clonazepam (Rx)

Brand and Other Names:Klonopin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet dispersible: Schedule IV

  • 0.125mg
  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg

tablet: Schedule IV

  • 0.5mg
  • 1mg
  • 2mg

Panic Disorder

0.25 mg PO q12hr initially; may increase to 1 mg/day after 3 days (up to 4 mg/day in some patients)

Seizure Disorders

1.5 mg/day PO divided q8hr; increase by 0.5-1 mg q3Days until desired effect achieved; not to exceed 20 mg/day

Maintenance: 2-8 mg PO; not to exceed 20 mg/day  

Essential Tremor (Off-label)

0.5 mg PO at bedtime; increase dose by 0.5 mg q3-4days; not to exceed 6 mg/day

REM Sleep Behavior Disorder (Off-label)

0.25-2 mg PO 30 min prior to bedtime; not to exceed 4 mg

Burning Mouth Syndrome (Off-label)

0.25 mg PO at bedtime for 1 week; increase dose by up to 0.25 mg qweek; not to exceed 3 mg daily in 3 divided doses

Alternatively, 1 mg topirally three times daily after each meal; suck on the tablet, retain salive in mouth near pain sites without swallowing for 3 min, then expectorate saliva

Tardive Dyskinesia (Off-label)

The American Academy of Neurology guidelines includes use of clonazepam for short-term treatment (~3 mo) to decrease tardive dyskinesia symptoms

Initial: 1 mg/day PO; adjust dose based on response and tolerability by 1 mg/day increments q3-4 days; not to exceed 4.5 mg/day

Dosage Modifications

Renal impairment: Supplemental dose in hemodialysis not necessary

Dosing Considerations

Discontinuation of treatment: Withdraw treatment gradually; decrease the dose q3Days by 0.125 mg PO q12hr until completely withdrawn

Hyperekplexia (Orphan)

Orphan indication sponsor

  • Hoffmann-La Roche, Inc; 340 Kingsland Street; Nutley, NJ 07110

Recurrent, Acute, Repetitive Seizures (Orphan)

Administration: Intranasal spray

Orphan indication sponsor

  • Jazz Pharmaceuticals, Inc; 3180 Porter Drive; Palo Alto, CA 94304

Tardive Dyskinesia (Off-label)

The American Academy of Neurology guidelines includes use of clonazepam for short-term treatment (~3 mo) to decrease tardive dyskinesia symptoms

Initial: 1 mg/day PO; adjust dose based on response and tolerability by 1 mg/day increments q3-4 days; not to exceed 4.5 mg/day

Dosage Forms & Strengths

tablet: Schedule IV

  • 0.125mg
  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg

Seizure Disorders

<6 years

  • Potential toxic dose: 0.05 mg/kg  

<10 years or <30 kg

  • 0.01-0.03 mg/kg/day PO divided q8hr; increase by 0.25-0.5 mg/day q3Days to maximum 0.1-0.2 mg/kg/day PO divided q8hr
  • Maintenance dose: 0.1-0.2 mg/kg/day PO divided q8hr; not to exceed 0.2 mg/kg/day

≥10 years or ≥30 kg

  • 1.5 mg/day PO divided q8hr; increase by 0.5-1 mg q3Days until desired effect achieved; not to exceed 20 mg/day
  • Maintenance: 2-8 mg PO; not to exceed 20 mg/day

Dosing Considerations

Discontinuation of treatment

  • <10 years: Treatment should be withdrawn gradually, as necessary
  • ≥10 years: Withdraw treatment gradually; decrease the dose q3Days by 0.125 mg PO q12hr until completely withdrawn
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Interactions

Interaction Checker

and clonazepam

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              Serious - Use Alternative (18)

              • abametapir

                abametapir will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • apalutamide

                apalutamide will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

              • benzhydrocodone/acetaminophen

                benzhydrocodone/acetaminophen, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • calcium/magnesium/potassium/sodium oxybates

                clonazepam, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • carbamazepine

                carbamazepine will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • conivaptan

                conivaptan will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • fexinidazole

                fexinidazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

              • hydrocodone

                hydrocodone, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • idelalisib

                idelalisib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

              • ivosidenib

                ivosidenib will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

              • lonafarnib

                lonafarnib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

              • metoclopramide intranasal

                clonazepam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • selinexor

                selinexor, clonazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sodium oxybate

                clonazepam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • sufentanil SL

                sufentanil SL, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • tucatinib

                tucatinib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

              • valerian

                valerian and clonazepam both increase sedation. Avoid or Use Alternate Drug.

              • voxelotor

                voxelotor will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

              Monitor Closely (240)

              • albuterol

                clonazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • alfentanil

                clonazepam and alfentanil both increase sedation. Use Caution/Monitor.

              • alprazolam

                alprazolam and clonazepam both increase sedation. Use Caution/Monitor.

              • amitriptyline

                clonazepam and amitriptyline both increase sedation. Use Caution/Monitor.

              • amobarbital

                amobarbital and clonazepam both increase sedation. Use Caution/Monitor.

                amobarbital will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • amoxapine

                clonazepam and amoxapine both increase sedation. Use Caution/Monitor.

              • apomorphine

                clonazepam and apomorphine both increase sedation. Use Caution/Monitor.

              • arformoterol

                clonazepam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • aripiprazole

                clonazepam and aripiprazole both increase sedation. Use Caution/Monitor.

              • armodafinil

                clonazepam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atazanavir

                atazanavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.

              • azelastine

                azelastine and clonazepam both increase sedation. Use Caution/Monitor.

              • baclofen

                clonazepam and baclofen both increase sedation. Use Caution/Monitor.

              • belladonna and opium

                clonazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

              • belzutifan

                belzutifan will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

              • benperidol

                clonazepam and benperidol both increase sedation. Use Caution/Monitor.

              • benzphetamine

                clonazepam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bosentan

                bosentan will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • brexanolone

                brexanolone, clonazepam. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • brompheniramine

                brompheniramine and clonazepam both increase sedation. Use Caution/Monitor.

              • buprenorphine

                clonazepam and buprenorphine both increase sedation. Use Caution/Monitor.

              • buprenorphine buccal

                clonazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.

              • buprenorphine subdermal implant

                clonazepam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.

              • buprenorphine, long-acting injection

                clonazepam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

              • butabarbital

                butabarbital and clonazepam both increase sedation. Use Caution/Monitor.

              • butalbital

                butalbital and clonazepam both increase sedation. Use Caution/Monitor.

              • butorphanol

                clonazepam and butorphanol both increase sedation. Use Caution/Monitor.

              • caffeine

                clonazepam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carbinoxamine

                carbinoxamine and clonazepam both increase sedation. Use Caution/Monitor.

              • carisoprodol

                clonazepam and carisoprodol both increase sedation. Use Caution/Monitor.

              • cenobamate

                cenobamate will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                cenobamate, clonazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

              • chloral hydrate

                clonazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

              • chlordiazepoxide

                chlordiazepoxide and clonazepam both increase sedation. Use Caution/Monitor.

              • chlorpheniramine

                chlorpheniramine and clonazepam both increase sedation. Use Caution/Monitor.

              • chlorpromazine

                clonazepam and chlorpromazine both increase sedation. Use Caution/Monitor.

              • chlorzoxazone

                clonazepam and chlorzoxazone both increase sedation. Use Caution/Monitor.

              • cimetidine

                cimetidine increases levels of clonazepam by decreasing metabolism. Use Caution/Monitor.

              • cinnarizine

                cinnarizine and clonazepam both increase sedation. Use Caution/Monitor.

              • clarithromycin

                clarithromycin will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • clemastine

                clemastine and clonazepam both increase sedation. Use Caution/Monitor.

              • clobazam

                clonazepam, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

              • clomipramine

                clonazepam and clomipramine both increase sedation. Use Caution/Monitor.

              • clonidine

                clonidine, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS depressant effects.

              • clorazepate

                clonazepam and clorazepate both increase sedation. Use Caution/Monitor.

              • clozapine

                clonazepam and clozapine both increase sedation. Use Caution/Monitor.

              • cobicistat

                cobicistat will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clinical monitoring is recommended upon coadministration with anticonvulsants.

              • codeine

                clonazepam and codeine both increase sedation. Use Caution/Monitor.

              • crizotinib

                crizotinib increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

              • crofelemer

                crofelemer increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

              • cyclizine

                cyclizine and clonazepam both increase sedation. Use Caution/Monitor.

              • cyclobenzaprine

                clonazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

              • cyproheptadine

                cyproheptadine and clonazepam both increase sedation. Use Caution/Monitor.

              • dabrafenib

                dabrafenib will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • dantrolene

                clonazepam and dantrolene both increase sedation. Use Caution/Monitor.

              • darunavir

                darunavir will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • desflurane

                desflurane and clonazepam both increase sedation. Use Caution/Monitor.

              • desipramine

                clonazepam and desipramine both increase sedation. Use Caution/Monitor.

              • deutetrabenazine

                clonazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.

              • dexchlorpheniramine

                dexchlorpheniramine and clonazepam both increase sedation. Use Caution/Monitor.

              • dexfenfluramine

                clonazepam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmedetomidine

                clonazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • dexmethylphenidate

                clonazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dextroamphetamine

                clonazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dextromoramide

                clonazepam and dextromoramide both increase sedation. Use Caution/Monitor.

              • diamorphine

                clonazepam and diamorphine both increase sedation. Use Caution/Monitor.

              • diazepam

                clonazepam and diazepam both increase sedation. Use Caution/Monitor.

              • diazepam intranasal

                diazepam intranasal, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

              • diethylpropion

                clonazepam increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • difenoxin hcl

                clonazepam and difenoxin hcl both increase sedation. Use Caution/Monitor.

              • dimenhydrinate

                dimenhydrinate and clonazepam both increase sedation. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and clonazepam both increase sedation. Use Caution/Monitor.

              • diphenoxylate hcl

                clonazepam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

              • dipipanone

                clonazepam and dipipanone both increase sedation. Use Caution/Monitor.

              • disulfiram

                disulfiram increases levels of clonazepam by decreasing metabolism. Use Caution/Monitor.

              • dobutamine

                clonazepam increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dopamine

                clonazepam increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dopexamine

                clonazepam increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                clonazepam and dosulepin both increase sedation. Use Caution/Monitor.

              • doxepin

                clonazepam and doxepin both increase sedation. Use Caution/Monitor.

              • doxylamine

                clonazepam and doxylamine both increase sedation. Use Caution/Monitor.

              • droperidol

                clonazepam and droperidol both increase sedation. Use Caution/Monitor.

              • duvelisib

                duvelisib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of

              • efavirenz

                efavirenz will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • elagolix

                elagolix will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; consider benzodiazepine dose reduction.

              • encorafenib

                encorafenib, clonazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

              • enzalutamide

                enzalutamide will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ephedrine

                clonazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • epinephrine

                clonazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • epinephrine racemic

                clonazepam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • esketamine intranasal

                esketamine intranasal, clonazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              • estazolam

                clonazepam and estazolam both increase sedation. Use Caution/Monitor.

              • ethanol

                clonazepam and ethanol both increase sedation. Use Caution/Monitor.

              • ethinylestradiol

                ethinylestradiol will increase the level or effect of clonazepam by Mechanism: decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.

              • etomidate

                etomidate and clonazepam both increase sedation. Use Caution/Monitor.

              • etravirine

                etravirine will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fenfluramine

                clonazepam increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • flibanserin

                clonazepam and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

              • fluphenazine

                clonazepam and fluphenazine both increase sedation. Use Caution/Monitor.

              • flurazepam

                clonazepam and flurazepam both increase sedation. Use Caution/Monitor.

              • formoterol

                clonazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fosamprenavir

                fosamprenavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.

              • fosphenytoin

                fosphenytoin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • gabapentin

                gabapentin, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

              • gabapentin enacarbil

                gabapentin enacarbil, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

              • haloperidol

                clonazepam and haloperidol both increase sedation. Use Caution/Monitor.

              • hyaluronidase

                hyaluronidase, clonazepam. Other (see comment). Use Caution/Monitor. Comment: Drug combination has been found to be incompatible.

              • hydromorphone

                clonazepam and hydromorphone both increase sedation. Use Caution/Monitor.

              • hydroxyzine

                hydroxyzine and clonazepam both increase sedation. Use Caution/Monitor.

              • iloperidone

                clonazepam and iloperidone both increase sedation. Use Caution/Monitor.

                iloperidone increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

              • imipramine

                clonazepam and imipramine both increase sedation. Use Caution/Monitor.

              • indinavir

                indinavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.

              • isoproterenol

                clonazepam increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • istradefylline

                istradefylline will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

              • itraconazole

                itraconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • kava

                kava and clonazepam both increase sedation. Use Caution/Monitor.

              • ketamine

                ketamine and clonazepam both increase sedation. Use Caution/Monitor.

              • ketoconazole

                ketoconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • ketotifen, ophthalmic

                clonazepam and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

              • lasmiditan

                lasmiditan, clonazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                lemborexant, clonazepam. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • letermovir

                letermovir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • levalbuterol

                clonazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                levonorgestrel oral/ethinylestradiol/ferrous bisglycinate will increase the level or effect of clonazepam by decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.

              • levorphanol

                clonazepam and levorphanol both increase sedation. Use Caution/Monitor.

              • lisdexamfetamine

                clonazepam increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lofepramine

                clonazepam and lofepramine both increase sedation. Use Caution/Monitor.

              • lofexidine

                clonazepam and lofexidine both increase sedation. Use Caution/Monitor.

              • lopinavir

                lopinavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Use alternatives if available. Consider lowering benzodiazepine dose.

              • loprazolam

                clonazepam and loprazolam both increase sedation. Use Caution/Monitor.

              • lorazepam

                clonazepam and lorazepam both increase sedation. Use Caution/Monitor.

              • lorlatinib

                lorlatinib will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lormetazepam

                clonazepam and lormetazepam both increase sedation. Use Caution/Monitor.

              • loxapine

                clonazepam and loxapine both increase sedation. Use Caution/Monitor.

              • loxapine inhaled

                clonazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.

              • lurasidone

                lurasidone, clonazepam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              • maprotiline

                clonazepam and maprotiline both increase sedation. Use Caution/Monitor.

              • marijuana

                clonazepam and marijuana both increase sedation. Use Caution/Monitor.

              • melatonin

                clonazepam and melatonin both increase sedation. Use Caution/Monitor.

              • meperidine

                clonazepam and meperidine both increase sedation. Use Caution/Monitor.

              • meprobamate

                clonazepam and meprobamate both increase sedation. Use Caution/Monitor.

              • metaproterenol

                clonazepam increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • metaxalone

                clonazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • methadone

                clonazepam and methadone both increase sedation. Use Caution/Monitor.

              • methamphetamine

                clonazepam increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methocarbamol

                clonazepam and methocarbamol both increase sedation. Use Caution/Monitor.

              • methylenedioxymethamphetamine

                clonazepam increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • midazolam

                clonazepam and midazolam both increase sedation. Use Caution/Monitor.

              • midazolam intranasal

                midazolam intranasal, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • midodrine

                clonazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mifepristone

                mifepristone will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • mirtazapine

                clonazepam and mirtazapine both increase sedation. Use Caution/Monitor.

              • mitotane

                mitotane decreases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

              • modafinil

                clonazepam increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • morphine

                clonazepam and morphine both increase sedation. Use Caution/Monitor.

              • motherwort

                clonazepam and motherwort both increase sedation. Use Caution/Monitor.

              • moxonidine

                clonazepam and moxonidine both increase sedation. Use Caution/Monitor.

              • nabilone

                clonazepam and nabilone both increase sedation. Use Caution/Monitor.

              • nafcillin

                nafcillin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nalbuphine

                clonazepam and nalbuphine both increase sedation. Use Caution/Monitor.

              • nefazodone

                nefazodone will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nelfinavir

                nelfinavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.

              • norepinephrine

                clonazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                clonazepam and nortriptyline both increase sedation. Use Caution/Monitor.

              • olanzapine

                clonazepam and olanzapine both increase sedation. Use Caution/Monitor.

              • oliceridine

                oliceridine, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • opium tincture

                clonazepam and opium tincture both increase sedation. Use Caution/Monitor.

              • orlistat

                orlistat decreases levels of clonazepam by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.

              • orphenadrine

                clonazepam and orphenadrine both increase sedation. Use Caution/Monitor.

              • oxazepam

                clonazepam and oxazepam both increase sedation. Use Caution/Monitor.

              • oxycodone

                clonazepam and oxycodone both increase sedation. Use Caution/Monitor.

              • oxymorphone

                clonazepam and oxymorphone both increase sedation. Use Caution/Monitor.

              • paliperidone

                clonazepam and paliperidone both increase sedation. Use Caution/Monitor.

              • papaveretum

                clonazepam and papaveretum both increase sedation. Use Caution/Monitor.

              • papaverine

                clonazepam and papaverine both increase sedation. Use Caution/Monitor.

              • pentazocine

                clonazepam and pentazocine both increase sedation. Use Caution/Monitor.

              • pentobarbital

                pentobarbital and clonazepam both increase sedation. Use Caution/Monitor.

              • perampanel

                perampanel and clonazepam both increase sedation. Use Caution/Monitor.

              • perphenazine

                clonazepam and perphenazine both increase sedation. Use Caution/Monitor.

              • phendimetrazine

                clonazepam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenobarbital

                phenobarbital and clonazepam both increase sedation. Use Caution/Monitor.

                phenobarbital will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • phentermine

                clonazepam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine

                clonazepam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine PO

                clonazepam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • phenytoin

                phenytoin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • pholcodine

                clonazepam and pholcodine both increase sedation. Use Caution/Monitor.

              • pimozide

                clonazepam and pimozide both increase sedation. Use Caution/Monitor.

              • pirbuterol

                clonazepam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • posaconazole

                posaconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • pregabalin

                pregabalin, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

              • primidone

                primidone and clonazepam both increase sedation. Use Caution/Monitor.

              • prochlorperazine

                clonazepam and prochlorperazine both increase sedation. Use Caution/Monitor.

              • promethazine

                promethazine and clonazepam both increase sedation. Use Caution/Monitor.

              • propofol

                propofol and clonazepam both increase sedation. Use Caution/Monitor.

              • propylhexedrine

                clonazepam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                clonazepam and protriptyline both increase sedation. Use Caution/Monitor.

              • quazepam

                clonazepam and quazepam both increase sedation. Use Caution/Monitor.

              • quetiapine

                clonazepam and quetiapine both increase sedation. Use Caution/Monitor.

              • ramelteon

                clonazepam and ramelteon both increase sedation. Use Caution/Monitor.

              • remimazolam

                remimazolam, clonazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

              • ribociclib

                ribociclib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • rifabutin

                rifabutin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • rifampin

                rifampin will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • rifapentine

                rifapentine will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • risperidone

                clonazepam and risperidone both increase sedation. Use Caution/Monitor.

              • ritonavir

                ritonavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.

              • rucaparib

                rucaparib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

              • salmeterol

                clonazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • saquinavir

                saquinavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.

              • scullcap

                clonazepam and scullcap both increase sedation. Use Caution/Monitor.

              • secobarbital

                secobarbital and clonazepam both increase sedation. Use Caution/Monitor.

                secobarbital will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of clonazepam

              • sevelamer

                sevelamer decreases levels of clonazepam by increasing elimination. Use Caution/Monitor.

              • sevoflurane

                sevoflurane and clonazepam both increase sedation. Use Caution/Monitor.

              • shepherd's purse

                clonazepam and shepherd's purse both increase sedation. Use Caution/Monitor.

              • stiripentol

                stiripentol, clonazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

                stiripentol, clonazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • sufentanil

                clonazepam and sufentanil both increase sedation. Use Caution/Monitor.

              • suvorexant

                suvorexant and clonazepam both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

              • tapentadol

                clonazepam and tapentadol both increase sedation. Use Caution/Monitor.

              • tazemetostat

                tazemetostat will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tecovirimat

                tecovirimat will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

              • teduglutide

                teduglutide increases levels of clonazepam by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

              • temazepam

                clonazepam and temazepam both increase sedation. Use Caution/Monitor.

              • terbutaline

                clonazepam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thioridazine

                clonazepam and thioridazine both increase sedation. Use Caution/Monitor.

              • thiothixene

                clonazepam and thiothixene both increase sedation. Use Caution/Monitor.

              • tipranavir

                tipranavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.

              • topiramate

                clonazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tramadol

                clonazepam and tramadol both increase sedation. Use Caution/Monitor.

              • trazodone

                clonazepam and trazodone both increase sedation. Use Caution/Monitor.

              • triazolam

                clonazepam and triazolam both increase sedation. Use Caution/Monitor.

              • triclofos

                clonazepam and triclofos both increase sedation. Use Caution/Monitor.

              • trifluoperazine

                clonazepam and trifluoperazine both increase sedation. Use Caution/Monitor.

              • trimipramine

                clonazepam and trimipramine both increase sedation. Use Caution/Monitor.

              • triprolidine

                triprolidine and clonazepam both increase sedation. Use Caution/Monitor.

              • voriconazole

                voriconazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • xylometazoline

                clonazepam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • yohimbine

                clonazepam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ziconotide

                clonazepam and ziconotide both increase sedation. Use Caution/Monitor.

              • ziprasidone

                clonazepam and ziprasidone both increase sedation. Use Caution/Monitor.

              • zotepine

                clonazepam and zotepine both increase sedation. Use Caution/Monitor.

              Minor (33)

              • acetaminophen

                clonazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • acetaminophen IV

                clonazepam decreases levels of acetaminophen IV by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • acetaminophen rectal

                clonazepam decreases levels of acetaminophen rectal by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • atracurium

                clonazepam decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • biotin

                clonazepam decreases levels of biotin by unspecified interaction mechanism. Minor/Significance Unknown. Biotin supplementation may be necessary.

              • brimonidine

                brimonidine increases effects of clonazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

              • ciprofloxacin

                ciprofloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • cisatracurium

                clonazepam decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • cyanocobalamin

                clonazepam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • dexmethylphenidate

                dexmethylphenidate increases effects of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • esomeprazole

                esomeprazole will increase the level or effect of clonazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • eucalyptus

                clonazepam and eucalyptus both increase sedation. Minor/Significance Unknown.

              • ezogabine

                ezogabine decreases levels of clonazepam by Other (see comment). Minor/Significance Unknown. Comment: Ezogabine may induce glucuronidation that results in small decreases of trough levels.

              • fleroxacin

                fleroxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • gemifloxacin

                gemifloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • green tea

                green tea decreases effects of clonazepam by pharmacodynamic antagonism. Minor/Significance Unknown. Caffeine component of green tea may decrease sedative effects of benzodiazepines.

              • levocarnitine

                clonazepam decreases levels of levocarnitine by unspecified interaction mechanism. Minor/Significance Unknown.

              • levofloxacin

                levofloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • moxifloxacin

                moxifloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • ofloxacin

                ofloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • omeprazole

                omeprazole increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • onabotulinumtoxinA

                clonazepam decreases effects of onabotulinumtoxinA by pharmacodynamic antagonism. Minor/Significance Unknown.

              • pancuronium

                clonazepam decreases effects of pancuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • rapacuronium

                clonazepam decreases effects of rapacuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • rifabutin

                rifabutin decreases levels of clonazepam by increasing metabolism. Minor/Significance Unknown.

              • rimabotulinumtoxinB

                clonazepam decreases effects of rimabotulinumtoxinB by pharmacodynamic antagonism. Minor/Significance Unknown.

              • rocuronium

                clonazepam decreases effects of rocuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • sage

                clonazepam and sage both increase sedation. Minor/Significance Unknown.

                sage decreases effects of clonazepam by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction; some species of sage may cause convulsions.

              • succinylcholine

                clonazepam decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.

              • valproic acid

                clonazepam, valproic acid. Mechanism: unknown. Minor/Significance Unknown. Possible risk of absence seizure.

              • vecuronium

                clonazepam decreases effects of vecuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • vinpocetine

                clonazepam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).

              • zolpidem

                zolpidem, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

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              Adverse Effects

              >10%

              Somnolence (37%)

              1-10%

              Abnormal coordination (5-10%)

              Ataxia (5-10%)

              Depression (5-10%)

              Dizziness (5-10%)

              Fatigue (5-10%)

              Memory impairment (5-10%)

              Upper respiratory infection (5-10%)

              Confusion (1-5%)

              Dysarthria (1-5%)

              Rhinitis (1-5%)

              Coughing (1-5%)

              Urinary frequency (1-5%)

              Impotence (1-5%)

              Decreased libido (1-5%)

              Frequency Not Defined

              Increased salivation

              Worsening tonic-clonic seizures

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              Warnings

              Black Box Warnings

              Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation

              Addiction, abuse, and misuse

              • On September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death
              • Physical dependence can occur when taken steadily for several days to weeks, even as prescribed
              • Stopping abruptly or reducing dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening
              • Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes; before prescribing and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction
              • Assess each patient’s risk prior to prescribing and monitor regularly for the development of these conditions
              • Risks of dependence and withdrawal increase with longer treatment duration and higher daily dose; although injection is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction may precipitate acute withdrawal reactions, including seizures, which can be life-threatening; use gradual taper when discontinuing therapy to reduce withdrawal reactions risk

              Contraindications

              Significant hepatic impairment

              Documented hypersensitivity

              Acute narrow angle glaucoma

              Cautions

              Withdraw gradually when used for panic disorder

              Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicidal ideation

              Not recommended in patients with depressed neuroses, psychotic reactions, severe respiratory depression, myasthenia gravis (allowable in limited circumstances), acute alcohol intoxication

              Anterograde amnesia reported benzodiazepine use

              May cause CNS depression and impairs ability to perform hazardous tasks

              Hyperactive or aggressive behavior reported with benzodiazepines in pediatric/adolescent patients and in psychiatric patients

              Increased risk of suicidal thoughts/behavior reported with antiepileptic agents; monitor patient for suicidal behavior and notify health-care provider immediately

              Use with caution in patients with a history of drug abuse or acute alcoholism; drug dependency possible; prolonged use may result in psychological and physical dependence

              Use with caution in patients with compromised respiratory function

              May have porphyrogenic effect; use with caution in patients with porphyria

              Not for concomitant administration with alcohol or other CNS-depressant drugs

              When used in patients in whom several different types of seizure disorders coexist, clonazepam may increase incidence or precipitate onset of generalized tonic-clonic seizures (grand mal); may require addition of appropriate anticonvulsants or increase in dosages; concomitant use of valproic acid and clonazepam may produce absence status

              Abrupt withdrawal, particularly in patients on long-term, high-dose therapy, may precipitate status epilepticus; when discontinuing clonazepam, gradual withdrawal essential; while being gradually withdrawn, simultaneous substitution of another anticonvulsant may be indicated

              Use of drug, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency

              Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate

              For patients using treated more frequently than recommended, to reduce risk of withdrawal reactions, use a gradual taper to discontinue therapy (a patient-specific plan should be used to taper the dose)

              Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use

              In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months

              May produce increase in salivation; consider before giving drug to patients who have difficulty handling secretions

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

              Paradoxical reactions, such as agitation, irritability, aggression, anxiety, anger, nightmares, hallucinations, and psychoses may occur when using benzodiazepines; discontinue therapy, should this occur; paradoxical reactions are more likely to occur in children and in the elderly

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              Pregnancy & Lactation

              Pregnancy

              There are no adequate and well-controlled studies of Klonopin in pregnant women; available human data on risk of teratogenicity are inconclusive; there is insufficient evidence in humans to assess effect of benzodiazepine exposure during pregnancy on neurodevelopment; administration of benzodiazepines immediately prior to or during childbirth can result in a syndrome of hypothermia, hypotonia, respiratory depression, and difficulty feeding; in addition, infants born to mothers who have taken benzodiazepines during later stages of pregnancy can develop dependence, and subsequently withdrawal, during the postnatal period

              Data for other benzodiazepines suggest possibility of adverse developmental effects (long-term effects on neurobehavioral and immunological function) in animals following prenatal exposure to benzodiazepines

              Lactation

              Effects on breastfed infant and on milk production are unknown; developmental and health benefits of breastfeeding should be considered along with mother's clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Long-acting benzodiazepine that increases the presynaptic GABA inhibition and reduces the monosynaptic and polysynaptic reflexes. Suppresses muscle contractions by facilitating inhibitory GABA neurotransmission and other inhibitory transmitters

              Suppresses the spike-and-wave discharge in absence seizures by depressing nerve transmission in motor cortex

              Absorption

              Bioavailability: 90%

              Onset: 20-40 min

              Peak plasma time: 1-4 hr; 5-7 days (steady state)

              Distribution

              Protein bound: 85%

              Vd: 1.5-3 L/kg

              Metabolism

              Metabolized by CYP3A4 (minor), glucuronic acid conjugation

              Metabolites: Inactive

              Elimination

              Half-life: 17-60 hr (adults); 22-33 hr (children)

              Excretion: Urine

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Klonopin oral
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              0.5 mg tablet
              Klonopin oral
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              2 mg tablet
              Klonopin oral
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              1 mg tablet
              clonazepam oral
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              2 mg tablet
              clonazepam oral
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              0.5 mg tablet
              clonazepam oral
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              0.5 mg tablet
              clonazepam oral
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              1 mg tablet
              clonazepam oral
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              0.5 mg tablet
              clonazepam oral
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              1 mg tablet
              clonazepam oral
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              1 mg tablet
              clonazepam oral
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              1 mg tablet
              clonazepam oral
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              0.5 mg tablet
              clonazepam oral
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              1 mg tablet
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              2 mg tablet
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              0.125 mg tablet
              clonazepam oral
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              1 mg tablet
              clonazepam oral
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              2 mg tablet
              clonazepam oral
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              0.25 mg tablet
              clonazepam oral
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              0.5 mg tablet
              clonazepam oral
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              2 mg tablet
              clonazepam oral
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              0.5 mg tablet
              clonazepam oral
              -
              0.25 mg tablet
              clonazepam oral
              -
              0.125 mg tablet
              clonazepam oral
              -
              2 mg tablet
              clonazepam oral
              -
              2 mg tablet
              clonazepam oral
              -
              0.5 mg tablet
              clonazepam oral
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              0.5 mg tablet
              clonazepam oral
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              1 mg tablet
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              0.5 mg tablet
              clonazepam oral
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              2 mg tablet
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              1 mg tablet
              clonazepam oral
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              0.5 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              clonazepam oral

              CLONAZEPAM - ORAL

              (klo-NAY-zeh-pam)

              COMMON BRAND NAME(S): Klonopin

              WARNING: Clonazepam has a risk for abuse and addiction, which can lead to overdose and death. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems (especially opioid medications such as codeine, hydrocodone) may cause very serious side effects, including death. To lower your risk, your doctor should have you take the smallest dose of clonazepam that works, and take it for the shortest possible time. Be sure you know how to take clonazepam and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Suddenly stopping this medication may cause serious (possibly fatal) withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as headaches, trouble sleeping, restlessness, hallucinations/confusion, depression, nausea, or seizures. Withdrawal symptoms may sometimes last weeks to months.

              USES: Clonazepam is used to prevent and control seizures. This medication is known as an anticonvulsant or antiepileptic drug. It is also used to treat panic attacks. Clonazepam works by calming your brain and nerves. It belongs to a class of drugs called benzodiazepines.

              HOW TO USE: See also Warning section.Read the Medication Guide provided by your pharmacist before you start taking clonazepam and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually 2 or 3 times daily.Dosage is based on your medical condition, age, and response to treatment. For children, the dose is also based on weight. Older adults usually start with a lower dose to decrease the risk of side effects. Do not increase your dose, take it more often, or take it for a longer time than directed.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.If you have several different types of seizure disorders, you may experience a worsening of seizures when you first start using clonazepam. Consult your doctor right away if this happens. Your doctor may need to add or adjust the dose of your other medications to control the seizures.Tell your doctor if your condition persists or worsens.

              SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, tiredness, loss of coordination, or increased saliva production may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior, including: confusion, memory problems, signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking clonazepam, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (such as diazepam, lorazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain type of eye problem (narrow angle glaucoma), a certain blood disorder (porphyria), liver disease, kidney disease, lung/breathing problems, mental/mood problems (such as depression, thoughts of suicide), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).For children, the long-term effects on physical and mental/behavioral development are uncertain and may not be seen until after many years. Discuss the risks and benefits of treatment with clonazepam with your doctor.Older adults may be more sensitive to the effects of this drug, especially drowsiness and confusion. These side effects can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. However, since untreated seizures are a serious condition that can harm both a pregnant woman and her unborn baby, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor about the benefits and risks of using this medication during pregnancy.This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: orlistat, sodium oxybate.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, confusion, loss of consciousness, slowed/decreased reflexes.

              NOTES: Do not share this medication with others. Sharing it is against the law.Laboratory and/or medical tests (such as liver function tests, complete blood count) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.