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clonazepam
Klonopin · Klonopin Wafers / ODT
Benzodiazepine⚠ Unverified beta content
At a glance
- Class
- Long-acting benzodiazepine (CIV)
- Black box
- ⚠ Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and…
- ⚠ Abuse, misuse, and addiction can lead to overdose or death (risk increased with other…
- ⚠ Dependence and withdrawal reactions
- Key monitoring
- Respiratory rate, SpO2, sedation
- Withdrawal signs / dependence
- Usual adult dose
- Panic disorder (label): Start 0.25 mg BID; ↑ to target 1 mg/day after 3 days; max 4 mg/day
- Call provider / escalate if
- Slow or shallow breathing; very hard to wake • Confusion, severe drowsiness, unsteadiness, falls • Withdrawal: shaking, sweating, severe anxiety, hallucinations, seizure
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- clonazepam (Klonopin, Klonopin Wafers / ODT) — long-acting benzodiazepine (CIV).
- Used for: Seizure disorders; Panic disorder with or without agoraphobia.
Usual adult dosing
- Panic disorder (label): Start 0.25 mg BID; ↑ to target 1 mg/day after 3 days; max 4 mg/day (Increase by 0.125–0.25 mg BID every 3 days if needed. 1 mg/day was optimal in the fixed-dose study.)
- Seizure disorders (adults, label): Start ≤1.5 mg/day in 3 doses; ↑ 0.5–1 mg every 3 days; max 20 mg/day
- Discontinuation (label): Gradual taper, e.g., decrease 0.125 mg BID every 3 days (Slower taper if withdrawal symptoms develop.)
- Older / debilitated: Start low; observe closely
Boxed warning
- Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death; reserve combined use for patients with no alternatives and limit dose and duration.
- Abuse, misuse, and addiction can lead to overdose or death (risk increased with other medications, alcohol or illicit substances); assess risk before and during treatment.
- Dependence and withdrawal reactions: continued use may cause physical dependence; abrupt discontinuation or rapid dose reduction can cause life-threatening withdrawal – use a gradual taper.
Monitor
- Respiratory rate, SpO2, sedation [Initiation, dose changes, with other CNS depressants/opioids]
- Withdrawal signs / dependence [With long-term use or taper]
Nursing priorities
- Baseline RR, SpO2, sedation, BP/HR.
- Substance use history (alcohol, opioids, benzodiazepines); misuse risk.
- Check sedation and respiratory status, especially at initiation and with other CNS depressants.
- Fall precautions.
- Do not stop abruptly – taper per provider orders; monitor for withdrawal (tremor, anxiety, insomnia, seizures).
Major interactions
- Opioids: Profound sedation, respiratory depression, coma, death (boxed warning).
- Alcohol, other CNS depressants: Additive CNS and respiratory depression.
- Olanzapine IM / clozapine: Additive CNS/cardiorespiratory depression – use caution.
Key teaching
- It can make you drowsy and unsteady. Do not drive or use machines until you know how it affects you.
- Do not drink alcohol or take opioid pain medicines or other sedatives with it unless your provider says so – this can slow breathing dangerously.
- It can be habit-forming. Take only as prescribed and never share it.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death; reserve combined use for patients with no alternatives and limit dose and duration.
- Abuse, misuse, and addiction can lead to overdose or death (risk increased with other medications, alcohol or illicit substances); assess risk before and during treatment.
- Dependence and withdrawal reactions: continued use may cause physical dependence; abrupt discontinuation or rapid dose reduction can cause life-threatening withdrawal – use a gradual taper.
Other serious warnings
- Respiratory depression (esp. with opioids/alcohol/CNS depressants)
- Dependence and withdrawal (including seizures) – taper slowly
- Suicidal thoughts and behavior (antiepileptic class warning)
- Paradoxical reactions (agitation, aggression)
- May increase generalized tonic-clonic seizures when multiple seizure types coexist
- Increased salivation / aspiration risk in those with compromised airway
- Falls and cognitive impairment (Beers criteria in older adults)
- Neonatal sedation/withdrawal with late-pregnancy use
Sources: FDA label (DailyMed): KLONOPIN (CLONAZEPAM) TABLET [H2-PHARMA, LLC] · FDA Drug Safety Communication (Sept 2020): boxed warning update for be
- Respiratory rate, SpO2, sedationWhen: Initiation, dose changes, with other CNS depressants/opioids
- Withdrawal signs / dependenceWhen: With long-term use or taper
- Falls / cognitionWhen: Every contact in older adults
- Seizure frequency (if used for seizures)
- Suicidality / mood
- Misuse risk / PDMPPer prescriber/facility policy
Sources: FDA label (DailyMed): KLONOPIN (CLONAZEPAM) TABLET [H2-PHARMA, LLC] · FDA Drug Safety Communication (Sept 2020): boxed warning update for be
Assessment
- Baseline RR, SpO2, sedation, BP/HR.
- Substance use history (alcohol, opioids, benzodiazepines); misuse risk.
- Fall risk, age, respiratory disease/sleep apnea.
- Seizure history; concurrent anticonvulsants; hepatic function.
- Suicidal ideation.
Interventions
- Check sedation and respiratory status, especially at initiation and with other CNS depressants.
- Fall precautions.
- Do not stop abruptly – taper per provider orders; monitor for withdrawal (tremor, anxiety, insomnia, seizures).
- Controlled substance (C-IV): follow facility handling and PDMP policy.
- ODT: place on tongue with dry hands; do not push through foil.
- Long duration of action: sedation may persist into next day (esp. older adults).
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Slow or shallow breathing; very hard to wake
- Confusion, severe drowsiness, unsteadiness, falls
- Withdrawal: shaking, sweating, severe anxiety, hallucinations, seizure
- Worsening seizures
- Suicidal thoughts or severe mood changes
- Agitation or aggression (paradoxical)
- Combined use with opioids or alcohol
Sources: FDA label (DailyMed): KLONOPIN (CLONAZEPAM) TABLET [H2-PHARMA, LLC] · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Sedation / drowsiness
- Dizziness, unsteadiness, ataxia
- Depression, fatigue
- Memory impairment, confusion
- Behavior problems (esp. children)
- Increased salivation
- Coordination problems
Sources: FDA label (DailyMed): KLONOPIN (CLONAZEPAM) TABLET [H2-PHARMA, LLC]
- Opioids MajorProfound sedation, respiratory depression, coma, death (boxed warning).
- Alcohol, other CNS depressants MajorAdditive CNS and respiratory depression.
- CYP3A4 inducers (carbamazepine, phenytoin, phenobarbital, rifampin)May lower clonazepam levels.
- CYP3A4 inhibitors (e.g., ketoconazole, some macrolides)May increase clonazepam effect.
- ValproateConcomitant use may produce absence status (label) – use caution in absence seizures.
- Olanzapine IM / clozapine MajorAdditive CNS/cardiorespiratory depression – use caution.
Sources: FDA label (DailyMed): KLONOPIN (CLONAZEPAM) TABLET [H2-PHARMA, LLC]
- It can make you drowsy and unsteady. Do not drive or use machines until you know how it affects you.
- Do not drink alcohol or take opioid pain medicines or other sedatives with it unless your provider says so – this can slow breathing dangerously.
- It can be habit-forming. Take only as prescribed and never share it.
- Do not stop suddenly if you take it regularly – this can cause seizures and other withdrawal symptoms. Your provider will lower the dose slowly.
- Because it lasts a long time, you may feel sleepy the next day.
- Rise slowly to prevent falls.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Seizure disorders (Lennox-Gastaut, akinetic, myoclonic; absence seizures refractory to succinimides)
- Panic disorder with or without agoraphobia
- Common off-label: akathisia, catatonia, short-term anxiety, REM-sleep behavior disorder
Dosing
- Panic disorder (label): Start 0.25 mg BID; ↑ to target 1 mg/day after 3 days; max 4 mg/dayIncrease by 0.125–0.25 mg BID every 3 days if needed. 1 mg/day was optimal in the fixed-dose study.
- Seizure disorders (adults, label): Start ≤1.5 mg/day in 3 doses; ↑ 0.5–1 mg every 3 days; max 20 mg/day
- Discontinuation (label): Gradual taper, e.g., decrease 0.125 mg BID every 3 daysSlower taper if withdrawal symptoms develop.
- Older / debilitated: Start low; observe closely
Sources: FDA label (DailyMed): KLONOPIN (CLONAZEPAM) TABLET [H2-PHARMA, LLC]
Prescriber-oriented details; limited in this beta.
geriatric
- Beers criteria: avoid when possible; start low.
pregnancy Lactation
- Neonatal sedation/withdrawal – see label.
discontinuation
- Label example: reduce 0.125 mg BID every 3 days; slow further if withdrawal.
Sources: FDA label (DailyMed): KLONOPIN (CLONAZEPAM) TABLET [H2-PHARMA, LLC]
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): KLONOPIN (CLONAZEPAM) TABLET [H2-PHARMA, LLC]
- FDA Drug Safety Communication (Sept 2020): boxed warning update for benzodiazepines (abuse, misuse, addiction, dependence, withdrawal)
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified
Reviewer notes – please double-check
- Long half-life (≈30–40 h) mentioned in teaching is general pharmacology, not directly confirmed in this entry’s label extract – verify.