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of treatment: Withdraw treatment gradually; decrease the dose q3Days by 0.125 mg PO q12hr until completely withdrawn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
Contraindicated (0)
Serious - Use Alternative (18)
- abametapir
abametapir will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- apalutamide
apalutamide will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- calcium/magnesium/potassium/sodium oxybates
clonazepam, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- carbamazepine
carbamazepine will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- conivaptan
conivaptan will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
- hydrocodone
hydrocodone, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- idelalisib
idelalisib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- ivosidenib
ivosidenib will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- lonafarnib
lonafarnib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
- metoclopramide intranasal
clonazepam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- selinexor
selinexor, clonazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sodium oxybate
clonazepam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sufentanil SL
sufentanil SL, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- tucatinib
tucatinib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- valerian
valerian and clonazepam both increase sedation. Avoid or Use Alternate Drug.
- voxelotor
voxelotor will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
Monitor Closely (244)
- albuterol
clonazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
clonazepam and alfentanil both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and clonazepam both increase sedation. Use Caution/Monitor.
- amitriptyline
clonazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and clonazepam both increase sedation. Use Caution/Monitor.
amobarbital will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - amoxapine
clonazepam and amoxapine both increase sedation. Use Caution/Monitor.
- apomorphine
clonazepam and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
clonazepam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
clonazepam and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
clonazepam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atazanavir
atazanavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.
- azelastine
azelastine and clonazepam both increase sedation. Use Caution/Monitor.
- baclofen
clonazepam and baclofen both increase sedation. Use Caution/Monitor.
- belladonna and opium
clonazepam and belladonna and opium both increase sedation. Use Caution/Monitor.
- belzutifan
belzutifan will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
- benperidol
clonazepam and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
clonazepam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bosentan
bosentan will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- brexanolone
brexanolone, clonazepam. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and clonazepam both increase sedation. Use Caution/Monitor.
- buprenorphine
clonazepam and buprenorphine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
clonazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
clonazepam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.
- buprenorphine, long-acting injection
clonazepam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- butabarbital
butabarbital and clonazepam both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and clonazepam both increase sedation. Use Caution/Monitor.
- butorphanol
clonazepam and butorphanol both increase sedation. Use Caution/Monitor.
- caffeine
clonazepam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and clonazepam both increase sedation. Use Caution/Monitor.
- carisoprodol
clonazepam and carisoprodol both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
cenobamate, clonazepam. Either increases effects of the other by sedation. Use Caution/Monitor. - chloral hydrate
clonazepam and chloral hydrate both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and clonazepam both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and clonazepam both increase sedation. Use Caution/Monitor.
- chlorpromazine
clonazepam and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
clonazepam and chlorzoxazone both increase sedation. Use Caution/Monitor.
- cimetidine
cimetidine increases levels of clonazepam by decreasing metabolism. Use Caution/Monitor.
- cinnarizine
cinnarizine and clonazepam both increase sedation. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- clemastine
clemastine and clonazepam both increase sedation. Use Caution/Monitor.
- clobazam
clonazepam, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
clonazepam and clomipramine both increase sedation. Use Caution/Monitor.
- clonidine
clonidine, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS depressant effects.
- clorazepate
clonazepam and clorazepate both increase sedation. Use Caution/Monitor.
- clozapine
clonazepam and clozapine both increase sedation. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clinical monitoring is recommended upon coadministration with anticonvulsants.
- codeine
clonazepam and codeine both increase sedation. Use Caution/Monitor.
- crizotinib
crizotinib increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
- crofelemer
crofelemer increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- cyclizine
cyclizine and clonazepam both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
clonazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and clonazepam both increase sedation. Use Caution/Monitor.
- dabrafenib
dabrafenib will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- dantrolene
clonazepam and dantrolene both increase sedation. Use Caution/Monitor.
- daridorexant
clonazepam and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darunavir
darunavir will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- desflurane
desflurane and clonazepam both increase sedation. Use Caution/Monitor.
- desipramine
clonazepam and desipramine both increase sedation. Use Caution/Monitor.
- deutetrabenazine
clonazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and clonazepam both increase sedation. Use Caution/Monitor.
- dexfenfluramine
clonazepam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
clonazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
clonazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
clonazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
clonazepam and dextromoramide both increase sedation. Use Caution/Monitor.
- diamorphine
clonazepam and diamorphine both increase sedation. Use Caution/Monitor.
- diazepam
clonazepam and diazepam both increase sedation. Use Caution/Monitor.
- diazepam intranasal
diazepam intranasal, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
- diethylpropion
clonazepam increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and clonazepam both increase sedation. Use Caution/Monitor.
- difenoxin hcl
clonazepam and difenoxin hcl both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and clonazepam both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and clonazepam both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
clonazepam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
- dipipanone
clonazepam and dipipanone both increase sedation. Use Caution/Monitor.
- disulfiram
disulfiram increases levels of clonazepam by decreasing metabolism. Use Caution/Monitor.
- dobutamine
clonazepam increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
clonazepam increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
clonazepam increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
clonazepam and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
clonazepam and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
clonazepam and doxylamine both increase sedation. Use Caution/Monitor.
- droperidol
clonazepam and droperidol both increase sedation. Use Caution/Monitor.
- duvelisib
duvelisib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of
- efavirenz
efavirenz will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- elagolix
elagolix will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; consider benzodiazepine dose reduction.
- encorafenib
encorafenib, clonazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- enzalutamide
enzalutamide will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ephedrine
clonazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
clonazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
clonazepam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, clonazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
clonazepam and estazolam both increase sedation. Use Caution/Monitor.
- ethanol
clonazepam and ethanol both increase sedation. Use Caution/Monitor.
- ethinylestradiol
ethinylestradiol will increase the level or effect of clonazepam by Mechanism: decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.
- etomidate
etomidate and clonazepam both increase sedation. Use Caution/Monitor.
- etravirine
etravirine will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fenfluramine
clonazepam increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flibanserin
clonazepam and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluphenazine
clonazepam and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
clonazepam and flurazepam both increase sedation. Use Caution/Monitor.
- formoterol
clonazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fosamprenavir
fosamprenavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.
- fosphenytoin
fosphenytoin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- gabapentin
gabapentin, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- ganaxolone
clonazepam and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
clonazepam and haloperidol both increase sedation. Use Caution/Monitor.
- hyaluronidase
hyaluronidase, clonazepam. Other (see comment). Use Caution/Monitor. Comment: Drug combination has been found to be incompatible.
- hydromorphone
clonazepam and hydromorphone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and clonazepam both increase sedation. Use Caution/Monitor.
- iloperidone
clonazepam and iloperidone both increase sedation. Use Caution/Monitor.
iloperidone increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. - imipramine
clonazepam and imipramine both increase sedation. Use Caution/Monitor.
- indinavir
indinavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.
- isoproterenol
clonazepam increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- itraconazole
itraconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- kava
kava and clonazepam both increase sedation. Use Caution/Monitor.
- ketamine
ketamine and clonazepam both increase sedation. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- ketotifen, ophthalmic
clonazepam and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, clonazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, clonazepam. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- letermovir
letermovir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levalbuterol
clonazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levoketoconazole
levoketoconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- levonorgestrel oral/ethinylestradiol/ferrous bisglycinate
levonorgestrel oral/ethinylestradiol/ferrous bisglycinate will increase the level or effect of clonazepam by decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.
- levorphanol
clonazepam and levorphanol both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
clonazepam increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
clonazepam and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
clonazepam and lofexidine both increase sedation. Use Caution/Monitor.
- lopinavir
lopinavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Use alternatives if available. Consider lowering benzodiazepine dose.
- loprazolam
clonazepam and loprazolam both increase sedation. Use Caution/Monitor.
- lorazepam
clonazepam and lorazepam both increase sedation. Use Caution/Monitor.
- lorlatinib
lorlatinib will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lormetazepam
clonazepam and lormetazepam both increase sedation. Use Caution/Monitor.
- loxapine
clonazepam and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
clonazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, clonazepam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
clonazepam and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
clonazepam and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
clonazepam and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
clonazepam and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
clonazepam and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
clonazepam increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
clonazepam and metaxalone both increase sedation. Use Caution/Monitor.
- methadone
clonazepam and methadone both increase sedation. Use Caution/Monitor.
- methamphetamine
clonazepam increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
clonazepam and methocarbamol both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
clonazepam increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
clonazepam and midazolam both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
clonazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mifepristone
mifepristone will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- mirtazapine
clonazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- mitotane
mitotane decreases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- modafinil
clonazepam increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
clonazepam and morphine both increase sedation. Use Caution/Monitor.
- motherwort
clonazepam and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
clonazepam and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
clonazepam and nabilone both increase sedation. Use Caution/Monitor.
- nafcillin
nafcillin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nalbuphine
clonazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- nefazodone
nefazodone will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nelfinavir
nelfinavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.
- norepinephrine
clonazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
clonazepam and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
clonazepam and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- opium tincture
clonazepam and opium tincture both increase sedation. Use Caution/Monitor.
- orlistat
orlistat decreases levels of clonazepam by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.
- orphenadrine
clonazepam and orphenadrine both increase sedation. Use Caution/Monitor.
- oxazepam
clonazepam and oxazepam both increase sedation. Use Caution/Monitor.
- oxycodone
clonazepam and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
clonazepam and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
clonazepam and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
clonazepam and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
clonazepam and papaverine both increase sedation. Use Caution/Monitor.
- pentazocine
clonazepam and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and clonazepam both increase sedation. Use Caution/Monitor.
- perampanel
perampanel and clonazepam both increase sedation. Use Caution/Monitor.
- perphenazine
clonazepam and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
clonazepam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and clonazepam both increase sedation. Use Caution/Monitor.
phenobarbital will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - phentermine
clonazepam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
clonazepam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
clonazepam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- phenytoin
phenytoin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pholcodine
clonazepam and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
clonazepam and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
clonazepam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- posaconazole
posaconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pregabalin
pregabalin, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone and clonazepam both increase sedation. Use Caution/Monitor.
- prochlorperazine
clonazepam and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and clonazepam both increase sedation. Use Caution/Monitor.
- propofol
propofol and clonazepam both increase sedation. Use Caution/Monitor.
- propylhexedrine
clonazepam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
clonazepam and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
clonazepam and quazepam both increase sedation. Use Caution/Monitor.
- quetiapine
clonazepam and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
clonazepam and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, clonazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- ribociclib
ribociclib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifabutin
rifabutin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifapentine
rifapentine will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
clonazepam and risperidone both increase sedation. Use Caution/Monitor.
- ritonavir
ritonavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.
- rucaparib
rucaparib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- salmeterol
clonazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- saquinavir
saquinavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- scullcap
clonazepam and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and clonazepam both increase sedation. Use Caution/Monitor.
secobarbital will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of clonazepam - sevelamer
sevelamer decreases levels of clonazepam by increasing elimination. Use Caution/Monitor.
- sevoflurane
sevoflurane and clonazepam both increase sedation. Use Caution/Monitor.
- shepherd's purse
clonazepam and shepherd's purse both increase sedation. Use Caution/Monitor.
- stiripentol
stiripentol, clonazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
stiripentol, clonazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. - sufentanil
clonazepam and sufentanil both increase sedation. Use Caution/Monitor.
- suvorexant
suvorexant and clonazepam both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tapentadol
clonazepam and tapentadol both increase sedation. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- teduglutide
teduglutide increases levels of clonazepam by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.
- temazepam
clonazepam and temazepam both increase sedation. Use Caution/Monitor.
- terbutaline
clonazepam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
clonazepam and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
clonazepam and thiothixene both increase sedation. Use Caution/Monitor.
- tipranavir
tipranavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- topiramate
clonazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
clonazepam and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
clonazepam and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
clonazepam and triazolam both increase sedation. Use Caution/Monitor.
- triclofos
clonazepam and triclofos both increase sedation. Use Caution/Monitor.
- trifluoperazine
clonazepam and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
clonazepam and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and clonazepam both increase sedation. Use Caution/Monitor.
- voriconazole
voriconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- xylometazoline
clonazepam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
clonazepam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
clonazepam and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
clonazepam and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
clonazepam and zotepine both increase sedation. Use Caution/Monitor.
Minor (34)
- acetaminophen
clonazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.
- acetaminophen IV
clonazepam decreases levels of acetaminophen IV by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.
- acetaminophen rectal
clonazepam decreases levels of acetaminophen rectal by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.
- atracurium
clonazepam decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.
- biotin
clonazepam decreases levels of biotin by unspecified interaction mechanism. Minor/Significance Unknown. Biotin supplementation may be necessary.
- brimonidine
brimonidine increases effects of clonazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- ciprofloxacin
ciprofloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- cisatracurium
clonazepam decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.
- cyanocobalamin
clonazepam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- dexmethylphenidate
dexmethylphenidate increases effects of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- esomeprazole
esomeprazole will increase the level or effect of clonazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.
- eucalyptus
clonazepam and eucalyptus both increase sedation. Minor/Significance Unknown.
- ezogabine
ezogabine decreases levels of clonazepam by Other (see comment). Minor/Significance Unknown. Comment: Ezogabine may induce glucuronidation that results in small decreases of trough levels.
- fleroxacin
fleroxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- gemifloxacin
gemifloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- green tea
green tea decreases effects of clonazepam by pharmacodynamic antagonism. Minor/Significance Unknown. Caffeine component of green tea may decrease sedative effects of benzodiazepines.
- levocarnitine
clonazepam decreases levels of levocarnitine by unspecified interaction mechanism. Minor/Significance Unknown.
- levofloxacin
levofloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- moxifloxacin
moxifloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- ofloxacin
ofloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- omeprazole
omeprazole increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- onabotulinumtoxinA
clonazepam decreases effects of onabotulinumtoxinA by pharmacodynamic antagonism. Minor/Significance Unknown.
- pancuronium
clonazepam decreases effects of pancuronium by pharmacodynamic antagonism. Minor/Significance Unknown.
- rapacuronium
clonazepam decreases effects of rapacuronium by pharmacodynamic antagonism. Minor/Significance Unknown.
- rifabutin
rifabutin decreases levels of clonazepam by increasing metabolism. Minor/Significance Unknown.
- rimabotulinumtoxinB
clonazepam decreases effects of rimabotulinumtoxinB by pharmacodynamic antagonism. Minor/Significance Unknown.
- rocuronium
clonazepam decreases effects of rocuronium by pharmacodynamic antagonism. Minor/Significance Unknown.
- sage
clonazepam and sage both increase sedation. Minor/Significance Unknown.
sage decreases effects of clonazepam by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction; some species of sage may cause convulsions. - serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate increases effects of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- succinylcholine
clonazepam decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- valproic acid
clonazepam, valproic acid. Mechanism: unknown. Minor/Significance Unknown. Possible risk of absence seizure.
- vecuronium
clonazepam decreases effects of vecuronium by pharmacodynamic antagonism. Minor/Significance Unknown.
- vinpocetine
clonazepam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).
- zolpidem
zolpidem, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Klonopin oral - | 1 mg tablet |  | |
| Klonopin oral - | 2 mg tablet |  | |
| Klonopin oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 0.25 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 0.25 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 0.25 mg tablet |  | |
| clonazepam oral - | 0.125 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 0.25 mg tablet |  | |
| clonazepam oral - | 0.125 mg tablet |  | |
| clonazepam oral - | 0.125 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 0.125 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 2 mg tablet |  | |
| clonazepam oral - | 1 mg tablet |  | |
| clonazepam oral - | 0.5 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
clonazepam oral
CLONAZEPAM - ORAL
(klo-NAY-zeh-pam)
COMMON BRAND NAME(S): Klonopin
WARNING: Clonazepam has a risk for abuse and addiction, which can lead to overdose and death. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems (especially opioid medications such as codeine, hydrocodone) may cause very serious side effects, including death. To lower your risk, your doctor should have you take the smallest dose of clonazepam that works, and take it for the shortest possible time. Be sure you know how to take clonazepam and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Suddenly stopping this medication may cause serious (possibly fatal) withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as headaches, trouble sleeping, restlessness, hallucinations/confusion, depression, nausea, or seizures. Withdrawal symptoms may sometimes last weeks to months.
USES: Clonazepam is used to prevent and control seizures. This medication is known as an anticonvulsant or antiepileptic drug. It is also used to treat panic attacks. Clonazepam works by calming your brain and nerves. It belongs to a class of drugs called benzodiazepines.
HOW TO USE: See also Warning section.Read the Medication Guide provided by your pharmacist before you start taking clonazepam and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually 2 or 3 times daily.Dosage is based on your medical condition, age, and response to treatment. For children, the dose is also based on weight. Older adults usually start with a lower dose to decrease the risk of side effects. Do not increase your dose, take it more often, or take it for a longer time than directed.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.If you have several different types of seizure disorders, you may experience a worsening of seizures when you first start using clonazepam. Consult your doctor right away if this happens. Your doctor may need to add or adjust the dose of your other medications to control the seizures.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, tiredness, loss of coordination, or increased saliva production may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior, including: confusion, memory problems, signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking clonazepam, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (such as diazepam, lorazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain type of eye problem (narrow angle glaucoma), a certain blood disorder (porphyria), liver disease, kidney disease, lung/breathing problems, mental/mood problems (such as depression, thoughts of suicide), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).For children, the long-term effects on physical and mental/behavioral development are uncertain and may not be seen until after many years. Discuss the risks and benefits of treatment with clonazepam with your doctor.Older adults may be more sensitive to the effects of this drug, especially drowsiness and confusion. These side effects can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. However, since untreated seizures are a serious condition that can harm both a pregnant woman and her unborn baby, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor about the benefits and risks of using this medication during pregnancy.This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: orlistat, sodium oxybate.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, confusion, loss of consciousness, slowed/decreased reflexes.
NOTES: Do not share this medication with others. Sharing it is against the law.Laboratory and/or medical tests (such as liver function tests, complete blood count) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).
Information last revised April 2022. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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