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Klonopin (clonazepam)

Brand/Generic Names

• Brand Name: Klonopin®

Tablets: 0.5mg, 1mg, 2mg

Wafers (orally disintegrating tablets): 0.125mg, 0.25mg, 0.5mg, 1mg, 2mg

• Generic Name: clonazepam

What is Klonopin® and what does it treat?

Clonazepam belongs to a class of medications called benzodiazepines.  Similar medications include diazepam (Valium®) and alprazolam (Xanax®).  This medication is FDA approved to treat certain types of seizure disorders (such as Lennox-Gastaut syndrome, akinetic myoclonic, and absence [also known as petit mal] seizures), and panic disorder, with or without agoraphobia.  

Panic disorder is associated with recurrent, unexpected panic attacks, that often involve a short period of intense fear or discomfort, along with other physical symptoms such as palpitations, sweating, shaking, shortness of breath, chest pain, nausea, dizziness, and fear of dying. The benefits of taking clonazepam for longer than 9 weeks have not been fully evaluated and dosage adjustments may be required when taking clonazepam for long periods of time (longer than 2-3 months).

What is the most important information I should know about Klonopin®?

• Take your medication exactly as prescribed by your healthcare provider to avoid relapse of the symptoms for which you are taking clonazepam.
• Seizure disorders, panic disorder, and other anxiety disorders usually require long-term treatment. Only your healthcare provider can determine the length of clonazepam treatment that is right for you.
• Do not stop taking clonazepam or change your dose without talking to your healthcare provider first.
• Stopping clonazepam abruptly can result in one or more of the following withdrawal effects:  insomnia, irritability, vomiting, sweating, restlessness, abdominal and muscle cramps, tremors, behavioral disturbances, and seizures. If you are taking clonazepam for a seizure disorder, stopping clonazepam suddenly can result in a condition called status epilepticus, or prolonged, treatment resistant seizures. This is why it is important to gradually decrease the dose of clonazepam, rather than abruptly stop.
• Clonazepam treatment must be monitored by a healthcare provider. Be sure to keep all of your scheduled appointments while on clonazepam.
• You should not take illegal drugs or drink alcohol while taking clonazepam.

Are there specific concerns about Klonopin® and pregnancy?

If you are taking clonzepam and would like to become pregnant, discuss your plans with your healthcare provider to weigh the risk versus benefits of the decision. The risks and benefits of the illness, medications, and the risks to the fetus may interact. This is a complex decision as untreated seizure disorders, panic disorder, or other psychiatric or medical disorders may also have risk to the mother and fetus.

Several studies have indicated there is an increased risk of congenital malformations when clonazepam is taken during pregnancy. If clonazepam is used during pregnancy, or if you become pregnant while taking clonazepam, you should ask your healthcare provider about the potential hazards to the fetus.

Children that are born to mothers taking clonazepam may experience withdrawal symptoms shortly after birth. These symptoms may include, decreased muscle tone, breathing and feeding difficulties, and decreased body temperature.

Clonazepam passes into breast milk during breast feeding, and it is not recommended for mothers taking clonazepam to breast feed their infants.

What should I discuss with my healthcare provider before taking Klonopin®?

• Symptoms that are most bothersome to you about your condition
• If you have thoughts of suicide
• The medications you have taken in the past for treatment of seizure disorders, panic disorder, or other conditions being treated with clonazepam
• Any medical problems you have
• All other medications you are currently taking and any medication allergies you have
• If you are pregnant, plan to become pregnant, or are breast-feeding
• Any medication side effects that you may have experienced in the past or are currently experiencing
• If you drink alcohol or use illegal drugs

How should I take Klonopin®?

• Clonazepam is usually taken once, twice, or three times daily, depending on why you are taking the medication. It may be taken with or without food. The wafers may be taken without water, as they dissolve quickly in the mouth. Your healthcare provider will determine the dose that is right for you based upon your response.
• Use a pillbox or calendar to help you remember to take your medication.

What happens if I miss a dose of Klonopin®?

If you miss a dose of clonazepam, take it as soon as you remember. but only if it is not too close to when your next dose is due. If it is close to your next dose, wait until then to take the medication and skip the missed dose. Do not double your next dose or take more than your prescribed dose. Discussing this scenario with your healthcare provider ahead of time is advised.

What should I avoid while taking Klonopin®?

• Use caution while driving.  In some patients, clonazepam may cause dizziness, drowsiness and slowed reaction time. Make sure you know how you react to this medication before you drive, operate machinery, or do other activities that may be dangerous if you are not alert.
• Avoid drinking alcohol or using illegal drugs.
• Avoid skipping or missing doses of this medication. Clonazepam is usually taken on a daily basis in order to best help with your symptoms.
• Federal law prohibits the transfer of Konopin® to a person other than the patient for whom it was prescribed.

What happens if I overdose with Klonopin®?

• If an overdose occurs, whether intentional or accidental, immediate medical attention is necessary. Call your doctor or emergency medical service (911).
• Symptoms that may occur in an overdose: drowsiness, confusion, decreased reflexes, muscle weakness, and dizziness and possibly falling. In severe cases, coma and death have occurred.

What are the possible side effects of Klonopin®?

Common side effects of clonazepam include drowsiness, dizziness, depression, fatigue, memory problems, nervousness, impaired coordination, and decreased ability to concentrate. These side effects will often decrease or go away after the first few weeks as your body adjusts to the medication.

Talk with your healthcare provider if you experience any side effects that are bothersome to you.

Are these any risks for taking Klonopin® for long periods of time?

Clonazepam is a Schedule IV controlled substance, similar to other benzodiazepine medications, such as Librium®, Ativan®, Valium®, and Xanax®. There is a risk of physical and psychological dependence when it is taken for long periods of time. Sudden discontinuation of clonazepam may result in withdrawal symptoms such as insomnia, irritability, vomiting, sweating, restlessness, abdominal and muscle cramps, tremors, behavioral disturbances, and seizures.

What other drugs may interact with Klonopin®?

Some medications, such as phenytoin, carbamazepine, and phenobarbital may decrease the blood levels of clonazepam.

Other medications or substances that may cause drowsiness may interact with clonazepam to cause excessive drowsiness, or dizziness. These could include: alcohol, antihistamines (such as diphenhydramine), narcotic pain medication (such as morphine, oxycodone, and hydrocodone), barbiturates (such as phenobarbital), sleeping medications (such as zolpidem), antianxiety medications, antipsychotic medications, certain anticonvulsant medications, and tricyclic antidepressant medications (such as amitriptyline).

How long does it take for Klonopin® to work?

The onset of action usually occurs within 20 to 60 minutes.  Although you may experience beneficial effects from clonazepam within a few days of starting to take the medication, it often takes several weeks to get the full effect of the medication. Your healthcare provider may also need to gradually adjust the dose over a period of several weeks to find the dose that works best for you.

Updated by Keith D. Anderson, Pharm.D., BCPP
May 2007

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