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clonazePAM

clonazePAM

Brand names: KlonoPIN

Form	Strength
TABLET, ORAL	0.5 mg; 1 mg

Display Benzodiazepines Class: 281208

Medication comments:

USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances. The following outlines must be followed.
generic (Brand) Route [Packaging: Manufacturer ⇒ Dispense]	Activities
clonazePAM (KlonoPIN) PO [Bulk ⇒ Packager]	0.5 mg tablet 1 mg tablet	Stock @ IDBH? Y NIOSH Table 2^B↑
Pharmacy: Receiving / Storage / Preparation Exposure Risk: minimal	• Handling/preparation PPE Requirements: Single CX glove Wash hands after handling
	• Receiving from Distributor: Standard
	• Pharmacy Storage Area: CSM
	• Packaging/Reconstitution Location: Repackaging area
	• Compounding (Non-Sterile/Sterile) Location: n/a
	• Omnicell Load: Yes
Transport	• Transport (dose is placed inside a plastic sealable bag): Standard
Nursing: Storage / Administration Exposure Risk: minimal	• Handling/administration PPE Requirements: Single pair of CX approved gloves. Wash hands after handling
	• Storage of Finished dose in Nursing Area/Procedural Area: Omnicell
	• Signage on Patient Door Required: No
	• Manipulation of Dosage Form: Standard
	• Special Manipulation for Administration: n/a
Disposal / Spills	• Disposal of Drug Waste: Full- Rx Destroyer Packaging- trash
	• Disposol of Used PPE: trash bin (inside plastic bag)
	• Spill management: n/a
NIOSH Supplemental Information: Increased risk of congenital abnormalities when taken in first trimester
Reason for exemption of USP<800> Containment Requirements: Minimal manipulation for dispensing. Does not require additional manipulation for administering.

2023 American Geriatrics Society Beers Criteria^® for potentially inappropriate medication use in older adults.
Medication:	clonazePAM (KlonoPIN)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s)	benzodiazepines
Rationale	The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction. Concomitant use of opioids may result in profound sedation, respiratory depression, coma, and death. Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents; the continued use of benzodiazepines may lead to clinically significant physical dependence. In general, all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults. May be appropriate for seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, severe generalized anxiety disorder, and periprocedural anesthesia.
Recommendation	Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong

Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome	benzodiazepines ⇄ Delirium
Rationale	Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium.
Recommendation	Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong

Drug(s) ⇆ disease or syndrome	benzodiazepines ⇄ Dementia or cognitive impairment
Rationale	Avoid because of adverse CNS effects.
Recommendation	Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong

Drug(s) ⇆ disease or syndrome	antiepileptics ⇄ History of falls or fractures
Rationale	May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation	Avoid except for seizures and mood disorders.
Quality of evidence: High, Strength of Recommendation: Strong

Drug(s) ⇆ disease or syndrome	benzodiazepines ⇄ History of falls or fractures
Rationale	May cause ataxia, impaired psychomotor function, syncope, or additional falls. Benzodiazepines: shorter-acting ones are not safer than long-acting ones. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation	Avoid unless safer alternatives are not available.
Quality of evidence: High, Strength of Recommendation: Strong

Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es)	benzodiazepines ⇄ CNS-active agents
Risk Rationale	Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation	Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
Quality of evidence: High, Strength of Recommendation: Strong

Interacting drug(s) or class(es)	antiepileptics (including gabapentinoids) ⇄ CNS-active agents
Risk Rationale	Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation	Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
Quality of evidence: High, Strength of Recommendation: Strong

Last updated: Sep. 18, 2025

Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug / Assessment of Risk
Black Box Warnings Risk From Concomitant Use With Opioids
Look-Alike/Sound-Alike clonazePAM confused with ALPRAZolam, cloBAZam, cloNIDine, cloZAPine, LORazepam

UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

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