Background Since 2010, the French Drug Agency (ANSM) has strengthened prescription and delivery conditions for clonazepam. This drug, indicated as an anticonvulsant, exposes patient to a risk of abuse, dependency and misuse according to the summary of product characteristics (SmPC). Prescriptions are limited to neurologists and paediatricians, for up to 12 weeks.
Purpose Our objective was to verify that clonazepam use was in line with ANSM recommendations in our hospital.
Material and methods Clonazepam computerised prescriptions for patients hospitalised between January 2015 and May 2016 were retrospectively gathered from the prescription software, Actipidos. Analysis of electronic medical records from Mediweb allowed us to obtain information on dosage and indication.
Results 263 collected prescriptions concerned 200 patients during 248 hospital stays. Hospital wards with the most prescriptions were internal medicine (15%), pneumology (12%) and oncology (11%). Clonazepam oral solution was prescribed more often (67%) than the injectable solution (18%) or tablet (15%). Daily dose average was 1.5 mg (dosage unknown in 50% of cases). Prescriptions were related to treatment continuation (51%) or initiation (19%) while no information was found in 30% of cases. Among all initiations, 56% were performed by the internal medicine and oncology department and 57% were indicated for epilepsy. After hospitalisation, treatment was continued (50%), stopped (10%) or on track (1%) while no information was found in 39% of cases. The main indications were neuropathic pain (33%), convulsive status (16%), epilepsy and pain for cancer (9%), sleep disorders (4%) and restless legs syndrome (3%).
Conclusion These results indicate that clonazepam use is not always in line with ANSM recommendations, which has also been observed in other studies.1–2 Indeed, clonazepam indication was respected in 16% of cases. Moreover, we cannot be certain that treatments were stopped under the 12 week limit as clonazepam was often prescribed in a renewal context and maintained after patient discharge in half of the cases. Despite an information campaign relayed by our hospital drug committee, a reminder about recommendations and therapeutic alternative seems to be necessary for prescribing physicians. Pharmacists may play an educative role in setting up effective, corrective and maybe coercive action.
References and/or acknowledgements
Elias C, et al. Pharmacien Hospitalier et Clinicien 2014;49:314–15.
Kempfer J. SWAPS2007;47:2–4.
References and/or acknowledgementsNo conflict of interest