<p><strong>Pediatric Use</strong>: In infants and small children Rivotril may cause increased production of saliva and bronchial secretion. Therefore special attention must be paid to maintaining patency of the airways.&nbsp;<br />
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<strong>Geriatric Use</strong>: Benzodiazepine pharmacologic effects appear to be greater in elderly patients than in younger patients even at similar plasma benzodiazepine concentrations, possibly because of age-related changes in drug&ndash;receptor interactions, post-receptor mechanisms and organ function.<br />
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<strong>Renal Impairment</strong>: Renal impairment does not affect the pharmacokinetics of clonazepam. Based on pharmacokinetic criteria, no dose adjustment is required in patients with renal impairment.<br />
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<strong>Hepatic Impairmen</strong>t: Plasma protein binding of clonazepam in cirrhotic patients is significantly different from that in healthy subjects (free fraction 17.1&plusmn;1.0% vs 13.9&plusmn;0.2%). Although the influence of hepatic impairment on clonazepam pharmacokinetics has not been further investigated, experience with another closely related nitrobenzodiazepine (nitrazepam) indicates that clearance of unbound clonazepam might be reduced in liver cirrhosis.</p>