Clonazepam

Aka: Clonazepam, Klonopin

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II. Class

  1. Long acting Benzodiazepine

III. Indications

  1. Anxiety Disorder
  2. Tic Disorder or Tourette's Syndrome
  3. Seizure Disorder
    1. Lennox-Gastaut Syndrome
    2. Akinetic Seizure
    3. Myoclonic Seizure

IV. Contraindications

  1. Hepatic Failure
  2. Narrow Angle Glaucoma

V. Dosing: Adults

  1. Panic Disorder or Generalized Anxiety Disorder
    1. Start 0.25 orally twice daily
    2. Titrate: Increase by 0.125 to 0.25 every 3 days to typical target dose of 1 mg/day divided
    3. Maximum Daily Dose: 4 mg (1.5 mg/day in elderly)
      1. No evidence of benefit for total daily dose above 1 to 2 mg
  2. Akinetic or Myoclonic Seizures or Lennox-Gestaut Syndrome (type of Petit Mal Seizures)
    1. Start 0.5 mg orally three times daily
    2. May increase dose by 0.5 to 1 mg orally every 3 days as needed to typical 2 to 8 mg/day in divided doses
    3. Maximum: 20 mg/day
  3. REM Sleep Behavior Disorder (Not FDA approved)
    1. Dose 1 to 2 mg orally at bedtime

VI. Dosing: Children (age <10 years or weight <30 kg)

  1. Akinetic or Myoclonic Seizures or Lennox-Gestaut Syndrome (type of Petit Mal Seizures)
    1. Start 0.01 to 0.03 mg/kg/day orally divided 2 to 3 times daily
    2. May increase dose by 0.25 to 0.5 mg orally every 3 days as needed
    3. Maximum: 0.1 to 0.2 mg/day divided 2 to 3 times daily

VII. Dosing: Equivalent Dosing (for Benzodiazepine Withdrawal)

  1. Valium = Clonazepam Dose x2.5
  2. Phenobarbital = Clonazepam Dose x7.5

VIII. Pharmacokinetics

  1. Half Life: 20-48 hours (up to 60 hours)
  2. Therapeutic Range: 20 to 80 ng/ml
  3. Rapidly and completely absorbed PO
  4. Metabolized via CYP3A4 to inactive metabolites

IX. Safety

  1. Pregnancy Category D (esp. avoid in first trimester)
  2. Avoid in Lactation
  3. Schedule IV Controlled Substance

X. Adverse Effects

  1. Sedation
  2. Weight gain
  3. Impaired academic performance
  4. Social anxiety with School Refusal in children
  5. Worsening of attention in children with ADHD
  6. Hypersalivation

XI. Resources

  1. Clonazepam Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=542f22e8-dad2-47a8-93b6-30936715d73b

XII. References

  1. (2019) Med Lett Drugs Ther 61(1578): 121-6
  2. (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

clonazepam (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CLONAZEPAM 0.125 MG DIS TAB Generic $0.57 each
CLONAZEPAM 0.125 MG ODT Generic $0.53 each
CLONAZEPAM 0.25 MG ODT Generic $0.56 each
CLONAZEPAM 0.5 MG DIS TABLET Generic $0.54 each
CLONAZEPAM 0.5 MG ODT Generic $0.49 each
CLONAZEPAM 0.5 MG TABLET Generic $0.03 each
CLONAZEPAM 1 MG DIS TABLET Generic $0.62 each
CLONAZEPAM 1 MG ODT Generic $0.42 each
CLONAZEPAM 1 MG TABLET Generic $0.03 each
CLONAZEPAM 2 MG ODT Generic $1.25 each
CLONAZEPAM 2 MG TABLET Generic $0.03 each
klonopin (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
KLONOPIN 0.5 MG TABLET Generic $0.03 each
KLONOPIN 1 MG TABLET Generic $0.03 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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