Clonazepam: Difference between revisions

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{{MedTemplate

| generic = Clonazepam

| brand = Klonopin

| structure =

| classes = Benzodiazepine, Anticonvulsant, ~~Anxiolytic~~

| classes = [[:Category:Benzodiazepines|Benzodiazepine]], [[:Category:Anxiolytics|Anxiolytic]], [[:Category:Anticonvulsants|Anticonvulsant]], [[:Category:Schedule IV controlled substances|Schedule IV controlled substance]]

| ~~mechanism = GABAA positive allosteric modulator~~

| uses = <vote slug="panic-disorder-use">Panic disorder (FDA)</vote>, <vote slug="lennox-gastaut-use">Lennox-Gastaut syndrome (FDA)</vote>, <vote slug="myoclonic-seizures-use">Akinetic and myoclonic seizures (FDA)</vote>, <vote slug="social-anxiety-disorder-use">Social anxiety disorder (off-label)</vote>, <vote slug="rem-sleep-behavior-disorder-use">REM sleep behavior disorder (off-label, evidence-supported)</vote>, <vote slug="restless-legs-syndrome-use">Restless legs syndrome (off-label, second-line)</vote>, <vote slug="acute-mania-adjunct-use">Acute mania adjunct (off-label)</vote>

| uses =

| starting_dose = Anxiety: 0.25 mg PO BID, titrate by 0.125-0.25 mg every 3 days to target 1-4 mg/day divided. Seizures: 1.5 mg/day divided TID, titrate by 0.5-1 mg every 3 days

~~| starting_dose~~ =

| preparations = Tablets 0.5, 1, 2 mg; orally disintegrating tablets 0.125, 0.25, 0.5, 1, 2 mg

~~| preparations~~ =

| fda_max = 20 mg/day (seizures); commonly limited to 4 mg/day for anxiety in current practice

~~| routes~~ =

| pill_id =

~~| onset~~ =

| routes = Oral

~~| duration~~ =

| onset = 20-60 minutes

~~| halflife~~ =

| duration = 6-12 hours (long-acting among benzodiazepines)

~~| bioavailability~~ =

| halflife = 30-40 hours (long; accumulates with chronic dosing)<ref name="klonopin-label">FDA Prescribing Information, Klonopin (clonazepam), Genentech/Roche, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017533s055lbl.pdf</ref>

| ~~pregnancy~~ =

| bioavailability = ~90% (oral)<ref name="klonopin-label" />

| ~~legal~~ =

| pregnancy = Limited human data; some signal for cleft palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.{{citation needed}}

| ~~intro~~ =

| legal = [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the benzodiazepine class '''Boxed Warning''' for risk of fatal respiratory depression, coma, and death when combined with opioids<ref name="klonopin-label" />

| ~~pharmacokinetics~~ =

| mechanism = <vote slug="clonazepam-mech-claim">Positive allosteric modulator of the GABA-A receptor at the benzodiazepine binding site (α-γ subunit interface), enhancing chloride ion conductance and consequent neuronal inhibition. The long elimination half-life is the clinical signature: smoother symptom coverage than short-acting alternatives but greater accumulation, longer next-day sedation, and longer protracted withdrawal.</vote> Strong CYP3A4 substrate; CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir, grapefruit juice) substantially raise plasma exposure. Tolerance to anxiolytic effect, dependence, and significant withdrawal syndrome on abrupt discontinuation; slow taper essential after extended use<ref name="klonopin-label" />.

| ~~pharmacodynamics~~ =

| ~~indications =~~

~~| dosing~~ =

| ~~effects~~ =

| ~~contraindications~~ =

~~| interactions~~ =

| ~~pregnancy_details~~ =

~~| monitoring~~ =

| ~~counseling~~ =

| ~~anecdotes~~ =

| ~~seealso~~ =

| ~~references~~ =

}}

== References ==

[[Category:Benzodiazepines]]

[[Category:Anxiolytics]]

[[Category:Anticonvulsants]]

[[Category:Schedule IV controlled substances]]

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