Clonazepam (Clonazepam) - Summary

CLONAZEPAM SUMMARY

Clonazepam, a benzodiazepine, is available as an orally disintegrating tablet containing 0.125 mg, 0.25 mg, 0.5 mg, 1 mg or 2 mg clonazepam.

Seizure Disorders:

Clonazepam is useful alone or as an adjunct in the treatment of the Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures. In patients with absence seizures (petit mal) who have failed to respond to succinimides, clonazepam may be useful.

In some studies, up to 30% of patients have shown a loss of anticonvulsant activity, often within 3 months of administration. In some cases, dosage adjustment may reestablish efficacy.

Panic Disorder:

Clonazepam is indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-IV. Panic disorder is characterized by the occurrence of unexpected panic attacks and associated concern about having additional attacks, worry about the implications or consequences of the attacks, and/or a significant change in behavior related to the attacks.

The efficacy of clonazepam was established in two 6- to 9-week trials in panic disorder patients whose diagnoses corresponded to the DSM-IIIR category of panic disorder (see CLINICAL PHARMACOLOGY, Clinical Trials).

Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i.e., a discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: (1) palpitations, pounding heart or accelerated heart rate; (2) sweating; (3) trembling or shaking; (4) sensations of shortness of breath or smothering; (5) feeling of choking; (6) chest pain or discomfort; (7) nausea or abdominal distress; (8) feeling dizzy, unsteady, lightheaded or faint; (9) derealization (feelings of unreality) or depersonalization (being detached from oneself); (10) fear of losing control; (11) fear of dying; (12) paresthesias (numbness or tingling sensations); (13) chills or hot flushes.

The effectiveness of clonazepam in long-term use, that is, for more than 9 weeks, has not been systematically studied in controlled clinical trials. The physician who elects to use clonazepam for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient (see DOSAGE AND ADMINISTRATION).

See all Clonazepam indications & dosage >>

NEWS HIGHLIGHTS

Published Studies Related to Clonazepam

A double-blind study on clonazepam in patients with burning mouth syndrome. [2012]
STUDY DESIGN: Randomized clinical trial... CONCLUSIONS: Clonazepam appears to have a positive effect on pain in BMS

Comparing effects of clonazepam and zolpidem on sleep quality of patients on maintenance hemodialysis. [2011]
patients... CONCLUSIONS: Clonazepam was more effective than zolpidem in the improvement of

Fluoxetine-clonazepam cotherapy for anxious depression: an exploratory, post-hoc analysis of a randomized, double blind study. [2010.01]
Anxious depression, defined as major depressive disorder (MDD) accompanied by high levels of anxiety, seems to be both common and difficult to treat, with antidepressant monotherapy often yielding modest results. We sought to examine the relative benefits of antidepressant-anxiolytic cotherapy versus antidepressant monotherapy for patients with anxious depression versus without anxious depression...

Fluoxetine-clonazepam cotherapy for anxious depression: an exploratory, post-hoc analysis of a randomized, double blind study. [2010]
Anxious depression, defined as major depressive disorder (MDD) accompanied by high levels of anxiety, seems to be both common and difficult to treat, with antidepressant monotherapy often yielding modest results. We sought to examine the relative benefits of antidepressant-anxiolytic cotherapy versus antidepressant monotherapy for patients with anxious depression versus without anxious depression...

Pharmacokinetic/pharmacodynamic modeling of psychomotor impairment induced by oral clonazepam in healthy volunteers. [2009.10]
This study was undertaken to model the relationship between clonazepam plasma concentrations and a central nervous system adverse effect (impairment of the psychomotor performance) following the oral administration of immediate-release tablets of clonazepam in healthy volunteers... However, an individual analysis of the data revealed a great interindividual variation in the relationship between clonazepam effect and plasma concentration, indicating that the phenomenon of acute tolerance can be predicted at a population, but not individual, level.

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Clinical Trials Related to Clonazepam

Bioavailability Study of Clonazepam Tablets Under Fasting Conditions [Completed]

Bioavailability Study of Clonazepam ODT Under Fasting Conditions [Completed]

Study of Antiepileptic Drug in Generalised Convulsive Status Epilepticus [Recruiting]

Clonazepam and Paroxetine for Rapid Treatment of Post-Traumatic Stress Disorder [Completed]
Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that follows exposure to an extremely traumatic stressors. PTSD is associated with serious symptoms. While numerous approaches have been used to treat PTSD, these treatments have several limiting factors. This study will evaluate a combination of the drugs clonazepam and paroxetine for the treatment of PTSD symptoms.

The main goal of treatment in patients with PTSD is to significantly reduce symptom severity and improve functioning. While numerous approaches have been used to treat PTSD, these treatments are limited by variable response rates, up to a 6-week lag period before clinical response, and sub-optimal side effect profile, including possible worsening of anxiety and insomnia prior to clinical response. The proposed study will examine whether combined treatment with a benzodiazepine (clonazepam) and a selective serotonin reuptake inhibitor (paroxetine) in patients with PTSD will accelerate the onset of clinical response. A second goal is to evaluate whether the rapid and clinically meaningful benefits are sustained until the end of the study, despite tapering off the benzodiazepine at the midpoint of the study. The safety and tolerability of a combination of paroxetine and clonazepam will be compared to paroxetine and placebo (an inactive pill) in the treatment of PTSD.

Participants in this study will be randomly assigned to receive either paroxetine plus clonazepam or paroxetine plus a placebo for 12 weeks. Participants will have weekly clinic visits for the first 4 weeks of the study and every other week for the last 8 weeks. Symptoms of PTSD, anxiety, and depression will be evaluated and drug side effects will be noted during the follow-up visits.

Evaluation of Clonazepam and Paroxetine for Panic Disorder With Depression [Completed]
The purpose of this study is to examine the safety and effectiveness of the drug combination paroxetine and clonazepam in treating people with panic disorder (PD) and major depression.

The main goal in treating people with PD is to rapidly reduce symptom severity and improve functioning. While numerous drug therapies have been used to treat PD, these treatments are limited by variable response rates and suboptimal side effect profiles. Evidence suggests that clonazepam given with a selective serotonin reuptake inhibitor (SSRI) can facilitate a rapid reduction in PD symptoms. However, it is unclear whether comorbid depression influences treatment response to the clonazepam and SSRI regimen. This study will examine whether combined treatment with clonazepam and the SSRI paroxetine will accelerate clinical response in participants with PD and comorbid depression. This study will also examine whether the benefits of treatment will be sustained until the end of the study despite tapering of clonazepam at the midpoint of the study.

Participants in this study will be screened with medical and psychiatric interviews, a physical examination, electrocardiogram (ECG), and blood tests. Participants will then be randomly assigned to receive either paroxetine plus clonazepam or paroxetine plus placebo (an inactive pill) for 12 weeks. Participants will have weekly clinic visits during which symptoms and drug side effects will be checked and an interview to evaluate panic disorder and depression symptoms will be conducted.

more trials >>

Reports of Suspected Clonazepam Side Effects

Completed Suicide (261),  Toxicity TO Various Agents (160),  Cardiac Arrest (117),  Respiratory Arrest (109),  Cardio-Respiratory Arrest (104),  Death (93),  Drug Ineffective (78),  Anxiety (78),  Somnolence (66),  Convulsion (66), more >>

PATIENT REVIEWS / RATINGS / COMMENTS

Clonazepam review by 21 year old female patient
		Rating
Overall rating:
Effectiveness:		Highly Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		Anxiety/ Panic Attacks
Dosage & duration:		0.5mg taken as needed for the period of 2 1/2 years
Other conditions:		BiPolar, Depression, Anxiety
Other drugs taken:		Welbutrin
		Reported Results
Benefits:		I get very bad panic attacks and completely break down no matter where I am. I decided that I couldn't let it control my life anymore, so I talked to my doctor and he prescribed me clonazepam. This drug is very dependable and works fast. Whenever I feel anxiety coming on I will take 1 or 2 pills and I'm fine.
Side effects:		It makes me sleepy, but it's definitely worth it. I'd rather feel tired than have a panic attack
Comments:		As needed

Clonazepam review by 32 year old female patient
		Rating
Overall rating:
Effectiveness:		Considerably Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		sleep walking/talking
Dosage & duration:		1mg taken before bedtime for the period of 7 months
Other conditions:		obesity, migraines
Other drugs taken:		Midrin
		Reported Results
Benefits:		This drug is very effective in making me sleep well, and works as a paralytic on my brain to keep me from sleep walking/talking. It has also cut down on my migraines since I started taking it.
Side effects:		Daytime drowsiness, highly addictive, bad withdrawal symptoms which caused terrible insomnia.
Comments:		I took 1mg at night (up from an initial 1/2 mg dose) before bed as a treatment for sleep walking/talking and the inability to progress to deep sleep. This medicine worked great at first, but after 6 months I was no longer seeing a benefit. The doctor took me off of it for 2 weeks as a drug holiday to let my brain rest, and had to put me on another med during that time because I had terrible insomnia as a result of withdrawal (I have never had insomnia in my life). I do have some short term memory problems, but overall saw a bigger benefit to feeling better and an increased quality of life to stop taking the drug.

Clonazepam review by 57 year old female patient
		Rating
Overall rating:
Effectiveness:		Marginally Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		Blepharospasm
Dosage & duration:		1 mg taken 1/day for the period of 3 months - still taking it
Other conditions:		none
Other drugs taken:		none
		Reported Results
Benefits:		Very slight reduction in muscle spasms around eyes. Ended up also getting light Botox injections in eyelid muscles. This combo therapy has not resulted in a total cessation of eyelid spasms, but has reduced them enough so that I can drive again (the main disability caused by the blepharospasm). Taking the clonazepam at night also helps me get a better night's rest than before I took it.
Side effects:		The first few days I took it I was dizzy and very sleepy. However, those side effects have now subsided.
Comments:		Take 1 MG tab at night before bed. As mentioned above, also got Botox injections to reduce eyelid spasmx.