Clonazepam

KLONOPIN

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What it isLong-acting GABA-A positive allosteric modulator; panic disorder and seizure disorders.

Why this oneLong persistence smooths interdose rebound compared with alprazolam and supports myoclonic-seizure control.

What limits itAccumulation causes sedation and falls; dependence and withdrawal remain. Opioids or alcohol add dangerous respiratory depression.

FDA-approved for

seizures (1975)
panic disorder (1997)

Off-label

REM sleep behavior disorder
restless legs

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Concomitant use with opioids: profound sedation, respiratory depression, coma, death. Benzodiazepine abuse, misuse, and addiction (overdose/death). Physical dependence; abrupt discontinuation or rapid dose reduction can cause life-threatening withdrawal.

FDA dosing	Population	Start	Target	Max
Seizure disorders	Adult	<=1.5 mg/day divided TID	Individualized	20 mg/day
Seizure disorders	Peds <=10 yr or <=30 kg	0.01-0.03 mg/kg/day divided BID-TID (max 0.05 mg/kg/day)	0.1-0.2 mg/kg/day	0.2 mg/kg/day
Panic disorder	Adult	0.25 mg BID	1 mg/day	4 mg/day

Titration Seizures: increase 0.5-1 mg every 3 days; panic: increase to 1 mg/day after 3 days

Renal Caution - metabolites renally excreted; risk of accumulation in renal impairment

Hepatic Contraindicated in significant liver disease; hepatic metabolism may be impaired

Instructions

Swallow tablet whole with water
Discontinue by gradual taper to avoid withdrawal, rebound seizures, and status epilepticus
Panic: taper by 0.125 mg BID every 3 days
Elderly: start at low end of dosing range

Contraindications

Significant liver disease
Acute narrow-angle glaucoma

Cautions

CNS depression/sedation; impaired driving and machine operation
Suicidal thoughts/behavior (antiepileptic class)
Respiratory depression with opioids/CNS depressants
Dependence and withdrawal reactions
Paradoxical reactions (agitation, aggression, hostility)
Neonatal sedation/withdrawal with late-pregnancy exposure

Adverse reactions

Drowsiness/somnolence
Ataxia
Dizziness
Behavior problems
Depression
Coordination abnormal
Fatigue
Memory disturbance
Upper respiratory tract infection

Pregnancy Benzodiazepines cross placenta; neonatal sedation, respiratory depression, hypotonia, and withdrawal with late-pregnancy exposure; AED pregnancy registry available

Lactation Clonazepam is excreted in human milk; monitor breastfed infant for sedation, poor feeding, poor weight gain

⚠ BOXED WARNINGS

Risk from concomitant use with opioids
Abuse, misuse and addiction
Dependence and withdrawal reactions

Cost, est. cash$4–$80/month

Generic entry1996

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryD

Defining liabilitySedation, falls, dependence and dangerous additive respiratory depression with opioids.

Active metabolites

7-amino clonazepam

Mechanism of action: Clonazepam ballicule

Clonazepam ballicule: receptor binding, kinetics and half-life diagram

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Memory aids: mascots and interaction avatars

Clonazepam KLONOPIN mascot mnemonic cartoon — **“Cloned pin”**

CYP3A4 substrate

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