clonazepam

Clonazepam is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). It affects chemicals in the brain that may become unbalanced and cause anxiety.

Clonazepam is used to treat seizure disorders or panic disorder.

Clonazepam may also be used for purposes not listed in this medication guide.

Important information

You should not use this medication if you have severe liver disease, of if you are allergic to clonazepam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax). Clonazepam may cause harm to an unborn baby, and may cause breathing or feeding problems in a newborn. But having seizures during pregnancy could harm both mother and baby. Do not start or stop taking clonazepam during pregnancy without medical advice.

You may have thoughts about suicide while taking clonazepam. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments. Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, depression, anxiety, or if you feel agitated, irritable, hostile, aggressive, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Before you take clonazepam, tell your doctor if you have kidney or liver disease, glaucoma, any breathing problems, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol.

Do not drink alcohol while taking clonazepam. This medication can increase the effects of alcohol. Clonazepam may be habit-forming and should be used only by the person it was prescribed for. Keep the medication in a secure place where others cannot get to it.

Before taking this medicine

You should not use this medication if you have severe liver disease or narrow-angle glaucoma, or if you are allergic to clonazepam or other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), lorazepam (Ativan), or oxazepam (Serax).

To make sure you can safely take clonazepam, tell your doctor if you have any of these other conditions:

• kidney or liver disease;

• glaucoma;

• asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;

• a history of depression or suicidal thoughts or behavior; or

• a history of drug or alcohol addiction.

FDA pregnancy category D. Clonazepam may cause harm to an unborn baby, and may cause breathing or feeding problems in a newborn. But having seizures during pregnancy could harm both mother and baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Do not start or stop taking clonazepam during pregnancy without medical advice. If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of clonazepam on the baby. Clonazepam may pass into breast milk and could harm a nursing baby. Do not breast-feed a baby while taking this medication.

See also: Pregnancy and breastfeeding warnings (in more detail)

The sedative effects of clonazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking clonazepam. Clonazepam may be habit forming and should be used only by the person it was prescribed for. Never share clonazepam with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

How should I take clonazepam?

Take clonazepam exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results.

Swallow the regular clonazepam tablet whole, with a full glass of water. Clonazepam should be used for only a short time. Do not take this medication for longer than 9 weeks without your doctor"s advice.

To take the clonazepam disintegrating tablet (wafer):

• Keep the tablet in its blister pack until you are ready to take it. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.

• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.

• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

• Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.

To be sure clonazepam is not causing harmful effects, your blood may need to be tested often. Your liver function may also need to be tested. Visit your doctor regularly.

Do not stop using clonazepam without first talking to your doctor, even if you feel fine. You may have increased seizures or unpleasant withdrawal symptoms if you stop using clonazepam suddenly. Ask your doctor how to avoid withdrawal symptoms when you stop using clonazepam.

You may need to use less and less before you stop the medication completely. Your doctor may also prescribe another seizure medication for you to start while you are stopping clonazepam.

Keep track of the amount of medicine used from each new bottle. Clonazepam is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Store clonazepam at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of clonazepam can be fatal.

Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, and fainting.

What should I avoid?

Drinking alcohol can increase certain side effects of clonazepam. This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Clonazepam side effects

Get emergency medical help if you have any of these signs of an allergic reaction to clonazepam: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, irritable, hostile, aggressive, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have a serious side effect while taking clonazepam such as:

• confusion, hallucinations, unusual thoughts or behavior;

• unusual risk-taking behavior, no fear of danger;

• weak or shallow breathing;

• unusual or involuntary eye movements;

• pounding heartbeats or fluttering in your chest;

• painful or difficult urination, urinating less than usual;

• pale skin, easy bruising or bleeding; or

• new or worsening seizures.

Less serious clonazepam side effects may include:

• drowsiness, dizziness, problems with thinking or memory;

• tired feeling, muscle weakness, loss of balance or coordination;

• slurred speech, drooling or dry mouth, sore gums;

• runny or stuffy nose;

• loss of appetite, nausea, diarrhea, constipation;

• blurred vision;

• headache;

• sleep problems (insomnia);

• skin rash; or

• weight changes.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Clonazepam dosing information

Usual Clonazepam Adult Dose for Seizure Prophylaxis:

Initial dose: Should not exceed 1.5 mg/day divided into three doses.

Dosage may be increased in increments of 0.5 to 1 mg every 3 days until seizures are adequately controlled or until side effects preclude any further increase.

Maintenance dose: Individualized for each patient depending upon response.

Maximum Daily Dose: 20 mg.

Usual Adult Clonazepam Dose for Bipolar Disorder:

Initial dose: Should not exceed 1.5 mg/day divided into three doses.

Dosage may be increased in increments of 0.5 to 1 mg every 3 days until seizures are adequately controlled or until side effects preclude any further increase.

Maintenance dose: Individualized for each patient depending upon response.

Maximum Daily Dose: 20 mg.

Usual Adult Clonazepam Dose for Panic Disorder:

Initial dose: 0.25 mg bid.

Maintenance dose: An increase to the target dose for most patients of 1 mg/day may be made after 3 days.

The dose may be increased in increments of 0.125 to 0.25 mg bid every 3 days until panic disorder is controlled or until side effects make further increases undesired. To reduce the inconvenience of somnolence, administration of one dose at bedtime may be desirable.

Maximum Dose: 4 mg/day

Treatment should be discontinued gradually, with a decrease of 0.125 mg bid every 3 days, until the drug is completely withdrawn.

Usual Pediatric Clonazepam Dose for Seizure Prophylaxis:

<= 10 years or < 30 kg of body weight:
Initial Dose: Orally:
In order to minimize drowsiness, the initial dose should be between 0.01 and 0.03 mg/kg/day but not to exceed 0.05 mg/kg/day given in two or three divided doses.

Dosage should be increased by no more than 0.25 to 0.5 mg every third day until a daily maintenance dose of 0.1 to 0.2 mg/kg of body weight has been reached, unless seizures are controlled or side effects preclude further increase. Whenever possible, the daily dose should be divided into three equal doses. If doses are not equally divided, the largest dose should be given before retiring.

>10 years and >30 kg of body weight:
The initial dose should not exceed 1.5 mg/day divided into three doses.

Dosage may be increased in increments of 0.5 to 1 mg every 3 days until seizures are adequately controlled or until side effects preclude any further increase.

The maintenance dosage should be individualized for each patient depending upon response.

Maximum Daily Dose: 20 mg.

What other drugs will affect clonazepam?

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for depression or anxiety can add to sleepiness caused by clonazepam. Tell your doctor if you regularly use any of these medicines, or any other seizure medications or benzodiazepines.

Also tell your doctor if you are using any of the following drugs:

• propantheline (Pro-Banthine);

• an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), or telithromycin (Ketek);

• an antifungal medicine such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend);

• an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), doxepin (Sinequan), nefazodone, nortriptyline (Pamelor), and others;

• a barbiturate such as butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton);

• an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate); or

• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), droperidol (Inapsine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), thioridazine (Mellaril), or thiothixene (Navane).

This list is not complete and other drugs may interact with clonazepam. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.