Clonazepam

💊 What is Clonazepam used for?

• •Seizure disorders, used alone or with other medicines. The label names Lennox-Gastaut syndrome (petit mal variant), akinetic seizures, and myoclonic seizures.
• •Absence seizures (petit mal) in patients who did not respond to succinimides. The label says clonazepam may be useful in these patients.
• •Panic disorder, with or without agoraphobia, in adults. Panic disorder involves unexpected panic attacks and ongoing worry about having more.

How it works

The label says clonazepam is a benzodiazepine that interacts with GABA-A sites in the central nervous system. It does not explain this further in the text provided.

How it is usually taken

• •Swallow the tablet whole with water.
• •The label says the dose is set for each person and may be changed over time. Follow the instructions from your prescriber or pharmacist.
• •The label says that for panic disorder, the dose is usually started low and adjusted over time, and that the long-term usefulness of the medicine should be reviewed periodically by the prescriber.

Comes as

• •0.5 mg orange, round, scored tablets
• •1 mg tablets marked C 1
• •2 mg tablets marked C 2
• •Inactive ingredients include lactose, magnesium stearate, microcrystalline cellulose, and corn starch. Colorants include FD&C Yellow No. 6 Lake (0.5 mg) and FD&C Blue No. 2 Lake (1 mg).

⚠️ Clonazepam side effects

🛑 Who should not take Clonazepam, and who should be careful

The label says not to take it if

• 🚨You have a history of sensitivity to benzodiazepines.
• 🚨You have clinical or lab evidence of significant liver disease.
• 🚨You have acute narrow angle glaucoma. The label says it may be used in people with open angle glaucoma who are receiving appropriate therapy.

Tell your doctor before taking it if

• •Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
• •Tell your provider about all medicines you take, including opioids, alcohol-containing products, and other drugs that cause sleepiness or dizziness.
• •The label says that the use of multiple anticonvulsants may increase CNS depressant side effects. This should be considered before adding clonazepam to an existing seizure medicine.
• •The label says elderly patients are generally started on low doses and watched closely.
• •The label says it is not known whether clonazepam is safe or effective for panic disorder in children younger than 18.
• •The label says clonazepam can cause drowsiness, dizziness, and problems with coordination. Do not drive or operate heavy machinery until you know how it affects you.

🔀 Clonazepam with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Opioids: the label says combining them can cause profound sedation, respiratory depression, coma, and death. Limit dose and duration, and watch closely for breathing problems and sleepiness.
• •Alcohol and other CNS depressants, including street drugs: may cause severe drowsiness and breathing problems.
• •Phenytoin: clonazepam may affect phenytoin levels, so monitoring of phenytoin concentration is recommended when they are given together.
• •Cytochrome P450 inducers such as phenytoin, carbamazepine, lamotrigine, and phenobarbital: the label says these can lower clonazepam levels by about 38%.
• •Oral antifungal agents such as fluconazole: the label says these should be used cautiously because they may raise clonazepam levels and effects.
• •Carbamazepine and phenobarbital: the label says clonazepam does not appear to change how these drugs work in the body.
• •Sertraline, fluoxetine, and felbamate: the label says these do not affect clonazepam levels.
• •Ranitidine: the label says it does not greatly alter clonazepam levels.
• •Flumazenil: the label says giving it can trigger acute withdrawal reactions, which can be life-threatening.

Alcohol and food

The label says not to drink alcohol while taking clonazepam until you have talked with your healthcare provider, because alcohol can make drowsiness and dizziness worse. The label text provided does not give food instructions beyond swallowing the tablet whole with water.

🤰 Clonazepam in pregnancy and breastfeeding

Pregnancy

The label says babies born to mothers who used benzodiazepines late in pregnancy may have sedation and neonatal withdrawal symptoms. Observational studies have not shown a clear link between benzodiazepines and major birth defects. Animal studies in pregnant rabbits showed developmental harm, including fetal malformations, at doses similar to or below therapeutic doses in patients. The label encourages healthcare providers to recommend that pregnant women taking clonazepam enroll in the NAAED Pregnancy Registry at 1-888-233-2334 or http://www.aedpregnancyregistry.org/.

Breastfeeding

The label says clonazepam passes into breast milk. Reports describe sedation, poor feeding, and poor weight gain in infants exposed through breast milk. The label says infants exposed this way should be monitored for these effects, and that the benefits of breastfeeding and the mother's need for the medicine should both be considered.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store at 25°C (77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep the tablets in a safe place away from children to prevent misuse and abuse. The label also advises proper disposal of unused medicine.

If a dose is missed

The label does not say.

If too much is taken

The label says a benzodiazepine overdose causes central nervous system depression, ranging from drowsiness to coma. Mild to moderate symptoms can include drowsiness, confusion, slurred speech, lethargy, diminished reflexes, poor coordination, and low muscle tone. Rarely, agitation, irritability, violent behavior, or excitement may occur. Severe overdoses may cause breathing problems and coma. Overdose combined with alcohol or opioids may be fatal. The label text provided does not describe treatment steps. If you think someone has taken too much, get emergency medical help right away.

🗒️ Questions to ask about Clonazepam

• How will you check whether clonazepam is controlling my seizures or panic symptoms?
• What signs of withdrawal should I watch for, and how will you plan a gradual reduction if I need to stop?
• Are any of my other medicines, including opioids or sleep aids, likely to add to the drowsiness or breathing risks?
• How should I handle drinking alcohol while I take this medicine?
• What should I do if I think I have missed a dose?
• Should I be watched for changes in mood, thoughts of suicide, or new behavior changes?
• What is the safest way to store and dispose of unused tablets at home?

❓ Clonazepam: frequently asked questions