Clonazepam is an alternative to diazepam in stage of early status epilepticus, and there is little to choose between the two drugs. It has a similar onset of action, and a longer duration of action (half-life, 22-33 hours), and may have a lower incidence of late relapse. There is wide experience with the drug in adults and children, although not in neonates, and the drug has proven efficacy in tonic-clonic, partial, and absence status. Clonazepam accumulates on prolonged infusion, with the resulting risk of respiratory arrest, hypotension and sedation—a side-effect profile very similar to that of diazepam (see below). The drug has a negative inotropic action, and as with diazepam thrombophlebitis may occur. There is also a danger of sudden collapse if the recommended rate of injection is exceeded. A continuous infusion of clonazepam is not now recommended because of the dangers of accumulation, and respiratory and cardiovascular collapse.
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