Seizure disorders can have a serious impact on an individual’s quality of life, putting them at an increased risk of injury, hospitalization and mortality while taking a toll on their mental health and self-confidence. Clonazepam is a powerful medication that helps to control seizures in both adults and children, helping them lead more stable and fulfilling lives. Read on for an in-depth look at how this medication works and its potential side effects.
Understanding Clonazepam and Its Uses
Clonazepam is a benzodiazepine that’s classified by the U.S. Drug Enforcement Administration as a Schedule IV controlled substance, meaning that it’s currently accepted for medical use and has a lower potential for misuse than Schedule III drugs. It was introduced to the U.S. market in 1975 to treat seizure disorders as well as panic disorder.
Currently, clonazepam is sold under nearly a dozen brand names, including Klonopin, Rivotril and Paxam, and several manufacturers offer generic versions of the drug. It’s only available by prescription, and you should never share someone else’s medication or attempt to acquire it without a doctor’s order.
Clonazepam comes in strengths ranging from 0.125 milligrams up to 2 mg, with a max daily dose for adults and children aged 10 and over coming in at 20 mg. It’s administered orally and comes in two tablet forms: an immediate-release tablet and an orally disintegrating tablet.
How Clonazepam Works for Anxiety and Seizure Disorders
As a benzodiazepine, clonazepam works by releasing a chemical in the brain called gamma-aminobutyric acid, or GABA. This chemical is considered an inhibitory transmitter because it blocks nerve signaling, altering brain cells’ ability to give and receive messages.
Because clonazepam reduces brain cell activity, it’s an effective treatment for severe anxiety and seizures. Along with these main uses, clonazepam has several off-label uses. These include:
- Restless leg syndrome
- Sleepwalking
- Social phobia
- Burning mouth syndrome
- Depression
- Multiple sclerosis
- Vertigo
- Attention deficit hyperactivity disorder
- Fibromyalgia
- Neuropathic pain
- Tinnitus
- Periodic limb movement disorder
- Tourette syndrome
- Essential tremor
Using a medication off label means that you’re taking the medication to treat something other than what the Food and Drug Administration approves it for. While there’s evidence that clonazepam may be useful for treating some of these conditions, the FDA considers treatment experimental. Your doctor may prescribe this or other medications off label, but your health insurance company probably won’t cover it in this case.
The Potential Side Effects and Risks of Clonazepam
Clonazepam is safe and effective when it’s used as directed. However, it can bring numerous side effects. These may include:
- Drowsiness and fatigue
- Sedation
- Indigestion
- Reduced muscle control, causing slurred speech, balance problems and clumsy movements
- Muscle weakness
- Dizziness
- Erectile dysfunction
- Cough
- Diarrhea
- Bronchitis
- Behavioral disorders
- Acute cognitive impairment
- Acute abdominal pain
For most people who experience side effects from clonazepam, these effects often go away after a few days or weeks as the body adjusts to the medicine. If you experience an increase in symptoms such as drowsiness, dizziness or loss of muscle control, it’s important to let your doctor know right away.
Serious Side Effects
In rare cases, people who take clonazepam experience more serious side effects, such as:
- Confusion
- Memory problems
- Depression
- Thoughts of suicide
- Thoughts of self-harm
- Slow or shallow breathing
- Signs of allergic reaction, including rash, itching, swelling or trouble breathing
These side effects may mean that the dosage you’re on is too high or that a different medication would be more appropriate for your condition.
Long-term Use
Additionally, long-term use of clonazepam is associated with a range of serious side effects, including:
- An increased risk of dependence
- Prolonged periods of depression
- Impulsive behavior and lowered inhibitions
- Mental health problems, including hallucinations and anxiety
- Blood disorders
Clonazepam Interactions
Many medications aren’t safe to take alongside clonazepam, including certain antidepressants, antihistamines and other seizure medications. Before taking another prescription or over-the-counter medication with clonazepam, be sure to talk to your doctor or pharmacist. Additionally, you should avoid or limit the use of alcohol, as well as other depressants, while you’re taking clonazepam.
Danger of Misuse
While clonazepam’s rating as a Schedule IV drug means that it’s less likely to be misused compared to Schedules I, II and III drugs, it can still be addictive even when it’s taken according to doctor’s orders. It has two components that make it habit-forming, especially for those with a history of substance use disorder, including a rapid onset and a long half-life.
Guidelines for Safe Usage and Withdrawal from Clonazepam
Because of its risk of misuse, as well as its potential interactions with other medications, it’s important to only take clonazepam according to your doctor’s orders. Your doctor may start you on a low dose and gradually increase it until the medication achieves the desired results. Initially, you may need to see your doctor more frequently, so they can monitor how you respond to the dosage and make necessary adjustments. Once your dosage is stabilized, you should expect to see your doctor every few months depending on your specific condition and how you respond to the medication.
Precautions and Considerations
Clonazepam reduces brain cell activity, slowing reaction times and sometimes causing reduced muscle control, drowsiness or confusion. Before driving or operating heavy machinery, it’s important to know how this medication affects you.
This medication isn’t right for everyone. Before you begin taking clonazepam, talk to your doctor about any health conditions you experience, including:
- Narrow-angle glaucoma
- Porphyria (a group of blood disorders)
- Liver disease
- Kidney disease
- Lung or breathing problems
- A history of allergic reactions to benzodiazepines
- Mental health or mood disorders, including suicidal ideation or depression
- A personal or family history of substance use disorder
Dosage and Administration
Clonazepam is administered orally as an immediate-release tablet and an orally disintegrating tablet. For the immediate-release tablet, it’s important to take the pill whole, without breaking or crushing, with a full glass of water. If you’re taking the disintegrating tablet, make sure your hands are completely dry. You can take the medication with or without food.
If you miss a dose, take it as soon as you remember. If it’s nearly time for your next dose, skip the missed dose and get back on your normal schedule. Don’t take two doses at one time.
Dosage for Controlling Seizures
Adults and children aged 10 and over start at a dose of 0.5 mg three times daily. The doctor may adjust it from there up to a max dose of 20 mg per day. For children under age 10, dosing is based on body weight and typically ranges between 0.01-0.05 mg per kilogram of body weight.
Dosage for Controlling Panic Disorder
Adults typically start at a dose of 0.25 mg twice per day. The doctor may adjust as needed up to 4 mg per day. There are no dosage guidelines for children taking this medication for panic disorder.
Treatment Duration and Withdrawal
Because clonazepam has the potential to be habit-forming, current guidelines recommend that users take the smallest dose possible to control their symptoms for the shortest duration possible. For those using the drug off-label or for panic disorder, it’s normal to only be on the drug for six to nine weeks. However, those using the drug for seizure management may be on it long-term based on their response to the medication.
Once it’s time to come off clonazepam, it’s important to taper usage under the guidance of your doctor. A typical withdrawal timeline is as follows:
- 1-4 days: During this period, individuals may experience rebound anxiety and insomnia, and they may have a craving for the medication
- 2-14 days: This period brings acute withdrawal symptoms such as muscle cramps, nausea, irritability, anxiety and in some cases, seizures
- 15+ days: persistent anxiety, depression and sleep disturbances
Tapering off the medication gradually is generally an effective way to reduce the severity of withdrawal symptoms.
Conclusion
Clonazepam provides relief from seizures and panic disorder, enabling many of its users to enjoy an improved quality of life and functioning. While this medication may be habit-forming and isn’t for everyone, including those with a history of substance abuse, it’s a valuable option for those who need it and take it responsibly under their doctor’s supervision.
