Clonazepam (Klonopin®)

This article provides a detailed overview of clonazepam, including its uses and indications, side effects, and interactions. It also covers important information regarding misuse, dependence, addiction, and withdrawal.

Key Takeaways:

• Clonazepam is a benzodiazepine medication primarily used for panic disorders and seizures. It works by increasing the effects of GABA, which is an inhibitory neurotransmitter that calms the brain and nervous system.
• Clonazepam works quickly and is particularly useful for short-term situations. There is a risk of dependence if it is used long-term.
• Opioids, alcohol, and other drugs can cause dangerous and potentially life-threatening reactions when combined with clonazepam. Understanding all possible side effects and interactions is crucial for the safest and most effective treatment.

Understanding Clonazepam

Clonazepam is a prescription medication that belongs to the class of benzodiazepines. Examples of other benzodiazepines include alprazolam, lorazepam, and diazepam. Clonazepam is a long-acting, high-potency benzodiazepine. It helps to calm down the brain and nervous system, and offers anti-anxiety and anticonvulsant properties, which may help with panic, anxiety, seizures, and other conditions. ^[1]

How it Works

Generally, clonazepam works by calming down activity in the central nervous system (CNS). Clonazepam binds to specific areas of GABA receptors throughout the CNS, which increases the effects of GABA, an inhibitory neurotransmitter. In turn, this decreases nerve cell excitability and offers sedative, anti-anxiety, and muscle relaxant effects. ^[1]

Brand Names

The most common brand name of clonazepam is Klonopin®. Other brand names include: ^[2]

• Ceberclon®
• Rivotril®
• Paxam®

Conditions Clonazepam is Used For

Clonazepam is approved to treat: ^{[1] [2]}

• Panic disorder (with or without agoraphobia)
• Acute treatment of panic attacks
• Seizure disorders (either alone or as an adjunct to other medications), including:
• Acute management of epilepsy
• Acute management of non-convulsive status epilepticus (complex partial seizures or absence seizures)
• Lennox-Gestaut syndrome
• Minor motor seizures of childhood (e.g. petit mal absences)
• Infantile spasms

Panic disorder is a mental health disorder characterized by recurrent, unexpected panic attacks. Clonazepam may help control symptoms of panic attacks, such as rapid heart rate, trembling, sweating, shortness of breath, chest pain, and extreme anxiety and fear (such as fear of dying). ^{[1] [2]}

Off-Label Uses

There are also several off-label clonazepam uses as well. Clonazepam may be used off-label on its own or in conjunction with other medications for: ^[1]

• Mania
• Restless leg syndrome
• Insomnia
• Tardive dyskinesia
• REM sleep behavior disorder

How Common is It?

Clonazepam is one of the most commonly prescribed medications, and it is also a common prescription medication in general. As of 2023, estimates show that over 2 million patients are taking clonazepam in the United States alone, with over 10 million total prescriptions. ^[3]

Clonazepam Side Effects

Clonazepam has numerous possible side effects, due to its effects on many areas of the body. The most common clonazepam side effects are due to its CNS depressant properties and include: ^{[1] [2]}

• Drowsiness
• Lethargy
• Fatigue
• Motor impairment, such as:
• Impaired coordination
• Trouble with balance
• Dizziness

Other side effects reported with clonazepam are: ^{[1] [2] [4] [5]}

• Blurred vision
• Confusion
• Irritability
• Low libido
• Lack of motivation
• Agitation
• Worsening of depression
• Anterograde amnesia (difficulty forming new memories)
• Short-term memory loss
• Headache
• Increased saliva
• Muscle or joint pain
• Frequent urination
• Personality changes
• Dysphoria
• Ataxia (poor muscle control that can cause clumsy movements)
• Nervousness
• Menstrual irregularities
• Changes in appetite
• Weight changes

This list may not contain all possible side effects. Contact your doctor as soon as possible if you notice these or any other side effects after starting clonazepam.

Dangerous and Rare Side Effects

There are also several rare side effects of clonazepam. While these are not as common, some may be severe or even life-threatening. This includes: ^{[1] [2] [6]}

• Worsening depression and/or suicidal thoughts or behaviors: This risk may be higher in individuals with a history of depression or other mental health concerns
• CNS Depression: Symptoms include slow/shallow breathing, significant sedation, confusion, dizziness, and feeling faint. Severe CNS depression can lead to coma or (uncommonly) death.
• Allergic reactions: This may involve skin rash, hives, itching, and swelling of the lips, eyes, face, tongue, or throat. Severe reactions are life-threatening.
• Increased frequency of seizures
• Thrombocytopenia: This involves low blood platelet count, which increases the risk of bleeding.

Rarely, some individuals have paradoxical reactions when taking clonazepam, which may lead to any of the following symptoms: ^{[1] [2]}

• Excitement
• Rage
• Impulsivity
• Anxiety
• Aggression
• Hostility
• Nightmares
• Abnormal dreams
• Hallucinations

Some individuals also report engaging in specific behaviors while asleep, such as driving, eating, talking on the phone, having sex, or making food. They do not remember these events when they wake up. ^[6]

Misuse, Dependence, and Addiction

Clonazepam is listed as a Schedule IV drug under the Drug Enforcement Administration’s (DEA’s) Controlled Substances Act. This is due to the potential for misuse/abuse, dependence, and addiction. ^[1]

Continued use of clonazepam may lead to dependence, especially if it is taken for several weeks or longer, even when used as prescribed. This is when your body adapts to the presence of a drug, and requires it to function normally. The risk of dependence is greater with higher doses and longer periods of administration. ^{[2] [6]}

The sedative, anti-anxiety, and relaxant properties of clonazepam are sometimes pleasurable and may reinforce usage, which makes clonazepam potentially addictive. Some individuals may try to enhance these effects by taking more clonazepam than prescribed, or combining it with alcohol, opioids, or other drugs. These instances of misuse and abuse increase the risk of dependence and addiction. ^{[1] [2] [5]}

Misuse and abuse of clonazepam also increase the risk of dangerous side effects. It can lead to coma, seizures, delirium, or death in severe instances. ^[2]

Precautions

There are several precautions to be aware of with clonazepam. The following populations require extra caution when using clonazepam: ^{[1] [2] [4] [5]}

• Pregnant women: Clonazepam use may increase the risk of birth defects and pregnancy complications. It should only be used if the benefits clearly outweigh the risks.
• Breastfeeding women: Taking clonazepam while breastfeeding may cause side effects for newborns. Use is not recommended.
• Older adults: They may have a reduced drug clearance ability for clonazepam, which also increases the risk of dangerous side effects, such as falls and delirium. It still may be used if justified, but usually at a lower dose.
• Children under 18: Possibly suitable in cases of seizure disorder. Should not be used for panic disorder
• Individuals with any of the following conditions:
• Substance use disorders (extreme caution for this situation)
• Compromised respiratory function (extreme caution)
• Chronic obstructive pulmonary disease (COPD)
• Obstructive sleep apnea
• Asthma
• Hepatic (liver) or renal (kidney) impairments
• Depression or any mental health conditions
• Porphyria
• Trouble swallowing

Clonazepam use is contraindicated in individuals with the following conditions: ^{[1] [2]}

• Known sensitivity to benzodiazepines
• Liver disease
• Acute narrow-angle glaucoma

Considerations and Risks

Clonazepam can cause drowsiness and sedation, which may make it unsafe to drive, operate machinery, or perform any complex or mentally demanding tasks. Do not perform these activities until you know how clonazepam affects you and you receive your doctor’s approval to do so. ^[5]

Clonazepam is primarily recommended for short-term use. Long-term use increases the risk of dependence. It’s important to use the lowest beneficial dose of clonazepam and only use it as long as is truly necessary.

Taking more clonazepam than prescribed can lead to toxicity and overdose. Symptoms of overdose are typically exaggerated forms of normal side effects. Severe overdose can lead to respiratory depression, heart attack, coma, and death. ^{[1] [2]}

Drug Interactions

Clonazepam interacts with opioids, such as codeine, hydrocodone, oxycodone, and morphine. Taking clonazepam alongside opioids increases the risk of severe sedation, respiratory depression, coma, and death. They should not be used simultaneously whenever possible. ^{[1] [2]}

Beyond opioids, clonazepam interacts with many other drugs and medications, including: ^{[1] [2] [4] [6]}

• Other benzodiazepines (e.g. alprazolam, diazepam)
• Sleep medications (e.g. eszopiclone, zolpidem)
• Antipsychotics (e.g. fluphenazine, haloperidol)
• Anticonvulsants (e.g. carbamazepine, phenytoin)
• Barbiturates (e.g. phenobarbital)
• Monoamine oxidase inhibitors (MAOIs) (e.g. selegiline, isocarboxazid)
• Tricyclic antidepressants (e.g. imipramine, nortriptyline)
• Antihistamines (e.g. diphenhydramine)
• Certain antifungals (e.g. ketoconazole, itraconazole)
• Certain antibiotics (e.g. telithromycin, clarithromycin)
• Certain antiviral agents (e.g. ritonavir)

This list does not contain all possible drug interactions with clonazepam. Always tell your doctor every medication you currently take or have taken in the past.

Other Interactions

Clonazepam has potentially dangerous interactions with alcohol. This combination increases the risk of CNS depression, which can lead to slow/shallow breathing, severe sedation, dizziness, and coma or death in severe instances. ^{[1] [2]}

Clonazepam may interact with other substances, including: ^[4]

• Green tea
• St. John’s wort
• Valerian (and other herbs used for sleep or anxiety)
• Melatonin

In addition to prescription medications, it's important to tell your doctor everything you take, including over-the-counter medicines, vitamins, and herbal supplements.

Clonazepam Dosage

Clonazepam is formulated as immediate-release (IR) tablets and orally disintegrating tablets (ODTs). The IR tablets are available in strengths of 0.5 mg, 1 mg, and 2 mg, while the ODTs have strengths of 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, and 2 mg. ^[1]

Listed below are common doses for the primary indications of clonazepam: ^[1]

• Seizures:
• Adults and adolescents: 0.5 mg orally 3 times per day. Increased as needed, with a maximum dose of 20 mg per day.
• Geriatric patients: Same dose as adults. However, a lower starting dose is used due to potentially greater medication sensitivity.
• Pediatric patients: Initially, 0.01 to 0.03 mg/kg per day, divided into 2 to 3 doses. Maximum dose should not exceed 0.1 to 0.2 mg/kg in 3 doses.
• Panic disorder:
• Initial dose of 0.25 mg orally taken twice per day for three days. After that, it’s increased to 0.5 mg tablets twice per day. Maximum dose of 1 to 4mg.

Clonazepam Cessation and Withdrawal

Individuals who have taken clonazepam for longer than several weeks may develop physical dependence, which can lead to withdrawal symptoms when the dose is lowered. Thus, stopping clonazepam involves a carefully controlled tapering schedule, in which the dose of clonazepam is gradually lowered over time. ^{[1] [2]}

Suddenly stopping clonazepam after long-term use can lead to dangerous and potentially life-threatening withdrawal symptoms. It also increases the risk of protracted withdrawal, which can last for several weeks up to 12 months. ^{[2] [5]}

It’s important to note that some individuals may experience withdrawal symptoms even when stopping clonazepam in a controlled, gradual manner. Listed below are common symptoms of withdrawal: ^{[1] [2] [5]}

• Anxiety
• Irritability
• Insomnia
• Headache
• Tremors
• Depression
• Sweating
• Confusion
• Seizures
• Hallucinations

Reach out to your doctor as soon as possible if you notice any of these symptoms.

Clonazepam and Integrated Therapy

Clonazepam is often integrated with other therapies to form a more comprehensive treatment plan and to promote better functioning and well-being. Depending on the situation, clonazepam may be combined with psychotherapy and/or additional medications.

Psychotherapy is often recommended alongside clonazepam for individuals with panic disorder. One of the most beneficial forms of psychotherapy for panic disorder is cognitive behavioral therapy (CBT). It involves many components, such as cognitive restructuring, breathing retraining, muscle relaxation, emotional regulation, and exposure, all of which can help reduce panic and anxiety. Furthermore, CBT is very valuable since it promotes long-term mental well-being and may reduce the need to rely on clonazepam or other medications. ^[7]

Regarding medications, SSRIs may be added alongside clonazepam for panic and anxiety. SSRIs take longer to work, but they may be safer to use long-term. Clonazepam may also be used in combination with other anti-seizure medications for individuals with seizures.

Clonazepam FAQs

Listed below are frequently asked questions about the use of clonazepam.

Can clonazepam be dangerous?

Yes, clonazepam can be dangerous, especially when it is combined with opioids, alcohol, or other drugs that depress the nervous system. These interactions can be fatal. Clonazepam can also lead to dependence and addiction, and there are many possible side effects and interactions.

Is clonazepam a controlled substance?

Yes, clonazepam is classified as a Schedule IV controlled substance under the DEA’s Controlled Substances Act.

Can you take clonazepam for sleep?

Clonazepam is sometimes prescribed off-label for sleep. Only take clonazepam for sleep if you’re specifically instructed to do so.

Is clonazepam hard to stop using?

Clonazepam may be difficult to stop using, especially if you’ve taken it continuously for several weeks or longer. You may experience uncomfortable withdrawal symptoms when the dose is lowered, which sometimes can be very distressing.

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

David MilesPharmD

David is a seasoned Pharmacist, natural medicines expert, medical reviewer, and pastor.

Activity History - Medically reviewed on March 26, 2026 and last checked on March 19, 2026