Clonazepam

Clonazepam is a prescription medication used to treat panic disorder and certain types of seizure disorders. Clonazepam belongs to a group of drugs called benzodiazepines, which help to slow down brain activity.

This medication comes in regular-release and orally disintegrating tablet form and is taken usually 1 or 3 times a day, with or without food. The regular-release tablets should be taken with water. The orally disintegrating tablets are placed in the mouth and will dissolve, with or without water.

Common side effects of clonazepam include drowsiness, walking or coordination problems, and dizziness. Do not drive or operate machinery until you know how clonazepam will affect you.

Clonazepam is a prescription medicine used alone or with other medicines to treat:

• certain types of seizure disorders (epilepsy) in adults and children
• panic disorder with or without fear of open spaces (agoraphobia) in adults

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Clonazepam may be found in some form under the following brand names:

• Klonopin

• KlonoPIN Wafer

The most common side effects of clonazepam include:

• drowsiness
• problems with walking and coordination
• dizziness
• depression
• fatigue
• problems with memory

Clonazepam can cause serious side effects (see "Clonazepam Precautions").

These are not all the possible side effects of clonazepam. For more information, ask your healthcare provider or pharmacist. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects. 

Tell your doctor about the medicines you take including prescription and nonprescription medications, vitamins, and nutritional supplements. Especially tell your doctor if you take any of the following:

• amiodarone (Cordarone, Pacerone)
• certain antibiotics such as clarithromycin (Biaxin) and erythromycin (Erythrocin, E-mycin),
• antidepressants
• certain antifungal medications such as itraconazole (Sporanox) and ketoconazole (Nizoral)
• antihistamines
• certain calcium channel blockers such as diltiazem (Cardizem, Dilacor, Tiazac) and verapamil (Calan, Isoptin, Verelan)
• cimetidine (Tagamet)
• HIV protease inhibitors including indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra)
• medications for anxiety, colds or allergies, mental illness, or pain
• other medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), or valproic acid (Depakene, Depakote)
• muscle relaxants
• nefazodone
• rifampin (Rifadin, Rimactane)
• sedatives
• certain selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine (Luvox)
• other sleeping pills
• tranquilizers

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

Tell your doctor what herbal products you are taking, especially St. John's wort.

Clonazepam can cause serious side effects, including:

• Clonazepam can slow your thinking and motor skills
  • Do not drive, operate heavy machinery, or do other dangerous activities until you know how clonazepam affects you.
  • Do not drink alcohol or take other drugs that may make you sleepy or dizzy while taking clonazepam until you talk to your healthcare provider. When taken with alcohol or drugs that cause sleepiness or dizziness, clonazepam may make your sleepiness or dizziness worse.
• Like other antiepileptic drugs, clonazepam may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.
  • Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:
    • thoughts about suicide or dying
    • attempt to commit suicide
    • new or worse depression
    • panic attacks
    • trouble sleeping (insomnia)
    • new or worse irritability
    • acting aggressive, being angry, or violent
    • acting on dangerous impulses
    • an extreme increase in activity and talking (mania)
    • other unusual changes in behavior or mood
  • How can I watch for early symptoms of suicidal thoughts and actions?
    • Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings.
    • Keep all follow-up visits with your healthcare provider as scheduled.
    • Call your healthcare provider between visits as needed, especially if you are worried about symptoms.
    • Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.
    • Do not stop clonazepam without first talking to a healthcare provider.
    • Stopping clonazepam suddenly can cause serious problems. Stopping clonazepam suddenly can cause seizures that will not stop (status epilepticus).
• Clonazepam may harm your unborn or developing baby.
  • If you take clonazepam during pregnancy, your baby is at risk for serious birth defects. These defects can happen as early as in the first month of pregnancy, even before you know you are pregnant. Birth defects may occur even in children born to women who are not taking any medicines and do not have other risk factors.
  • Children born to mothers receiving benzodiazepine medications (including clonazepam) late in pregnancy may be at some risk of experiencing breathing problems, feeding problems, hypothermia, and withdrawal symptoms.
  • Tell your healthcare provider right away if you become pregnant while taking clonazepam. You and your healthcare provider should decide if you will take clonazepam while you are pregnant.
  • If you become pregnant while taking clonazepam, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. You can register by calling 1-888-233-2334. The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy.
  • Clonazepam can pass into breast milk. Talk to your healthcare provider about the best way to feed your baby if you take clonazepam. You and your healthcare provider should decide if you will take clonazepam or breastfeed. You should not do both.
• Clonazepam can cause abuse and dependence.
  • Do not stop taking clonazepam all of a sudden. Stopping clonazepam suddenly can cause seizures that do not stop, hearing or seeing things that are not there (hallucinations), shaking, and stomach and muscle cramps.
  • Talk to your doctor about slowly stopping clonazepam to avoid getting sick with withdrawal symptoms.
  • Physical dependence is not the same as drug addiction. Your healthcare provider can tell you more about the differences between physical dependence and drug addiction.

Clonazepam is a federally controlled substance (C-IV) because it can be abused or lead to dependence. Keep clonazepam in a safe place to prevent misuse and abuse. Selling or giving away clonazepam may harm others, and is against the law. Tell your doctor if you have ever abused or been dependent on alcohol, prescription medicines or street drugs.

Do not take clonazepam if you:

• are allergic to benzodiazepines
• have significant liver disease
• have an eye disease called acute narrow angle glaucoma

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of clonazepam there are no specific foods that you must exclude from your diet when receiving clonazepam.

Before you take clonazepam, tell your healthcare provider if you:

• have liver or kidney problems
• have lung problems (respiratory disease)
• have or have had depression, mood problems, or suicidal thoughts or behavior
• have any other medical conditions

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Taking clonazepam with certain other medicines can cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category D. Taking this medication while pregnant may cause harm to the unborn baby. Tell your doctor if you become pregnant or intend to become pregnant during therapy with clonazepam. It is encouraged to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry if you become pregnant. This registry is collecting information about the safety of antiepileptic drugs during pregnancy. To enroll, you can call the toll free number 1-888-233-2334.

Tell your doctor if you are breastfeeding or planning to breastfeed. Clonazepam may be excreted in human breast milk and may cause harm to your nursing baby.

• Take clonazepam exactly as your doctor tells you. Clonazepam is available as a tablet or as an orally disintegrating tablet (wafer).
• Do not stop taking clonazepam without first talking to your doctor. Stopping clonazepam suddenly can cause serious problems.
• Clonazepam immediate-release tablets should be taken with water and swallowed whole.
• Clonazepam disintegrating tablets can be taken with or without water.
  • Do not open the pouch until you are ready to take clonazepam.
  • After opening the pouch, peel back the foil on the blister pack.
  • Do not push the wafer through the foil.
  • After opening the blister pack, with dry hands, take the disintegrating tablet and place it in your mouth.
  • The disintegrating tablet will melt quickly. It can be taken with or without water.
• If you take too much clonazepam, call your healthcare provider or local Poison Control Center right away.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your height
• your age
• your gender

Klonopin (regular-release tablet) and orally disintegrating tablets:

• The recommended dose for adults with seizure disorders should not exceed 1.5 mg/day divided into 3 doses. Maximum recommended daily dose is 20 mg.
• In order to minimize drowsiness, the starting dose for infants and children (up to 10 years of age or 30 kg of body weight) should be between 0.01 and 0.03 mg/kg/day but not to exceed 0.05 mg/kg/day given in 2 or 3 divided doses. Whenever possible, the daily dose should be divided into 3 equal doses. If doses are not equally divided, the largest dose should be given before going to bed.

If you take too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If this medication is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store between 59°F to 86°F (15°C to 30°C).
• Keep clonazepam and all medicines out of the reach of children.