Dosing & Uses
Dosage Forms & Strengths
tablet dispersible: Schedule IV
- 0.125mg
- 0.25mg
- 0.5mg
- 1mg
- 2mg
tablet: Schedule IV
- 0.5mg
- 1mg
- 2mg
Panic Disorder
0.25 mg PO q12hr initially; may increase to 1 mg/day after 3 days (up to 4 mg/day in some patients)
Seizure Disorders
1.5 mg/day PO divided q8hr; increase by 0.5-1 mg q3Days until desired effect achieved; not to exceed 20 mg/day
Maintenance: 2-8 mg PO; not to exceed 20 mg/day
Essential Tremor (Off-label)
0.5 mg PO at bedtime; increase dose by 0.5 mg q3-4days; not to exceed 6 mg/day
REM Sleep Behavior Disorder (Off-label)
0.25-2 mg PO 30 min prior to bedtime; not to exceed 4 mg
Burning Mouth Syndrome (Off-label)
0.25 mg PO at bedtime for 1 week; increase dose by up to 0.25 mg qweek; not to exceed 3 mg daily in 3 divided doses
Alternatively, 1 mg topirally three times daily after each meal; suck on the tablet, retain salive in mouth near pain sites without swallowing for 3 min, then expectorate saliva
Tardive Dyskinesia (Off-label)
The American Academy of Neurology guidelines includes use of clonazepam for short-term treatment (~3 mo) to decrease tardive dyskinesia symptoms
Initial: 1 mg/day PO; adjust dose based on response and tolerability by 1 mg/day increments q3-4 days; not to exceed 4.5 mg/day
Dosage Modifications
Renal impairment: Supplemental dose in hemodialysis not necessary
Dosing Considerations
Discontinuation of treatment: Withdraw treatment gradually; decrease the dose q3Days by 0.125 mg PO q12hr until completely withdrawn
Hyperekplexia (Orphan)
Orphan indication sponsor
- Hoffmann-La Roche, Inc; 340 Kingsland Street; Nutley, NJ 07110
Recurrent, Acute, Repetitive Seizures (Orphan)
Administration: Intranasal spray
Orphan indication sponsor
- Jazz Pharmaceuticals, Inc; 3180 Porter Drive; Palo Alto, CA 94304
Tardive Dyskinesia (Off-label)
The American Academy of Neurology guidelines includes use of clonazepam for short-term treatment (~3 mo) to decrease tardive dyskinesia symptoms
Initial: 1 mg/day PO; adjust dose based on response and tolerability by 1 mg/day increments q3-4 days; not to exceed 4.5 mg/day
Dosage Forms & Strengths
tablet: Schedule IV
- 0.125mg
- 0.25mg
- 0.5mg
- 1mg
- 2mg
Seizure Disorders
<6 years
<10 years or <30 kg
- 0.01-0.03 mg/kg/day PO divided q8hr; increase by 0.25-0.5 mg/day q3Days to maximum 0.1-0.2 mg/kg/day PO divided q8hr
- Maintenance dose: 0.1-0.2 mg/kg/day PO divided q8hr; not to exceed 0.2 mg/kg/day
≥10 years or ≥30 kg
- 1.5 mg/day PO divided q8hr; increase by 0.5-1 mg q3Days until desired effect achieved; not to exceed 20 mg/day
- Maintenance: 2-8 mg PO; not to exceed 20 mg/day
Dosing Considerations
Discontinuation of treatment
- <10 years: Treatment should be withdrawn gradually, as necessary
- ≥10 years: Withdraw treatment gradually; decrease the dose q3Days by 0.125 mg PO q12hr until completely withdrawn
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Adverse Effects
>10%
Somnolence (37%)
1-10%
Abnormal coordination (5-10%)
Ataxia (5-10%)
Depression (5-10%)
Dizziness (5-10%)
Fatigue (5-10%)
Memory impairment (5-10%)
Upper respiratory infection (5-10%)
Confusion (1-5%)
Dysarthria (1-5%)
Rhinitis (1-5%)
Coughing (1-5%)
Urinary frequency (1-5%)
Impotence (1-5%)
Decreased libido (1-5%)
Frequency Not Defined
Increased salivation
Worsening tonic-clonic seizures
Warnings
Black Box Warnings
Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation
Addiction, abuse, and misuse
- On September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death
- Physical dependence can occur when taken steadily for several days to weeks, even as prescribed
- Stopping abruptly or reducing dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening
- Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes; before prescribing and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction
- Assess each patient’s risk prior to prescribing and monitor regularly for the development of these conditions
- Risks of dependence and withdrawal increase with longer treatment duration and higher daily dose; although injection is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction may precipitate acute withdrawal reactions, including seizures, which can be life-threatening; use gradual taper when discontinuing therapy to reduce withdrawal reactions risk
Contraindications
Significant hepatic impairment
Documented hypersensitivity
Acute narrow angle glaucoma
Cautions
Withdraw gradually when used for panic disorder
Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicidal ideation
Not recommended in patients with depressed neuroses, psychotic reactions, severe respiratory depression, myasthenia gravis (allowable in limited circumstances), acute alcohol intoxication
Anterograde amnesia reported benzodiazepine use
May cause CNS depression and impairs ability to perform hazardous tasks
Hyperactive or aggressive behavior reported with benzodiazepines in pediatric/adolescent patients and in psychiatric patients
Increased risk of suicidal thoughts/behavior reported with antiepileptic agents; monitor patient for suicidal behavior and notify health-care provider immediately
Use with caution in patients with a history of drug abuse or acute alcoholism; drug dependency possible; prolonged use may result in psychological and physical dependence
Use with caution in patients with compromised respiratory function
May have porphyrogenic effect; use with caution in patients with porphyria
Not for concomitant administration with alcohol or other CNS-depressant drugs
When used in patients in whom several different types of seizure disorders coexist, clonazepam may increase incidence or precipitate onset of generalized tonic-clonic seizures (grand mal); may require addition of appropriate anticonvulsants or increase in dosages; concomitant use of valproic acid and clonazepam may produce absence status
Abrupt withdrawal, particularly in patients on long-term, high-dose therapy, may precipitate status epilepticus; when discontinuing clonazepam, gradual withdrawal essential; while being gradually withdrawn, simultaneous substitution of another anticonvulsant may be indicated
Use of drug, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency
Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate
For patients using treated more frequently than recommended, to reduce risk of withdrawal reactions, use a gradual taper to discontinue therapy (a patient-specific plan should be used to taper the dose)
Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use
In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months
May produce increase in salivation; consider before giving drug to patients who have difficulty handling secretions
In some studies, up to 30% of patients who initially responded have shown a loss of anticonvulsant activity, often within 3 months of administration; in some cases, dosage adjustment may reestablish efficacy
Paradoxical reactions, such as agitation, irritability, aggression, anxiety, anger, nightmares, hallucinations, and psychoses may occur when using benzodiazepines; discontinue therapy, should this occur; paradoxical reactions are more likely to occur in children and in the elderly
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies of Klonopin in pregnant women; available human data on risk of teratogenicity are inconclusive; there is insufficient evidence in humans to assess effect of benzodiazepine exposure during pregnancy on neurodevelopment; administration of benzodiazepines immediately prior to or during childbirth can result in a syndrome of hypothermia, hypotonia, respiratory depression, and difficulty feeding; in addition, infants born to mothers who have taken benzodiazepines during later stages of pregnancy can develop dependence, and subsequently withdrawal, during the postnatal period
Data for other benzodiazepines suggest possibility of adverse developmental effects (long-term effects on neurobehavioral and immunological function) in animals following prenatal exposure to benzodiazepines
Lactation
Effects on breastfed infant and on milk production are unknown; developmental and health benefits of breastfeeding should be considered along with mother's clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Long-acting benzodiazepine that increases the presynaptic GABA inhibition and reduces the monosynaptic and polysynaptic reflexes. Suppresses muscle contractions by facilitating inhibitory GABA neurotransmission and other inhibitory transmitters
Suppresses the spike-and-wave discharge in absence seizures by depressing nerve transmission in motor cortex
Absorption
Bioavailability: 90%
Onset: 20-40 min
Peak plasma time: 1-4 hr; 5-7 days (steady state)
Distribution
Protein bound: 85%
Vd: 1.5-3 L/kg
Metabolism
Metabolized by CYP3A4 (minor), glucuronic acid conjugation
Metabolites: Inactive
Elimination
Half-life: 17-60 hr (adults); 22-33 hr (children)
Excretion: Urine
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Formulary
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