ccccc2Cl)c2cc([N+](=O)[O-])ccc2N1, InChI=1S/C15H10ClN3O3/c16-12-4-2-1-3-10(12)15-11-7-9(19(21)22)5-6-13(11)18-14(20)8-17-15/h1-7H,8H2,(H,18,20), "Benzodiazepine Equivalency Table" based on, Rapid eye movement sleep behavior disorder, Long-term effects of benzodiazepines Neonatal effects, "Addiction: Part I. Benzodiazepines--side effects, abuse risk and alternatives", "Benzodiazepines in epilepsy: pharmacology and pharmacokinetics", "Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature", "Propofol treatment of refractory status epilepticus: a study of 31 episodes", "Clonazepam: medicine to control seizures or fits, muscle spasms and restless legs syndrome", "Clonazepam add-on therapy for drug-resistant epilepsy", "[Restless legs syndrome: diagnosis and treatment. World Psychiatry. 1. [10] Effects begin within one hour and last between six and twelve hours. These data illustrate the limitations of using a 200 ng/ mL cutoff to monitor clonazepam compliance and suggest that a cutoff of 40 ng/mL or less is needed to reliably monitor use of this drug. The criteria for non-medical use in this study were purposefully broad, and include, for example, drug abuse, accidental or intentional overdose, or adverse reactions resulting from legitimate use of the medication.[134]. Brand names: KlonoPIN, KlonoPIN Wafer An official website of the United States government. A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences", "FDA expands Boxed Warning to improve safe use of benzodiazepine drug", "Get Some Sleep: Beware the sleeping pill hangover", "Recent advances in drug therapy for epilepsy", "The effects of neuroleptics on the GABA-induced Cl- current in rat dorsal root ganglion neurons: differences between some neuroleptics", "Interictal acute psychoses in temporal lobe epilepsy during withdrawal of anticonvulsant therapy", "Clonazepam, Prescription Marketed Drugs", "Sleep and aging: 2. 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 . The range of clonazepam+7-aminoclonazepam concentrations in these five cases ranged from 0.26 to 0.54 mg/kg (median 0.29 mg/kg). Further information regarding specimen stability is available in the Aegis Clinical Reference Guide at https://www.aegislabs.com/resources/clinical-reference-guide/. and deuterated internal standard transition ions for -OH alprazolam, 7-aminoclonazepam, desalkylflurazepam, 2-OH ethyl flurazepam, lorazepam, -OH midazolam, nordiazepam, oxazepam, temazepam, and -OH triazolam. When it is important to detect the presence of any amount of a drug, one should choose an assay designed specifically to measure the drug in question, and not a screening test. Clonazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). It may also be used to treat The .gov means its official. Unauthorized use of these marks is strictly prohibited. It differs from other anticonvulsant drugs it was compared to in a study. 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. Negrusz A, Bowen AM, Moore CM, Dowd SM, Strong MJ, Janicak PG. Both clonazepam and 7-aminoclonazepam break down easily. Standard curves for CLO (500-4000 pg x mL(-1)) and 7-ACLO (50-2000 pg x mL(-1)) were prepared by spiking aliquots of negative urine. 2002 Oct;26(7):471-8. doi: 10.1093/jat/26.7.471. xb```b`` " ,@QU@CM^R2x_c The use of 7AC as an analyte for the detection of both CLON compliance and undisclosed use is also recommended. [97][99][100][101] In turn, Phenytoin may lower clonazepam plasma levels by increasing the speed of clonazepam clearance by approximately 50% and decreasing its half-life by 31%. Prolonged excretion of 7-aminoclonazepam in urine after repeated ingestion of clonazepam: a case report. Unable to load your collection due to an error, Unable to load your delegates due to an error. Read the medication guide or patient instructions provided with each medication. Extraction and analysis of clonazepam and 7-aminoclonazepam in whole blood using a dual internal standard methodology. [10] It is a tranquilizer of the benzodiazepine class. 2009;48(12):1787-9.16. 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. Disclaimer. When was the patients last dose? Am J Health-Syst Pharm. Some withdrawal symptoms may last up to 12 months or longer after stopping this medicine suddenly. Drugs of abuse in oral fluid collected by two different sample kitsstability testing and validation sing ultra performance tandem mass spectrometry. Long-acting benzodiazepines such as clonazepam are not generally recommended for the elderly due to the risk of drug accumulation. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide. These values do not apply to results that are converted to other units of measure. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. In addition, BZ are highly protein bound, reducing the free fraction of . As a result, drugs present at therapeutic concentrations may not always be detected. National Library of Medicine These Would you like email updates of new search results? Disclaimer. The site is secure. Clonazepam doses are based on weight in children. In these cases, the claimed sensitivity is inadequate to detect the presence of the drug in urine even after an overdose. [16][17], Clonazepam is prescribed for short term management of epilepsy, anxiety, and panic disorder with or without agoraphobia.[18][19][20]. Quantitation of clonazepam and its major metabolite 7-aminoclonazepam in hair. 2013 Feb 23;74:213-22. doi: 10.1016/j.jpba.2012.11.002. The concentrations were thus similar among the groups, although the median value was highest in the postmortem group. Anti-epileptic drugs, benzodiazepines such as clonazepam in particular, should be reduced in dose slowly and gradually when discontinuing the drug to mitigate withdrawal effects. [116] The anticonvulsant properties of benzodiazepines are due to the enhancement of synaptic GABA responses, and the inhibition of sustained, high-frequency repetitive firing. FOIA A review of medical records may be necessary to determine the medications given to the patient prior to or during a procedure. [30][31] Bruxism also responds to clonazepam in the short-term. Clonazepam was the second most frequently implicated benzodiazepine in ED visits. It may also be used to treat panic attacks, insomnia, and generalized anxiety. Application to forensic cases of drug facilitated crimes. Disclaimer. 2013:416:80-58. Six of the volunteers had urine concentrations of 7-ACLO that peaked at 1 day after administration. 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).