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The eMC  

Last Updated 22 Oct 2013

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Rivotril 2mg tablets

Rivotril (Riv-oh-tril) is a medicine which is used in all forms of epilepsy and treatment of status epilepticus. Rivotril contains clonazepam. It is supplied by Roche Products Limited.

The information in this Medicine Guide for Rivotril varies according to the condition being treated and the particular preparation used.

There are 2 preparations of Rivotril available. If Rivotril 2mg tablets is not the preparation you are looking for, please select from the drop down list below.

Select your preparation (type) of Rivotril

Rivotril 2mg tablets

Information specific to Rivotril 2mg tablets when used in all forms of epilepsy

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Your medicine

Rivotril is used to treat epilepsy. People with epilepsy are prone to having periods of uncontrolled electrical activity in the brain. These periods of uncontrolled electrical activity may lead to seizures. Rivotril helps to control electrical activity in the brain. This reduces the chances of having seizures.

Rivotril can also be given by injection to help stop a seizure which has already started.

Rivotril can cause tolerance, dependence and even withdrawal symptoms in some people and you must never stop taking it suddenly. If you need to stop taking Rivotril then it must be stopped gradually.

Other information about Rivotril:

  • your doctor may start you on a low dose of this medicine and then increase the dose depending on how you respond to treatment

Do not share your medicine with other people. It may not be suitable for them and may harm them.

The pharmacy label on your medicine tells you how much medicine you should take. It also tells you how often you should take your medicine. This is the dose that you and your prescriber have agreed you should take. You should not change the dose of your medicine unless you are told to do so by your prescriber.

If you feel that the medicine is making you unwell or you do not think it is working, then talk to your prescriber.

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When to take your medicine

Some medicines work best if they are taken at a specific time of day. Getting the most from your medicine can also be affected by what you eat, when you eat and the times at which you take other medicines. Make sure you follow any specific instructions given to you by your prescriber or that are in the Patient Information Leaflet that comes with this medicine.

In the case of Rivotril:

  • if you only take Rivotril once a day you should take it in the evening
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How to take your medicine

Some medicines have specific instructions about how to take them. This is because they work better when taken correctly. These instructions can include getting the right dose and special instructions for preparing the medicine.

In the case of Rivotril:

  • you can break this medicine into halves or quarters. There are breaklines to help you break the medicine into pieces. Swallow the tablet or the pieces with a glass of water

If you are having problems taking this form of Rivotril, you should talk to your prescriber or pharmacist. They may be able to give you advice on other ways to take your medicine or other preparations that are easier for you to take.

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Taking too much of your medicine

Taking extra doses of some medicines can be harmful. In some cases even one extra dose can cause you problems. If you take extra doses of your medicine, you must get medical advice immediately. You may need a test to assess the effect of taking extra doses. This is because the effects of taking too much medicine are very complex so it is very important that you seek medical advice.

Contact your prescriber, pharmacist, specialist clinic or call 111 for advice.

Make sure you take all of your medicine containers with you if you are advised to go to hospital.

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Stopping your medicine

If you are not having any problems taking this medicine then do not stop taking it, even if you feel better, unless advised to do so by your prescriber. If, however, you find that this medicine is causing you problems then you should talk to your prescriber about your concerns.

If your medical team decides that it is best that you do not take this medicine any more, they may advise that you do not stop Rivotril abruptly. This is because, in some instances, stopping Rivotril abruptly can cause withdrawal symptoms or cause your original condition to return. In these instances, reducing the dose of Rivotril gradually over time may reduce the chances of having these problems.

If you are in any doubt, contact your prescriber, pharmacist, specialist clinic or call 111.

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Looking after your medicine

The instructions on how you should keep your medicine are on the pharmacy label. You should keep your medicine in the original container. This will help to keep your medicine in the best condition and also allow you to check the instructions. Do not take the medicine if the packaging appears to have been tampered with or if the medicine shows any signs of damage. Make sure that the medicine is out of the sight and reach of children.

In the case of Rivotril:

  • store the medicine in the original container and in outer carton to protect it from light

You must not take the medicine after the expiry date shown on the packaging. If you have any unused medicine, return it to your pharmacist who will dispose of it safely.

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Whether this medicine is suitable for you

Rivotril is not suitable for everyone and some people should never use it. Other people should only use it with special care. It is important that the person prescribing this medicine knows your full medical history.

Your prescriber may only prescribe this medicine with special care or may not prescribe it at all if you:

Over time it is possible that Rivotril can become unsuitable for some people, or they may become unsuitable for it. If at any time it appears that Rivotril has become unsuitable, it is important that the prescriber is contacted immediately.

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Side-effects

A medicine is only made available to the public if the clinical trials have shown that the benefits of taking the medicine outweigh the risks.

Once a medicine has been licensed, information on the medicine's effects, both intended and unintended, is continuously recorded and updated.

Some side-effects may be serious while others may only be a mild inconvenience.

Everyone's reaction to a medicine is different. It is difficult to predict which side-effects you will have from taking a particular medicine, or whether you will have any side-effects at all. The important thing is to tell your prescriber or pharmacist if you are having problems with your medicine.

Isolated reports:

The frequency of these side-effects is unknown:

  • a feeling of lack of interest or lack of energy
  • abnormal eye movement
  • abnormal laboratory test results
  • allergic reactions
  • anaphylactic reactions
  • angioedema
  • blood problems
  • cardiac arrest
  • concentration problems
  • confusion
  • convulsions - these may occur in people with porphyria
  • decreased libido
  • erectile dysfunction
  • falls or fractures you may have more falls or fractures if you are elderly after taking Rivotril.
  • feeling dizzy
  • feeling restless
  • feelings of disorientation
  • gastrointestinal problems
  • hair loss
  • headaches
  • heart problems
  • increased salivation or increased bronchial secretions may occur in small children or infants
  • itching
  • memory problems - these may occur with behavioural changes
  • muscle tone decreased
  • muscle weakness
  • nausea
  • paradoxical reactions - you or your carer must seek medical advice if you have feelings of irritability, anxiety, nervousness, excitability, agitation, aggressiveness or hostility or if you have vivid dreams, nightmares, sleeping problems or new types of seizures
  • physical and psychic dependence
  • porphyria or porphyria-like reaction
  • psychosis or psychotic-like behaviour
  • side effects that may occur if Rivotril is taken at a high dose or for long period of time. These may include speech problems, gait disorder, coordination problems or eye or eyesight problems such as double vision or abnormal eye movements
  • skin colour changes
  • skin rash or rashes
  • sleepiness
  • slowed action or reaction time
  • tiredness
  • uncovering symptoms of depression or suicidal tendencies - seek medical advice if you get thoughts of committing suicide or attempt suicide
  • urinary incontinence
  • urticaria
  • withdrawal symptoms can occur when this medicine is stopped. These include tremors, sweating, agitation, sleeping problems, anxiety, headaches, muscle pain, tension, restlessness, confusion, irritability or seizures. If withdrawal is severe the following may occur: derealisation, depersonalisation, hallucinations, numbness and tingling of the extremities or hypersensitivity to light, noise and physical contact
  • worsening of seizure frequency - this may happen in people with certain types of seizures who have taken Rivotril for a long time

If you feel unwell or if you have concerns about a side-effect, you will need to seek advice. If you feel very ill, get medical help straight away. Contact your prescriber, pharmacist, nurse or call 111.

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Taking other medicines

If you are taking more than one medicine they may interact with each other. At times your prescriber may decide to use medicines that interact, in other cases this may not be appropriate.

The decision to use medicines that interact depends on your specific circumstances. Your prescriber may decide to use medicines that interact, if it is believed that the benefits of taking the medicines together outweigh the risks. In such cases, it may be necessary to alter your dose or monitor you more closely.

Tell your prescriber the names of all the medicines that you are taking so that they can consider all possible interactions. This includes all the medicines which have been prescribed by your GP, hospital doctor, dentist, nurse, health visitor, midwife or pharmacist. You must also tell your prescriber about medicines which you have bought over the counter without prescriptions.

The following medicines may interact with Rivotril:

The following types of medicine may interact with Rivotril:

If you are taking Rivotril and one of the above medicines or types of medicines, make sure your prescriber knows about it.

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Complementary preparations and vitamins

Medicines can interact with complementary preparations and vitamins. In general, there is not much information available about interactions between medicines and complementary preparations or vitamins.

If you are planning to take or are already taking any complementary preparations and vitamins you should ask your prescriber whether there are any known interactions with Rivotril.

Your prescriber can advise whether it is appropriate for you to take combinations that are known to interact. They can also discuss with you the possible effect that the complementary preparations and vitamins may have on your condition.

If you experience any unusual effects while taking this medicine in combination with complementary preparations and vitamins, you should tell your prescriber.

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Driving and operating machinery

When taking any medicine you should be aware that it might interfere with your ability to drive or operate machinery safely.

In the case of Rivotril:

  • this medicine could affect your ability to drive or operate machinery

You should seek advice from your prescriber as to whether you may drive while taking this medicine.

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Diet

Medicines can interact with certain foods. In some cases, this may be harmful and your prescriber may advise you to avoid certain foods.

In the case of Rivotril:

  • there are no specific foods that you must exclude from your diet when taking Rivotril
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Alcohol

Alcohol can interact with certain medicines.

In the case of Rivotril:

You must not drink any alcohol if you are taking this medicine.

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Family planning and pregnancy

Most medicines, in some way, can affect the development of a baby in the womb. The effect on the baby differs between medicines and also depends on the stage of pregnancy that you have reached when you take the medicine.

In the case of Rivotril:

  • if you take this medicine during your pregnancy, your baby may have some problems after birth. Also, if you repeatedly take this medicine during the late stages of pregnancy, your baby may come to be physically dependent on Rivotril. This may lead to your baby having withdrawal symptoms from Rivotril after birth
  • you should only take this medicine during pregnancy if your doctor thinks that you need it

You should discuss your personal circumstances with your doctor if you are pregnant or want to become pregnant. This is so that together you can make a decision about what treatment you may need during your pregnancy.

You should discuss whether there are any other medicines which you could take during pregnancy which would treat your condition.

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Breast-feeding

Certain medicines can pass into breast milk and may reach your baby through breast-feeding.

In the case of Rivotril:

  • women who are taking Rivotril should not breast-feed

Before you have your baby you should discuss breast-feeding with your doctor or midwife. They will help you decide what is best for you and your baby based on the benefits and risks associated with this medicine. If you wish to breast-feed you should discuss with your prescriber whether there are any other medicines you could take which would also allow you to breast-feed. You should not stop this medicine without taking advice from your doctor.

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Ingredients of your medicine

Medicines contain active ingredients. They may also contain other, additional ingredients that help ensure the stability, safety and effectiveness of the medicine. They are also added to improve the medicine's taste and appearance and to make it easier to take. Some may be used to prolong the life of the medicine.

You should check that you are able to take the ingredients in your medicine, especially if you have any allergies.

Rivotril contains:

  • lactose anhydrous
  • magnesium stearate
  • microcrystalline cellulose
  • pregelatinised maize starch

If you are not able to take any of the ingredients in your medicine, talk to your prescriber or pharmacist to see if they can suggest an alternative medicine. If you have reacted badly to Rivotril before, do not take Rivotril. Talk to your prescriber, pharmacist or nurse as soon as possible.

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Rivotril, Version 11, last updated 22 Oct 2013