Question

O.R. is a 27 year old married woman who has just started the her local technical college. Soon after she started her A & P class, she began to experience insomnia, chiefly difficulty falling asleep. Also, she found herself constantly worrying about how she was doing in class, about her daughter who had just started 2nd grade, and about problems her husband was having on his job, and financial problems from going back to school. She started to have a couple d rinks before going to bed but found that she would wake up a few hours later and wasn't able to fall back asleep. One time she woke up at midnight, and when it was 3 a.m. and she still wasn't sleeping, she had a few glasses of wine, fell asleep, missed her morning lecture and was warned by her instructor that because she wasn't ill, if she missed one more lecture would flunk the course. She went to the clinic at the school and was started on diazepam (Valium) 2 mg. every 6 hours prn anxiety. Generally she only took the diazepam before going to bed. She started sleeping better but would wa ke up several hours later and not be able to fall back asleep. After returning to the clinic, the diazepam was stopped and she was started on clonazepam (Klonopin) 0.5 mg. TID. A week after starting the clonazepam, she was sleeping well and "I'm not driving my husband crazy anymore." 1. Does clonazepam have a higher efficacy than diazepam? 2. Is clonazepam more potent than diazepam? 3. Why was alcohol helping her sleep? 4. If O.R. beca me pregnant, could she continue to safely take the clonaze pam? 5. Would a fatal overdose be as likely to occur with either of these benzodiazepines compared to a barbiturate?

Answer 1

1. Both Clonazepam and Diazepam are benzodiazepines used also known as minor tranquilizers. There is no statistically significant difference in their efficacy.  

2. Clonazepam is in the class of highly potent benzodiazepines,(BZD). Clonazepam has high-potency than Diazepam and it is the second high potent drug in entire  BZD discovered. Clonazepam behaves both as a GABA-A receptor agonist in a highly-potent, long-acting manner and also as a serotonin agonist. Clonazepam has anticonvulsant and anxiolytic effects. Diazepam is a long-acting, medium-potency BZD that is used as an anticonvulsant and for anxiolysis, sedation, and myorelaxation

3. Alcohol does allow healthy people to fall asleep quicker and sleep more deeply for a while, but it reduces rapid eye movement (REM) sleep. Research shows that alcohol consumed within an hour of bedtime will disrupt sleep in the second half of the sleep period, causing the person to sleep fitfully—awakening from dreams and not being able to get back to sleep easily. Thus, alcohol does not improve sleep quality this seem's to be Ms. OR's problem.

4. Clonazepam and other benzodiazepines(BZD) have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Clonazepam is best avoided in the first trimester and probably throughout pregnancy.