Klonopin (Clonazepam): Uses, Side Effects, Dosage, & More

What Is Klonopin?

Klonopin, also known as clonazepam, is a benzodiazepine medication that is FDA-approved to treat seizure and panic disorders. Klonopin is believed to work by increasing the activity of a neurotransmitter, a substance sent between brain cells for communication. Specifically, Klonopin increases the neurotransmitter, gamma-aminobutyric acid (GABA), which helps to reduce overactivity and promote a general calming effect.¹ The FDA has approved Klonopin for the treatment of seizures in both adults and children, as well as panic disorders in adults.

How Does Klonopin Work?

Excessive activity in the brain and nervous system can cause symptoms of anxiety. Klonopin works by increasing the activity of GABA, which helps to reduce this overactivity and promote a sense of relaxation. This is likely due to the ability of GABA to inhibit activity in the fear circuits of the brain.² By reducing activity in these areas, Klonopin can help alleviate symptoms of anxiety and panic.

What Is Klonopin Used to Treat?

Benzodiazepines like Klonopin are usually prescribed by physicians after non-medication treatments have been unsuccessful or when symptoms are significantly impacting daily life. Although the FDA has approved Klonopin for the treatment of seizure disorders in adults and children, it is only approved for the treatment of panic disorders in adults. It is also important to note that Klonopin, like other medications, may be prescribed for off-label use, which means it is being used to treat a condition for which it has not been approved by the FDA. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to their patient.

Klonopin is an FDA-approved medication to treat:^1,3

• Panic Disorders (with or without Agoraphobia)
• Seizure disorders

Klonopin is also sometimes used off-label (non-FDA-approved) for treating:^2,4,5,6,7

• Bipolar disorder
• Restless leg syndrome
• Catatonic reactions
• Insomnia

Who Should Not Take Klonopin?

To ensure the safe use of Klonopin, there are certain groups of people who should not take this medication or use it with caution. Individuals with known hypersensitivity or allergy to clonazepam or other benzodiazepines should avoid taking Klonopin. It should also be avoided in those with severe liver disease and acute narrow glaucoma, as it can worsen these conditions. Klonopin is usually suggested to be avoided for pregnant and breastfeeding people as it can increase the risk of birth defects and lead to feeding difficulties, sedation, and weight loss in infants. If you are pregnant, breastfeeding, or become pregnant while taking Klonopin, talk with your doctor to understand the pros and cons of taking the medication

For those starting Klonopin, it is important to consult with your doctor and inform them of your medical history and current medications. It is important to take caution when using other CNS depressants or seizure medications, as it can result in harmful side effects. Additionally, dose adjustments may be necessary for elderly individuals or those with a history of kidney or heart impairment.

People who may need to avoid taking Klonopin include:

• Pregnant and breastfeeding people
• People with pre-existing health conditions, especially liver disease and acute narrow glaucoma
• People with allergies to other benzodiazepines
• People who also take opioid pain medications
• People with a history of medication abuse or addiction

Klonopin Dosages for FDA-Approved Treatment

The Klonopin dosage for FDA-approved treatment can vary based on the individual’s age, medical condition, and other factors, including weight and kidney function. When a medication is FDA-approved, it means that the United States Food and Drug Administration has evaluated and approved the medication for a specific use based on clinical trials and scientific evidence.

For adults, the dose range for the treatment of panic disorders is 0.25 mg to 4 mg per day. Typically, treatment will start at 0.25 mg taken twice a day. After three days, this can be increased to 1 mg per day. Although higher doses can be used, 1 mg per day is often the target dose to decrease the chance of adverse effects. The dosage may vary depending on the individual’s specific medical needs, and Klonopin should always be prescribed by a healthcare provider.

Klonopin Forms & Strengths

Klonopin is only available as a tablet. Available strengths of Klonopin include 0.5 mg, 1 mg, and 2 mg tablets. Klonopin is also available as a generic medication, clonazepam, which may have different dosages available. The appropriate strength for each individual depends on the medical condition being treated, the age of the patient, and the severity of symptoms. Klonopin is not available in extended-release, delayed-release, or sustained-release formulations.

Prescribers consider several factors when choosing the appropriate strength and dosage form of Klonopin for their patients. These include the patient’s medical history, the presence of comorbid medical conditions, potential drug interactions, and the patient’s overall response to the medication. The dosage may also vary based on the severity of the individual’s symptoms. Furthermore, the dosage will vary depending on the condition being treated.

Klonopin is available in the following forms and strengths:

• Tablets: 0.5 mg (scored*), 1 mg, 2 mg

*A scored tablet is able to be split in half to create a smaller dose if someone needs to take a different dose.

It is essential to take Klonopin as prescribed by your healthcare provider. Klonopin comes in different strengths and forms, and the appropriate strength and form are dependent on your medical condition, age, and severity of symptoms. When taking the medication, it is important to follow the instructions on the label and to not exceed the prescribed dose. If you have questions about how to take the medication, speak with your healthcare provider or pharmacist for recommendations.

How Should I Take Klonopin?

Klonopin should be taken around the same time every day with or without food to ensure maximum effectiveness and minimize potential side effects. Additionally, individuals taking Klonopin should avoid consuming grapefruit as this can interfere with the medication.⁸

What Happens If I Miss a Dose of Klonopin?

In case a dose of Klonopin is missed, it is recommended to take it as soon as possible. However, if the next dose is due soon, it is best to skip the dose instead of doubling up on the medication. It is crucial to seek advice from a doctor before stopping Klonopin. If a dose is missed, an individual should take the dose as soon as it is remembered.

Abruptly stopping the medication can lead to withdrawal symptoms, including anxiety, headaches, abdominal pain, sweating, dizziness, and depression.⁹ For individuals with a seizure disorder, withdrawal can also trigger seizures. If you want to stop taking your medication, you should talk with your prescriber. They will help you to create a plan to safely taper off your medication.

Side Effects of Klonopin

Because of the increase in gamma-aminobutyric acid (GABA) in the brain, Klonopin can cause side effects ranging from mild to rare, life-threatening side effects. The side effects typically occur shortly after taking the medication and disappear with time. Common Klonopin side effects are typically mild and go away as the body adjusts to the medication. However, the severity of each reaction can vary based on the individual.

Common Side Effects of Klonopin

Klonopin can cause a variety of side effects, with the most common being sedation or drowsiness, dizziness, and abnormal coordination. While not all side effects require medical care, it is important to be aware of any symptoms that are severe or persistent. In such cases, it is recommended to contact your doctor for appropriate recommendations and guidance.

Common side effects of Klonopin include:^5,6

• Sedation or drowsiness
• Dizziness
• Nausea
• Headache
• Abnormal coordination
• Muscle pain
• Joint pain
• Forgetfulness
• Confusion
• Slurred speech
• Blurred vision
• Frequent urination
• Decreased sex drive

Severe Side Effects of Klonopin

Klonopin can cause several severe side effects, although these are less common. These may include respiratory depression, mood changes, hallucinations, and allergic reactions. If you experience these side effects, seek medical attention immediately.  Additionally, long-term use can lead to physical dependence, which means stopping the medication abruptly can cause Klonopin withdrawal symptoms and rebound anxiety.

Severe side effects of Klonopin may include:^1,5,6,9

• Benzodiazepine withdrawal: Long-term use of Klonopin can lead to physical dependence leading to withdrawal symptoms when discontinued. This includes anxiety, seizures, and insomnia.
• Mood changes: Klonopin can cause changes in mood, including depression and suicidal ideation.
• Respiratory depression: Respiratory depression, characterized by slow and shallow breathing, is a potentially severe, life-threatening side effect of Klonopin. This can be very dangerous if taken with other medications that cause respiratory depression, such as opioid medications.
• Hallucinations: Some people may experience hallucinations and delusions when taking Klonopin, which can be alarming and dangerous.
• Severe drowsiness: In severe cases, particularly with overdose, Klonopin can lead to severe drowsiness, confusion, and coma.

Klonopin Withdrawal

Like all benzodiazepines, when Klonopin is discontinued abruptly it can lead to withdrawal symptoms that can range from mild to severe. It is essential to follow the advice of your healthcare provider when stopping Klonopin. They will help you to create a plan to safely and slowly taper off your medication to minimize withdrawal symptoms. The chance of withdrawal is highest in those who have been prescribed Klonopin in higher doses or for longer periods of time.

Benzodiazepine withdrawal symptoms can include anxiety, insomnia, seizures, and sweating. More severe reactions include seizures, hallucinations, and delirium. In these cases, medical attention is required. Withdrawal typically lasts about 14 days, but every patient’s experience is different.

Early withdrawal symptoms typically last 1-4 days and can include anxiety and insomnia. Acute withdrawal symptoms typically last 10-14 days and can include delusions, hallucinations, and seizures. It may take a month or longer for anxiety symptoms caused by the withdrawal to resolve.

Allergic Reactions to Klonopin

Like other medications, some individuals may be allergic to Klonopin, which could result in allergic reactions. The symptoms of an allergic reaction can include skin rash, hives, difficulty breathing, vomiting, or swelling of the face, lips, tongue, or throat. Individuals who have a history of allergic reactions to other benzodiazepines are at a high risk of allergic reactions to Klonopin. If allergic reaction symptoms occur, seek medical attention immediately.

Allergic reactions to Klonopin may include:

• Difficulty breathing or speaking
• Swelling of the face, lips, tongue, or throat.
• Rash/hives
• Dizziness
• Itching

If an individual experiences allergic reactions to Klonopin or any other medication, they should seek medical attention immediately. Allergic reactions can range from mild to severe and may even be life-threatening. While some mild allergic reactions can be managed with antihistamines and corticosteroids, some severe reactions require emergency medical care. It is important to stop taking the medication that caused the allergic reaction and inform your healthcare provider as soon as possible.

Klonopin Warnings & Precautions

Klonopin comes with several warnings and precautions that need to be considered before use. Due to the medication’s function, there is a potential risk for addiction and misuse, particularly with prolonged use or high doses. Additionally, Klonopin may cause drowsiness and affect motor skills, posing a risk of accidents while operating a vehicle or machinery.

Taking other medications or supplements with Klonopin may lead to harmful interactions. Talk with your healthcare provider about your current medications and any concerns you may have about Klonopin before you begin taking it.

Precautions for taking Klonopin include:^4,5,6

• Potential for misuse and addiction: There is a risk for misuse and addiction when taking Klonopin, especially at higher doses or for a prolonged period of time. It should only be used as prescribed by a healthcare provider. If you have concerns about misuse or addiction, seek immediate medical help.
• Risk of suicidal thoughts or behavior: Klonopin may increase the risk of suicidal ideation or behavior. When taking Klonopin, patients should be monitored for worsening depression or suicidal thoughts and seek medical attention if they experience these symptoms.
• Taking Klonopin while pregnant: There are risks when taking anti-anxiety medications while pregnant such as Klonopin. It may be harmful to a developing fetus and is usually not recommended for pregnant individuals.
• Taking Klonopin while breastfeeding: Klonopin may pass into the breast milk and is therefore usually not recommended for mothers when breastfeeding.
• Operating vehicles and machinery: Individuals taking Klonopin should refrain from driving or operating machinery until they know how the medication affects them.
• Respiratory depression: Klonopin may cause respiratory depression, such as slow and shallow breathing. This risk increases if a patient is already on medications that also cause respiratory depression.
• Drug interactions: Kloponin may interact with other medications and supplements, including opioids, alcohol, and antidepressants.
• Elderly patients: Elderly patients may be more sensitive to the effects of Klonopin and may need lower doses. The elderly may be at an increased risk of falls if Klonopin causes them to have cognitive impairment.
• Glaucoma: For individuals with glaucoma, Klonopin may cause worsening symptoms.

Interactions With Klonopin

It is important to be aware that Klonopin may interact with other medications, substances, and herbal supplements, which can lead to potentially harmful side effects. These interactions can result in exacerbation of the side effects of Klonopin, such as increased drowsiness and respiratory depression, which may become life-threatening. It is crucial to understand the possible interactions between Klonopin and other substances when taking the medication.

It is highly necessary that individuals disclose all medications, substances, and supplements they are taking to their healthcare provider before starting Klonopin. This will allow for a thorough evaluation of any potential interactions and adjustments to the medication regimen if necessary. Failure to disclose this information may increase the risk of serious adverse effects.

11 substances you should avoid while taking Klonopin include:^1,2,10

• Other benzodiazepines: Taking other benzodiazepines with Klonopin can increase the risk of side effects, including drowsiness and respiratory depression.
• Opioids: Taking opioids with Klonopin can increase the risk of respiratory depression, which can be life-threatening.
• Alcohol: Klonopin may enhance the effects of alcohol, leading to increased drowsiness and impaired coordination.
• Antihistamines: Respiratory depression may be worsened when taken with Klonopin.
• Antidepressants: Some antidepressant medications can lead to increased side effects of Klonopin, including sedation.
• Anti-seizure medications: Medications to prevent seizures may increase the risk for sedation and respiratory depression.
• Antibiotics: When taking some antibiotics, such as clarithromycin, may cause increased levels of Klonopin in the body.
• Antifungal medications: Similar to antibiotics, antifungal medications, such as itraconazole and ketoconazole, can cause increased levels of Klonopin in the body.
• St. John’s Wort: Klonopin may have decreased effectiveness when taken with St. John’s Wort.
• Muscle relaxants: Taking Klonopin with muscle relaxants such as cyclobenzaprine can increase the risk of respiratory depression and sedation.
• Calcium channel blockers: Diltiazem, verapamil, and other calcium channel blockers may decrease the breakdown of Klonopin in the body leading to compounding effects.

This is not a comprehensive list of possible interactions with Klonopin. You should talk with your prescriber about any medications you are taking or will be starting while taking Klonopin.

Can You Overdose on Klonopin?

Like all benzodiazepines, Klonopin overdose can occur if taken in excessive amounts. This can occur if someone takes a higher dose than prescribed or if mixed with other substances that cause similar side effects, such as opioids or alcohol. Symptoms of Klonopin overdose may include drowsiness, confusion, slurred speech, slowed breathing, coma, and even death.⁵ If someone is developing these symptoms of overdose, they should call 911 or their local emergency number immediately.

What Should You Do If You Take Too Much Klonopin?

If you take too much Klonopin, you should call 9-1-1 or be taken to the emergency department immediately. You may also contact the poison control helpline at 1-800-222-1222.

Questions to Ask Your Healthcare Provider About Klonopin

If you believe that starting Klonopin may be beneficial, it is essential to have a thorough understanding of the potential side effects and risks associated with the medication. You should discuss your concerns with your healthcare provider, psychiatrist, and therapist, to discuss treatment options. While Klonopin may help with panic disorders and anxiety, finding the right therapist can be a beneficial part of anxiety treatment.

Questions to ask your care team about Klonopin include:

• Can I use Klonopin along with therapy to treat anxiety?
• How long does it take for Klonopin to start working, and how long does it last?
• How soon might I notice side effects from taking Klonopin?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• Are there drugs I am taking that could have negative interactions?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• Are there any lifestyle changes or precautions that I should take while taking Klonopin?
• What are the other options for treatment I should consider before starting Klonopin?

How to Get a Klonopin Prescription

When considering whether getting a prescription for Klonopin may help with a panic disorder or anxiety, it is important to have a thorough evaluation by a healthcare provider. This will often include a physical exam, a review of medical history, and a discussion of symptoms/concerns.

The healthcare provider may also want to conduct additional tests or referral to a specialist. For those interested in exploring Klonopin as a treatment option, an online psychiatry service may be a convenient option. These services allow virtual consultations with licensed psychiatrists to receive a personalized treatment plan.

In My Experience

In my experience, talking with a healthcare professional about your concerns and symptoms is a great place to start. If Klonopin does not seem like a suitable option for you, there are many other alternatives to consider, including therapy and other medications. However, Klonopin is an effective medication for the treatment of anxiety disorders such as panic disorders, especially when used with therapy. Seeking out treatment for anxiety can be daunting, and the first step is always the hardest, but it is always worth it in the end.

For Further Reading

• How Long Does it Take for Anxiety Medication to Work?
• How to Get Anxiety Medication: Everything You Need to Know
• Clonazepam Handout
• Clonazepam Withdrawal Symptoms, Timeline, & Detox Treatment
• Klonopin for Anxiety: How It Works & Comparisons to Other Medications