Clonazepam (Klonopin)

Brand Names

Klonopin®

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

Generic name: clonazepam (kloe NA ze pam)

Medication class: benzodiazepine, anxiolytic (anti-anxiety)

All FDA black box warnings are at the end of this fact sheet.  Please review before taking this medication.

What Is Clonazepam And What Does It Treat?

Clonazepam is a benzodiazepine. It is approved for the treatment of panic disorder (with or without agoraphobia), as well as certain types of seizure disorders. However, benzodiazepines are also commonly used to treat difficulty sleeping and alcohol withdrawal.

Panic Disorder occurs when a person experiences unexpected and repeated episodes of intense fear. These episodes have physical symptoms including chest pain, shortness of breath, heart palpitations, sweating, dizziness, and nausea. Fear of future episodes is also part of panic disorder.

What Is The Most Important Information I Should Know About Clonazepam?

Do not drive a car or operate machinery until you know how this medication affects you because you may notice that you feel tired or dizzy.

Benzodiazepines, such as clonazepam, are often used for short periods of time only. They may produce emotional and/or physical dependence (addiction) even when used as recommended. Only your healthcare provider can determine the length of treatment that is right for you.

Do not stop taking clonazepam without talking to your healthcare provider first. Stopping clonazepam abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, tremor, dizziness, blood pressure changes, rapid heart rate, and seizures.

The use of clonazepam with drugs like opioid medications has led to serious side effects including slowed and difficulty breathing and death.  Opioid drugs are medications used to treat pain and include medications such as: codeine, oxycodone, morphine, and illegal drugs like heroin.  Some opioid medications are also in cough syrup. 

If you are taking clonazepam with an opioid medication, get medical assistance immediately if you feel dizziness or sleepiness, if you have slow or troubled breathing, or if you pass out.  Caregivers must get medical help right away if a patient does not respond and does not wake up. 

Avoid alcohol while taking this medication

Are There Specific Concerns About Clonazepam And Pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with anxiety disorders who wish to become pregnant face important decisions. It is important to discuss this with your doctor and caregivers.

Regarding breastfeeding, caution is advised since clonazepam does pass into breast milk.

What Should I Discuss With My Healthcare Provider Before Taking Clonazepam?

  • Symptoms of your condition that bother you the most
  • If you have thoughts of suicide or harming yourself
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
  • If you experience side effects from your medications, discuss them with your healthcare provider. Some side effects may pass with time, but others may require changes in the medication.
  • Any other psychiatric or medical problems you have including obstructive sleep apnea
  • All other medications you are currently taking (including over the counter products and herbal and nutritional supplements) and any medication allergies you have
  • Other non-medication treatment you are receiving such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breast-feeding
  • If you drink alcohol or use drugs

How Should I Take Clonazepam?

Clonazepam may be taken with or without food.  Take with food if you experience an upset stomach.  

Clonazepam may be taken everyday at regular times or on an as needed (“PRN”) basis.  Typically, your healthcare provider will limit the number of doses you should take in one day.

Your healthcare provider will determine the dose and method of taking the medication that is right for you based upon your response.

Clonazepam oral disintegrating tablets must remain in their original packaging.  Open the package with clean dry hands before each dose.  Do not try to put tablets in a pillbox if you take the orally disintegrating tablets.  Take the tablets right away, do not store for later use.

Clonazepam oral disintegrating tablets will dissolve in your mouth within seconds and can be swallowed with or without liquid.

If you take the medication everyday (instead of ‘as needed’), use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take it.  You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.

What Happens If I Miss A Dose Of Clonazepam?

If you miss a dose of clonazepam, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

What Should I Avoid While Taking Clonazepam?

Avoid drinking alcohol and using illegal drugs while you are taking clonazepam. They may decrease the benefits (e.g., worsen your condition) and increase the adverse effects (e.g., sedation) of the medication. Alcohol increases the risk of accidental overdose with medications like clonazepam.

What Happens If I Overdose With Clonazepam?

If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

Symptoms of overdose include confusion, impaired coordination, slow reflexes, coma, and death.

A specific treatment to reverse the effects of clonazepam does exist. This medicine, called flumazenil, can reverse the effects of clonazepam but must be given through an IV at a hospital. Only a doctor can decide if you need this medication.

What Are The Possible Side Effects Of Clonazepam?

Common Side Effects

  • Feeling dizzy, drowsy, fatigued, or lightheaded
  • Impaired coordination, decreased ability to concentrate

If you experience these side effects after starting clonazepam they will often improve over the first week or two as you continue to take the medication.

Rare/Serious Side Effects

Shortness of breath, trouble speaking, feeling very tired, dizziness, or passing out. Increased heart rate, headache, memory impairment, irritability, and restlessness may occur.

Some people taking benzodiazepines develop a severe allergic reaction and swelling of the face.  This can occur as early as with the first dose.

Some people taking benzodiazepines for sleep have experienced various behaviors while they were asleep/not fully awake, such as sleep driving, making phone calls, and preparing or eating food.  The individuals have no memory of the events when they awaken.

Signs of feeling depressed or low mood, thoughts of harming or killing yourself, or lack of interest in life.

Are There Any Risks For Taking Clonazepam For Long Periods Of Time?

Clonazepam is a safe and effective medication when used as directed. Benzodiazepines may produce emotional and/or physical dependence (addiction) even when used as recommended. Physical dependence may develop after 2 or more weeks of daily use.

What Other Medications Interact With Clonazepam?

The following medications may increase the levels and effects of clonazepam:

  • Ketoconazole (Nizoral®), itraconazole (SporanoxÒ), nefazodone (Serzone®), fluvoxamine (LuvoxÒ), and cimetidine (TagametÒ)

The following medications may decrease the levels and effects of clonazepam:

  • Carbamazepine (Tegretol®), phenytoin (Dilantin®), and phenobarbital (Luminal®)

Clonazepam should not be taken with other benzodiazepine medications.

Clonazepam may cause drowsiness, so caution should be used when combining it with other medications that cause drowsiness. These could include:

  • Antihistamines such as diphenhydramine (BenadrylÒ)
  • Narcotic pain medication such as morphine, oxycodone (OxyContinÒ), and hydrocodone (VicodinÒ and LortabÒ)
  • Opioid cough medications such as codeine cough syrup
  • Sleeping medications such as zolpidem (AmbienÒ)
  • Other anti-anxiety medications, antipsychotic medications, certain anticonvulsant medications, and tricyclic antidepressant medications (such as amitriptyline)

How Long Does It Take For Clonazepam To Work?

When starting clonazepam, anxiety or insomnia may improve rapidly or over a period of days or within hours of the first dose of medication.

Summary of Black Box Warning

The FDA has found that benzodiazepine drugs, such as clonazepam, when used in combination with opioid medications or other sedating medications can result in serious adverse reactions including slowed or difficult breathing and death.  Patients taking opioids with benzodiazepines, other sedating medications, or alcohol, and caregivers of these patients, should seek immediate medical attention if they start to experience unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficulty breathing, or unresponsiveness. 

 

Provided by the College of Psychiatric and Neurologic Pharmacists

(October 2016)