{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T16:50:19Z","timestamp":1759942219474,"version":"3.37.3"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pharmacol Toxicol"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The adverse drug reactions (ADRs) related to clonazepam are mild, and only two cases of myotoxicity induced by clonazepam have been reported, with both patients recovering well. We present a unique case of a serious ADR outcome after taking clonazepam.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 24-year-old woman with a long-standing history of polio and a 2-year history of epilepsy developed a serious ADR after repeated exposure to oral clonazepam combined with sodium valproate that manifested as myotoxicity and elevated levels of creatine phosphokinase. The patient is currently bedridden and unable to take care of herself.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Clinicians should be vigilant of the possibility of myotoxicity induced by clonazepam, especially in specific populations such as polio patients or when clonazepam is used in combination therapies.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40360-019-0366-y","type":"journal-article","created":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T17:03:46Z","timestamp":1572973426000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A serious adverse drug reaction probably induced by clonazepam: a case report of myotoxicity"],"prefix":"10.1186","volume":"20","author":[{"given":"Xiaonian","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4325-9939","authenticated-orcid":false,"given":"Jinping","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,11,5]]},"reference":[{"key":"366_CR1","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1056\/NEJMra1004418","volume":"365","author":"P Kwan","year":"2011","unstructured":"Kwan P, Schachter SC, Brodie MJ. Drug-resistant epilepsy. N Engl J Med. 2011;365:919\u201326.","journal-title":"N Engl J Med"},{"key":"366_CR2","first-page":"NBK247130","volume-title":"The epilepsies: the diagnosis and management ofthe epilepsies in adults and children in primary and secondary care. Pharmacological update of clinical guideline","author":"National Institute for Health and Clinical Excellence","year":"2012","unstructured":"National Institute for Health and Clinical Excellence. The epilepsies: the diagnosis and management ofthe epilepsies in adults and children in primary and secondary care. Pharmacological update of clinical guideline. London: Royal College of Physicians (UK); 2012. p. NBK247130."},{"key":"366_CR3","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1111\/j.1600-0404.2008.01004.x","volume":"118","author":"J Riss","year":"2008","unstructured":"Riss J, Cloyd J, Gates J, Collins S. Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Acta Neurol Scand. 2008;118:69\u201386.","journal-title":"Acta Neurol Scand"},{"key":"366_CR4","unstructured":"US Food, Drug Administration. Klonopin tablets (clonazepam) Klonopin wafers (clonazepam orally disintegrating tablets). FDA. 2010. \n                    www.accessdata.fda.gov\/drugsatfda_docs\/label\/2010\/017533s046s048,020813s006s007lbl.pdf\n                    \n                  . Accessed 14 July 2015."},{"issue":"4","key":"366_CR5","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1185\/146300903774115838","volume":"5","author":"R Gupta","year":"2003","unstructured":"Gupta R. Myotoxicity induced by clonazepam_ a case report.pdf. Paediatr Perinat Drug Ther. 2003;5(4):214\u20136.","journal-title":"Paediatr Perinat Drug Ther"},{"issue":"1","key":"366_CR6","first-page":"98","volume":"22","author":"C Yang","year":"2014","unstructured":"Yang C, Luo S, Qiao K, Wang Y, Jiahong LU. Myotoxicity induced by clonazepam: a case report and literature review. Chin J Clin Neurosci. 2014;22(1):98\u2013102.","journal-title":"Chin J Clin Neurosci"},{"issue":"3","key":"366_CR7","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/BF02859266","volume":"72","author":"L Kasturi","year":"2005","unstructured":"Kasturi L, Sawant SP. Sodium valproate \u2014 induced skeletal myopathy. Indian J Pediatr. 2005;72(3):243\u20134.","journal-title":"Indian J Pediatr"},{"issue":"4","key":"366_CR8","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/0960-8966(91)90097-C","volume":"1","author":"A Papadimitriou","year":"1991","unstructured":"Papadimitriou A, Servidei S. Late onset lipid storage myopathy due to multiple acyl CoA dehydrogenase deficiency triggered by valproate. Neuromuscul Disord. 1991;1(4):247\u201352.","journal-title":"Neuromuscul Disord"},{"issue":"4","key":"366_CR9","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1097\/JCP.0b013e3181ad2256","volume":"29","author":"I Reiche","year":"2009","unstructured":"Reiche I, Tr\u00f6ger U, Postel SC, et al. Valproic acid-induced myopathy in a patient with schizoaffective disorder. J Clin Psychopharmacol. 2009;29(4):402\u20133.","journal-title":"J Clin Psychopharmacol"},{"key":"366_CR10","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1038\/clpt.1981.154","volume":"30","author":"CA Naranjo","year":"1981","unstructured":"Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239\u201345.","journal-title":"Clin Pharmacol Ther"},{"key":"366_CR11","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1136\/jnnp.2008.168294","volume":"80","author":"MC Dalakas","year":"2009","unstructured":"Dalakas MC. Toxic and drug-induced myopathies. J Neurol Neurosurg Psychiatry. 2009;80:832\u20138.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"366_CR12","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.jbspin.2004.04.010","volume":"72","author":"S Guis","year":"2005","unstructured":"Guis S, Mattei JP, Cozzone PJ, Bendahan D. Pathophysiology and clinical presentations of rhabdomyolysis. Joint Bone Spine. 2005;72:382\u201391.","journal-title":"Joint Bone Spine"},{"key":"366_CR13","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/j.1469-8749.1977.tb08015.x","volume":"19","author":"PM Jeavons","year":"1977","unstructured":"Jeavons PM, Clark JE, Maheshwari MC. Treatment of generalized epilepsies of childhood and adolescence with sodium valproate (\u2018Epilim\u2019). Dev Med Child Neurol. 1977;19:9\u201325.","journal-title":"Dev Med Child Neurol"},{"issue":"2","key":"366_CR14","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1111\/j.1472-8206.1993.tb00219.x","volume":"7","author":"EJ Seree","year":"1993","unstructured":"Seree EJ, Pisano PJ, Placidi M, Rahmani R, Barra YA. Identification of the human and animal hepatic cytochromes P450 involved in clonazepam metabolism. Fundam Clin Pharmacol. l993;7:69\u201375.","journal-title":"Fundamental & Clinical Pharmacology"},{"issue":"6","key":"366_CR15","first-page":"750","volume":"25","author":"WN Raymond","year":"1997","unstructured":"Raymond WN, Russell AP, Collins RJ, Diana LS, Konstantin HD, et al. In vivo induction and in vitro inhibition of hepatic cytochrome P450 activity by the benzodiazepine anticonvulsants clonazepam and diazepam. Drug Metab Dispos. 1997;25(6):750\u20136.","journal-title":"Drug Metab Dispos"},{"key":"366_CR16","first-page":"403","volume":"15","author":"A Baruzzi","year":"1977","unstructured":"Baruzzi A, Bordo B, Bossi L, et al. Plasma levels of di-N-propylacetate and clonazepam in epileptic patients. Int J Clin Pharmacol Biopharm. 1977;15:403\u20138.","journal-title":"Int J Clin Pharmacol Biopharm"},{"key":"366_CR17","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1212\/WNL.25.3.255","volume":"25","author":"FE Dreifuss","year":"1975","unstructured":"Dreifuss FE, Penny JK, Rose SW, et al. Serum clonazepam concentrations in children with absence seizures. Neurology. 1975;25:255\u20138.","journal-title":"Neurology"},{"key":"366_CR18","first-page":"103","volume":"53","author":"J Naestoft","year":"1973","unstructured":"Naestoft J, Lund M, Larsen N-E, et al. Assay and pharmacokinetics of clonazepam in humans. Acta Neruol Scand Suppl. 1973;53:103\u20138.","journal-title":"Acta Neruol Scand Suppl"}],"container-title":["BMC Pharmacology and Toxicology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40360-019-0366-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s40360-019-0366-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40360-019-0366-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:14:54Z","timestamp":1604448894000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpharmacoltoxicol.biomedcentral.com\/articles\/10.1186\/s40360-019-0366-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,5]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["366"],"URL":"https:\/\/doi.org\/10.1186\/s40360-019-0366-y","relation":{},"ISSN":["2050-6511"],"issn-type":[{"type":"electronic","value":"2050-6511"}],"subject":[],"published":{"date-parts":[[2019,11,5]]},"assertion":[{"value":"18 July 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Before writing the report, we obtained the consent of the Medical Ethics Committee approval of Xi\u2019an Central Hospital.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The patient gave her informed consent for a case report publication. A copy of the written consent is available in annex.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"64"}}