How and when to take clonazepam

It’s important to take clonazepam exactly as your doctor tells you to.

Dosage and strength

Clonazepam tablets come in strengths of 0.5mg, 1mg or 2mg. The liquid contains either 0.5mg or 2mg in 5ml.

If you’re taking it for epilepsy or muscle spasms you’ll usually start on a low dose and gradually increase it over 2 to 4 weeks until your doctor thinks the dose is right for you.

Your doctor will tell you if you need to take clonazepam in 1 dose or split your dose so you take it up to 3 times each day. Ask a doctor or pharmacist if you’re not sure how to take it.

The usual dose for:

• epilepsy in adults – 1mg taken at night as the starting dose, increasing to 4mg to 8mg over 2 to 4 weeks
• epilepsy in children – the dose varies depending on their age. It will be increased gradually over 2 to 4 weeks
• involuntary muscle spasms in adults – 1mg taken at night as the starting dose, increasing to 4mg to 8mg over 2 to 4 weeks
• panic disorder – 1mg to 2mg each day
• restless legs syndrome – 500 micrograms to 2mg each day

If you’re older than 65 or have kidney, liver or severe breathing problems, your doctor may recommend a lower dose.

How to take it

Take clonazepam tablets with a drink of water.

You can take the tablets or liquid with or without food.

If you’re taking clonazepam as a liquid, the medicine will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How long to take it for

How long you take clonazepam for will depend on why you’re taking it.

When used for epilepsy, clonazepam is usually prescribed long term.

For other conditions, your doctor will want to regularly review if you still need it.

If you’re prescribed clonazepam for more than 4 weeks, your doctor may reduce your dose gradually before stopping it, to prevent withdrawal symptoms.

Important

Do not stop taking clonazepam without talking to a doctor.

If you forget to take it

If you forget to take your clonazepam, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to remember your medicines.

If you take too much

The amount of clonazepam that can lead to an overdose varies from person to person.

If you take too much clonazepam, you may get symptoms including:

• poor coordination or trouble speaking
• feeling sleepy
• a slow or irregular heartbeat
• uncontrolled eye movements
• muscle weakness
• feeling overexcited

Urgent advice: Contact 111 for advice now if:

• you take more than your prescribed dose of clonazepam

Go to 111. nhs.uk or call 111

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the clonazepam packet, or the leaflet inside it, plus any remaining medicine with you.

Page last reviewed: 27 January 2023

Next review due: 27 January 2026

Clonazepam (Klonopin) | NAMI: National Alliance on Mental Illness

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Generic name: clonazepam (kloe NA ze pam)

• Tablets: 0.5 mg, 1 mg, 2 mg
• Orally disintegrating tablets: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg

Brand name: Klonopin®

• Tablets: 0.5 mg, 1 mg, 2 mg

​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.

When starting clonazepam, anxiety or insomnia may improve rapidly or over a period of days.

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. With input from you, your health care provider will assess how long you will need to take the medicine.

Do not stop taking clonazepam or change your dose without talking to your health care 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. Withdrawal reactions may occur when dosage reduction occurs for any reason.

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

If you are taking clonazepam with an opioid medication, get medical assistance immediately if you feel dizziness, sleepiness, 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 pregnant or planning to become pregnant, notify your health care provider to best manage your medications. People living with anxiety disorders who wish to become pregnant face important decisions regarding risk versus benefit of benzodiazepine use in pregnancy. Clonazepam can increase the risk of premature birth and low birth weight. Newborn withdrawal and “floppy baby syndrome” are other possible side effects. 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 Health Care 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 health care 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 elderly or are prone to falls
• If you are pregnant, plan to become pregnant, or are breastfeeding
• If you have acute narrow-angle glaucoma or untreated open-angle glaucoma
• If you have liver disease
• If you have phenylketonuria (PKU)
• 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 every day at regular times or on an as needed (“PRN”) basis. Typically, your health care provider will limit the number of doses you should take in one day.

Your health care 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 every day (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 health care 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. If side effects do not improve or become problematic, consult your health care provider.

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. The risk of withdrawal reactions when stopping therapy with clonazepam is increased with prolonged use of the medication.

What Other Medications May Interact With Clonazepam?

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

• Ketoconazole (Nizoral®), itraconazole (Sporanox®), nefazodone (Serzone®), fluvoxamine (Luvox®), cimetidine (Tagamet®), and ritonavir (Norvir®)

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 (Benadryl®)
• Narcotic pain medication such as morphine, oxycodone (OxyContin®), and hydrocodone (Vicodin® and Lortab®)
• Opioid cough medications such as codeine cough syrup
• Sleeping medications such as zolpidem (Ambien®)
• 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 FDA Black Box Warnings

The FDA has found that benzodiazepines, such as clonazepam, when used in combination with opioids or other sedating medications can result in serious adverse reactions including death. Patients, and caregivers of these patients, should seek immediate medical attention if the patient starts to experience unusual dizziness or lightheadedness, extreme sleepiness, slow or difficult breathing, or unresponsiveness.

As a benzodiazepine, clonazepam comes with the risk of abuse, misuse, and addiction to the medication. Physical dependence to clonazepam can occur with prolonged use of the medication. A withdrawal reaction may occur when stopping clonazepam, but this risk can be reduced by slowly reducing the dose of clonazepam when stopping. Do not stop taking clonazepam abruptly, and do not make any changes to therapy without consulting your health care provider.

Provided by

(January 2023)

©2022 The American Association of Psychiatric Pharmacists (AAPP) and the National Alliance on Mental Illness (NAMI). AAPP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4. 0 International License. Last Updated: January 2016.

This information is being provided as a community outreach effort of the American Association of Psychiatric Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The American Association of Psychiatric Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

Arpimed

Like all medicines, clonazepam can cause side effects, although not everyone gets them.

Important side effects:

Allergic reactions .

If you develop an allergic reaction, call your doctor immediately . Allergic reactions may manifest as the following symptoms:

• Sudden swelling of the larynx, face, lips and mouth. These symptoms can lead to difficulty breathing or swallowing.
• Sudden swelling of hands, feet and ankles.
• Skin rash or itching.

Cardiovascular adverse reactions

If you experience any of these symptoms, you should call your doctor immediately.

These symptoms include:

• Shortness of breath, swelling of the ankles, cough, fatigue and palpitations.
• Pain in the chest, which may radiate to the neck, shoulder and left arm.

Nervous system side effects

If you have any of these symptoms, you should talk to your doctor. These symptoms include:

• Feelings of aggression, agitation, irritability, nervousness, agitation, anxiety and hostility.
• Sleep disturbance, nightmares and vivid dreams.
• Hallucinations, manias and speech disorder.
• Development of new types of seizures not previously observed

Children and infants

• Special care should be taken when administering clonazepam to children and infants, as clonazepam may cause airway dysfunction, coughing and a feeling of choking. This may be caused by excessive salivation.
• Early puberty possible. After the abolition of clonazepam, this process stops.

Other possible side effects

Taking clonazepam may cause the following symptoms:

• Drowsiness and fatigue
• Dizziness and fatigue.
• Muscle weakness or flexibility, jerky movements (poor coordination)
• Walking instability

Tell your doctor if you have any of these symptoms. Your doctor will prescribe you a low dose, if necessary, by gradually increasing the dose of clonazepam.

The following symptoms may appear at any time during treatment with clonazepam

Mental activity and nervous system

• Impaired concentration, confusion and feeling lost (disorientation)
• Anxiety
• Difficulty in remembering new things
• Headache
• Depression
• Slow or broken speech
• Poor motor coordination, including unsteadiness when walking
• Increased incidence of epileptic seizures

Circulatory, renal and hepatic system

• Liver dysfunction (diagnosed by laboratory liver tests)
• Uncontrolled urination
• Problems with the circulatory system. Symptoms include feeling tired, bruising from minor concussions, shortness of breath, and nosebleeds.

Your healthcare provider should perform periodic blood tests if necessary.

Gastrointestinal tract

• Nausea
• Gastric disorders

Organs of vision

• Diplopia (double vision)
• Involuntary oscillatory movements (nystagmus)

Respiratory system

• Respiratory failure (respiratory depression). The first signs include sudden noisy, labored and irregular breathing. The development of cyanosis of the skin is possible.

Skin and hair

• Skin rash, urticaria and pruritus.
• Skin discoloration
• Hair loss

Reproductive system

• Decreased libido
• Erectile dysfunction

Withdrawal

When taking benzodiazepines such as clonazepam, addiction to the drug may develop. Therefore, with a sudden discontinuation or dose reduction of clonazepam, a withdrawal syndrome may develop.

Withdrawal may lead to the following symptoms:

• Sleep disturbance
• Muscle pain, tremor and restlessness
• Feelings of increased anxiety, tension, feelings of irritability or agitation, or changes in mood
• Increased sweating
• Headache

The following symptoms are less common:

• Hypersensitivity to light, noise and physical contact
• Hallucinations
• Tingling and numbness of hands and feet
• Feeling out of touch with reality

Trauma

Patients taking benzodiazepines are at an excessive risk of falling or breaking bones, especially the elderly, patients taking sedatives, including alcohol.

Reporting side effects

If you notice any side effects, tell your doctor, pharmacist or pharmacist, including any side effects not listed in this package insert. You can also report side effects to Arpimed LLC by going to the website www.arpimed.com and filling out the appropriate form “Report a side effect or ineffectiveness of a drug” and to the Scientific Center for Expertise of Drugs and Medical Technologies named after. Academician E.Gabrielyan, by going to the website www.pharm.am in the section “Report a side effect of a drug” and fill out the form “Map of reporting a side effect of a drug”. Scientific center hotline: +37410200505; +37496220505.

instructions for use, price, analogues, composition, indications

Tell the doctor about all currently or recently used medicines, as well as those that the patient plans to use. Clonazepam, taken concomitantly with other drugs, may change their effect, while other drugs may affect its effect.

The inhibitory effect of clonazepam on the central nervous system is enhanced by opium painkillers, drugs for general anesthesia (anesthetics), psychotropic drugs, antidepressants, antihistamines, drugs that reduce blood pressure of central action.

Disulfiram, cimetidine, erythromycin, ketoconazole, ritonavir, being inhibitors of cytochrome P-450 isoenzymes, inhibit the processes of biotransformation of 1,4-benzodiazepine derivatives and enhance their inhibitory effect on the central nervous system.

Drugs that induce the activity of cytochrome P-450 (for example, rifampicin, phenobarbital, phenytoin, primidone, carbamazepine) affect the processes of biotransformation of 1,4-benzodiazepine derivatives and lead to a weakening of their pharmacological action.

The use of alcohol during treatment with clonazepam enhances the inhibitory effect on the central nervous system and can lead to the development of paradoxical reactions, such as psychomotor agitation, aggressive behavior. In addition, alcohol enhances the sedative effect of clonazepam up to impaired coordination of movements and loss of consciousness.

Clonazepam, taken together with skeletal muscle relaxants, prolongs and potentiates the action of the latter.

Co-administration of clonazepam with the class III antiarrhythmic drug amiodarone may cause increased toxicity typical of benzodiazepines (eg, central depression, motor coordination disorder).

Clonazepam, used simultaneously with other anticonvulsants, especially hydantoin or phenobarbital, may cause an increase in side effects associated with depression of the functions of the central nervous system.

Clonazepam, used simultaneously with sodium valproate, can induce epileptic seizures in the form of absences.

Tobacco smoking may reduce the effect of clonazepam.

Method of administration and dosage

Clonazepam should always be used as directed by a physician.

In case of doubt, a doctor should be consulted.

The doctor will determine the dose and duration of treatment individually for each patient.

Adults

The initial daily dose should not exceed 1.5 mg. Clonazepam should be used in doses divided into 3 divided doses at regular intervals. The dose should be increased gradually by 0.5-1 mg every 3 days, depending on the patient’s response to the drug, until a maintenance dose is reached, usually 4 mg to 8 mg per day.

The maximum maintenance daily dose, which should be achieved within 2-4 weeks of treatment, should not exceed 20 mg.

The simultaneous use of several antiepileptic drugs can lead to an increase in their inhibitory effect. This should be taken into account before the inclusion of Clonazepam in the treatment regimen with other antiepileptic drugs.

Children

Due to possible negative effects on physical or mental development after years of use, the benefits and risks of long-term use of clonazepam in children treated for epilepsy should be considered.

The initial dose in children aged 6 to 16 years is 0.5 mg / day.

Maintenance dose: 2-4 mg/day.

The daily dose should be divided into 3 or 4 parts and applied at regular intervals.

Patients with impaired renal and/or liver function

Caution should be exercised when using clonazepam in patients with impaired renal and hepatic function. It may be necessary to reduce the dose of the drug.

Elderly patients

Elderly patients are more sensitive to drugs that act on the central nervous system. It is recommended that the initial dose for these patients should not exceed 0.5 mg per day.

Mode of application

Clonazepam tablets should be taken orally with a small amount of water. The doctor will start treatment with the lowest effective dose and, if necessary, will gradually increase it.

If the use of the drug in equal doses is not possible, a larger dose should be taken at bedtime.

After reaching an effective maintenance dose, the drug can be used in a single daily dose at bedtime.

Duration of treatment

No data are available regarding the duration of treatment with Clonazepam. The doctor who prescribes long-term treatment with Clonazepam should periodically monitor the effectiveness of treatment in each patient individually. The duration of treatment is determined by the doctor, depending on the patient’s condition.

You can not abruptly stop taking the drug, it is always necessary to gradually reduce the dose under the supervision of a physician.

The dose should be reduced gradually by 0.125 mg 2 times a day every 3 days until the drug is completely discontinued.

If during treatment the patient feels that the effect of the drug is too strong or weak, he should consult a doctor.

In case of using Clonazepam at a dose of greater than prescribed

Symptoms

As a result of an overdose of clonazepam, the following symptoms may appear: drowsiness, a state of disorientation, slurred speech, and in severe cases, loss of consciousness, coma. Life-threatening poisoning can be caused by the simultaneous use of clonazepam and alcohol, or clonazepam and other drugs that have a depressant effect on the central nervous system.

If you use Clonazepam in a dose greater than prescribed, you should immediately contact your doctor or the nearest hospital emergency department. You should take the drug in the original packaging with you so that the staff can carefully check which drug has been used.

Measures taken

In case of poisoning with clonazepam, measures are aimed at the rapid elimination of the still unabsorbed drug from the body or a decrease in its absorption from the digestive tract. Airway patency, pulse, blood pressure should be monitored, and, if necessary, depending on the patient’s condition, appropriate symptomatic treatment should be carried out. The specific antidote is flumazenil.

In the event of missing a dose of the drug Clonazepam

If the patient forgets to take a dose of the drug, he should take the next dose as soon as possible, as soon as he remembers. However, if the time for the next dose is already approaching, you should skip the forgotten dose and take the next one as is. as scheduled. If the patient forgets to take two or more doses, you should consult a doctor.

Do not take a double dose to make up for a missed one.

Interruption of treatment with Clonazepam

You should not interrupt treatment with the drug, unless prescribed by a doctor. Possible recurrence of symptoms of the disease. If the doctor decides that it is necessary to stop using the drug, its dose should be reduced gradually over several days.

Abrupt discontinuation of clonazepam may cause a withdrawal syndrome (see section “Cautions Concerning Use”). Especially dangerous is the abrupt cessation of treatment carried out for a long time, or treatment requiring high doses of the drug. Withdrawal symptoms are then more pronounced. The doctor will determine the gradual withdrawal of the drug individually for each patient.

Side effects

The frequency and severity of side effects depends on the individual sensitivity of the patient and the dose of the drug taken.

Discontinuation of Clonazepam due to side effects is rare.

Blood and lymphatic system disorders: violations of the morphological composition of the blood.

Hypersensitivity reactions:

Immune system disorders: anaphylactic reactions, vasomotor edema are described very rarely.

Skin and subcutaneous tissue disorders: allergic skin reactions (rash, itching, urticaria).

Metabolic and nutritional disorders: lack of appetite.

mental disorder

Paradoxical reactions – psychomotor anxiety, insomnia, agitation and aggressiveness, irritability, hostility, sleep disturbances, nightmares, personality disorders, muscle tremors, convulsions (new types).

Paradoxical reactions are most often observed after alcohol consumption, in elderly patients and in patients with mental illness.

Physical and psychological dependence may develop during treatment with clonazepam at therapeutic doses. The risk of developing dependence increases as the dose and duration of treatment increase. Patients with a history of alcoholism or other types of addiction are especially predisposed to developing addiction. Abrupt discontinuation of treatment may cause a withdrawal syndrome.

Pre-existing undiagnosed depression may occur during treatment with clonazepam.

Nervous system disorders: drowsiness, slow reaction, headache and dizziness, increased sensitivity to light, confusion and disorientation, ataxia. These effects are most often observed at the beginning of treatment, in elderly patients and, as a rule, disappear during ongoing therapy. In the event of an increase in these reactions, a corresponding dose reduction usually reduces their severity and frequency.

Sometimes, as well as after taking other benzodiazepines, especially in large doses, dysarthria with slurred speech and incorrect pronunciation, memory impairment may develop.

On the part of the organ of vision: visual impairment (blurred vision, diplopia, nystagmus).

Cardiac disorders: bradycardia, chest pain.

Vascular disorders: slight decrease in blood pressure.

Respiratory, thoracic and mediastinal disorders: rarely, respiratory center depression may develop especially when used simultaneously with other drugs that have a depressant effect on the respiratory center. In infants and children, especially if there are mental disorders, clonazepam may increase the production of bronchial secretions and saliva. In such cases, it is recommended to control the airway more often.

Gastrointestinal disorders: nausea, dyspepsia, dry mouth, unpleasant taste are rare.

From the side of the liver and biliary tract: a slight increase in aminotransferase activity, abnormal liver function, accompanied by jaundice.

Skin and subcutaneous tissue disorders: urticaria, rash, hair loss, pigmentation disorders.