How does this medication work? What will it do for me?
Clonazepam belongs to the class of medications called benzodiazepines. In general, benzodiazepines are used as a sedative or to decrease seizures or anxiety. Clonazepam is used to treat seizure disorders. It helps by slowing the activity of the nerves in the brain (i.e., the central nervous system).
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each orange, round, flat-faced, bevelled-edge, compressed tablet, engraved modified “N” over “N” on one side and “0.5” on the reverse, contains 0.5 mg of clonazepam. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, FD&C Yellow No. 6, glycerin, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and polysorbate 20.
Each white, round, flat-faced, bevelled-edge, compressed tablet, engraved modified “N” over “N” on one side and “2” on the reverse, contains 2 mg of clonazepam. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, glycerin, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and polysorbate 20.
How should I use this medication?
The dose of clonazepam is determined based on how much is needed to control seizures and varies from person to person. It is important that the dose be individualized to your specific needs to avoid decreased coordination or excessive drowsiness.
The recommended adult starting dose of clonazepam should not be greater than 1.5 mg per day in 3 divided doses. This helps to minimize drowsiness and other side effects. Your doctor will gradually increase the dose until your seizures are controlled. The recommended maintenance dose for adults is 8 mg to 10 mg per day in 3 divided doses.
For children up to 10 years old or who weigh 30 kilograms or less, the dose is based on body weight. The starting dose should be calculated as 0.01 mg per kilogram of body weight per day to 0.03 mg per kilogram of body weight per day, divided into 2 or 3 doses. The maximum starting dose should be no more than 0.05 mg per kilogram of body weight per day. The doctor will gradually increase the dose until the child’s seizures are controlled. Generally, the maintenance dose is between 0.1 mg per kilogram and 0.2 mg per kilogram of body weight.
Clonazepam may be taken with food or on an empty stomach. Avoid drinking grapefruit juice while you are taking this medication as it can increase the levels of clonazepam in your blood.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not use clonazepam if you:
- are allergic to clonazepam, or any ingredients of the medication
- have had an allergic reaction to any other benzodiazepine (e.g., lorazepam, diazepam, oxazepam)
- have acute narrow or closed angle glaucoma
- have myasthenia gravis
- have severe breathing problems
- have severe liver disease
- have sleep apnea
Clonazepam may be used by people with open angle glaucoma who are receiving appropriate treatment.
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- clumsiness or unsteadiness
- delayed reaction
- dizziness or lightheadedness
- increased watering of the mouth
- muscle weakness
- unusual tiredness or weakness
Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- abnormal thinking (disorientation, delusions, or loss of sense of reality)
- behaviour changes (e.g., aggressiveness, agitation, unusual excitement, nervousness, or irritability)
- convulsions (seizures)
- hallucinations (hearing or seeing things that aren’t there)
- increased falls
- memory loss of recent events
- nightmares or trouble sleeping
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- signs of a severe allergic reaction (e.g., hives; difficulty breathing; or swelling of the mouth, tongue, lips, or throat)
- thoughts of self-harm, suicide
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.
Alcohol: People taking this medication should not consume alcohol since doing so can reduce the effectiveness of this medication and increase the risk of side effects.
People who have an addiction to alcohol or other drugs should not take clonazepam except in rare situations under medical supervision.
Breathing: Clonazepam can suppress breathing. This effect on breathing may be more pronounced for people with breathing problems, brain damage, or who are taking other medications that suppress breathing (e.g., codeine, morphine). If you have severe breathing problems, discuss the risks and benefits of taking this medication your doctor.
Coordination problems: If you have a medical condition that affects coordination (e.g., spinal or cerebellar ataxia, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Dependence and withdrawal: Physical dependence (a need to take regular doses to prevent physical symptoms) has been associated with benzodiazepines such as clonazepam. Severe withdrawal symptoms may occur if the dose is significantly reduced or suddenly stopped. These symptoms include seizures, irritability, nervousness, sleep problems, agitation, tremors, diarrhea, abdominal cramps, vomiting, memory impairment, headache, muscle pain, extreme anxiety, tension, restlessness, and confusion. Reducing the dose gradually under medical supervision can help prevent or decrease these withdrawal symptoms. Do not suddenly stop taking this medication without talking to your doctor.
Depression: Clonazepam, like other benzodiazepines, has been known to cause mood swings and symptoms of depression. If you have depression or a history of depression, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, or notice them in a family member who is taking this medication contact your doctor as soon as possible.
Clonazepam is not recommended for use by people with depression or psychosis or who have attempted suicide.
Drowsiness/reduced alertness: Because clonazepam causes drowsiness and sedation, avoid activities requiring mental alertness, judgment, and physical coordination (such as driving or operating machinery) while taking it. This is particularly true when first taking the medication and until you have established how clonazepam affects you. Alcohol can increase the drowsiness effects and should be avoided.
Grapefruit juice: Avoid drinking grapefruit juice while you are taking this medication as it can increase the levels of clonazepam in your blood.
Kidney function: Decreased kidney function or kidney disease may cause this medication to build up in the body, causing side effects. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Lactose intolerance: Lactose is one of the ingredients in this medication. If you have a hereditary condition that makes you intolerant to lactose, discuss other alternatives with your doctor.
Liver function: If you have liver disease or decreased liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severe liver problems should not take this medication.
Memory: This medication may impair recent memory. If you experience this while taking this medication, contact your doctor.
Porphyria: If you have porphyria, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Seizures: For some people taking this medication, seizures may worsen or a new type of seizure can occur. If you experience worsening seizures or the frequency of your seizures does not decrease while taking this medication, contact your doctor.
Pregnancy: Taking clonazepam during pregnancy can increase the risk of certain birth defects. This medication should only be used during pregnancy if the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. Do not stop taking this medication suddenly, as this may result in withdrawal symptoms. Discuss the options with your doctor and follow their instructions closely.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking clonazepam, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: If long-term use of clonazepam is being considered for a child, discuss with your child’s doctor the benefits and the risks of clonazepam use. Long-term use may have an effect on your child’s physical and mental development.
Seniors: Seniors may be at increased risk for the sedative and impaired coordination effects of this medication. This can increase the risk of falls and fractures. Seniors may require lower doses of this medication.
What other drugs could interact with this medication?
There may be an interaction between clonazepam and any of the following:
- abiraterone acetate
- antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
- antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- barbiturates (e.g., butalbital, phenobarbital)
- benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- chloral hydrate
- general anesthetics (medications used to put people to sleep before surgery) grapefruit juice
- HIV non-nucleoside reverse transcriptase inhibitors (e.g., delavirdine, efavirenz, etravirine, nevirapine)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- kava kava
- macrolide antibiotics (e.g., clarithromycin, erythromycin)
- magnesium sulfate
- muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
- narcotic-containing medications (e.g., codeine, oxycodone, morphine)
- proton pump inhibitors (e.g., lansoprazole, omeprazole)
- St. John’s wort
- seizure medications (e.g., clobazam, carbamazepine, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
- theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
- tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, the nicotine from cigarettes, or street drugs can affect the action of many medications; you should let your prescriber know if you use them.