Indications Pandura is indicated for the treatment of:

1. Panic Disorder: With or without agoraphobia, characterized by unexpected panic attacks and associated worry.
2. Seizure Disorders: Alone or as an adjunct for:
   • Lennox-Gastaut Syndrome (petit mal variant)
   • Akinetic and myoclonic seizures
   • Absence seizures (petit mal) that failed to respond to succinimides.

Pharmacology Clonazepam is a benzodiazepine that provides anticonvulsive, sedative, muscle relaxing, and anxiolytic effects. Its central actions are achieved by enhancing $GABAergic$ neurotransmission at inhibitory synapses, which increases the affinity of the GABA receptor for the neurotransmitter.

Dosage & Administration

• Seizures (Adults, Oral): Initial dose should not exceed 1.5 mg/day divided into three doses. Maximum recommended daily dose is 20 mg.
• Panic Disorder (Adults, Oral): Initial dose is 0.25 mg given in two divided doses, increasing after 3 days to a target of 1 mg/day.
• Pediatric Seizures (Oral): Initial dose is 0.01−0.03 mg/kg/day, not to exceed 0.05 mg/kg/day, in 2 or 3 divided doses.
• Injection (Adults, IV): 1 vial (1 mg) by slow IV injection (rate ≤0.25−0.5 mg/min).

Contraindications & Warnings

• Contraindicated in: Patients with hypersensitivity to benzodiazepines, significant liver disease, or acute narrow-angle glaucoma.
• CNS Depression: The most frequent side effects are CNS depression, including drowsiness (50% of seizure patients) and ataxia (30%). These may diminish over time.
• Seizure Risk: May increase the incidence of generalized tonic-clonic seizures in patients with coexisting seizure disorders.
• Elderly/Children: Effects are greater in elderly patients. In infants/small children, it may increase saliva and bronchial secretion, requiring attention to airway patency.
• Pregnancy/Lactation: Administer only if benefits outweigh risks. Mothers undergoing treatment should not breastfeed.

Overdose Overdose causes drowsiness, ataxia, and may lead to cardiorespiratory depression and coma. Treatment is supportive, and the antagonist flumazenil may be considered in severe cases under close monitoring.