clonazepam

Adjunctive therapy

Brands: KLONOPIN

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is clonazepam?
Clonazepam (brand Klonopin) is a high-potency, long-acting benzodiazepine approved for seizure disorders (1975) and panic disorder (1998). In psychiatric practice it is used off label for catatonia, acute agitation, or short-term augmentation of severe anxiety while primary therapies take effect.
What is KLONOPIN?
KLONOPIN is a brand name for clonazepam.
What is KLONOPIN (clonazepam) used for?
Label indications include: Seizure disorders; panic disorder.
What drug class is KLONOPIN (clonazepam)?
Benzodiazepine; enhances GABA‑A receptor activity.
What strengths does KLONOPIN (clonazepam) come in?
Tablets: 0.5 mg, 1 mg, 2 mg (scored).

Snapshot

Class: Adjunctive therapy
Common US brands: KLONOPIN
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Seizure disorders; panic disorder.

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Clinical Highlights

Clonazepam (brand Klonopin) is a high-potency, long-acting benzodiazepine approved for seizure disorders (1975) and panic disorder (1998). In psychiatric practice it is used off label for catatonia, acute agitation, or short-term augmentation of severe anxiety while primary therapies take effect. Its 30–40 hour half-life provides sustained coverage but leads to accumulation in older adults or hepatic impairment. Tablets and orally disintegrating tablets (0.5 mg, 1 mg, 2 mg) can be swallowed or administered sublingually when rapid absorption is required. Dependence risk mandates clear treatment goals and taper plans for every course.

Schedule IV status reflects misuse potential. It is often reserved for targeted indications, with frequent reassessment; counseling commonly focuses on dependence/withdrawal risk and impaired driving risk.
The compare view, clonazepam evidence feed, and clonazepam print page can support shared decision-making and take-home counseling; the schizophrenia hub and bipolar disorder hub include catatonia and agitation workflows.
Seizure disorders (FDA 1975)
Panic disorder (FDA 1998)
Generic: Generic tablets and ODTs widely available from multiple manufacturers.

Dosing & Formulations

Tablets: 0.5 mg, 1 mg, 2 mg (scored). Orally disintegrating tablets: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg.

Panic disorder (label): start 0.25 mg twice daily; increase every 3 days to 1 mg twice daily; maximum 4 mg/day.
Catatonia or acute agitation (off label): 0.5–1 mg orally or sublingually every 8–12 hours with daily reassessment; taper once stabilized.
Seizure disorders (label): initiate 0.5 mg three times daily, increasing by 0.5–1 mg every 3 days; maximum 20 mg/day.
Reduce initial doses in older adults, hepatic impairment, respiratory disease, or when co-prescribing other CNS depressants. The largest portion is often scheduled at bedtime, and taper planning is typically addressed before initiation.

Monitoring & Risks

Boxed warning: Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death. Sedation and psychomotor slowing can increase fall risk and impair driving or operating machinery.

Cognitive impairment: Anterograde amnesia, slowed processing—dose dependent.
Ataxia and dizziness: Most evident during titration or with dose escalation.
Respiratory depression, especially when combined with opioids, alcohol, or sleep apnea.
Paradoxical agitation or disinhibition in susceptible individuals.

Drug Interactions

Additive CNS and respiratory depression with opioids, alcohol, antihistamines, or antipsychotics—co-use increases overdose risk and is generally avoided when alternatives exist; overdose education is important. CYP3A inhibitors (ketoconazole, clarithromycin, ritonavir) increase clonazepam exposure—reduce dose and monitor for oversedation.

CYP enzyme inducers (carbamazepine, phenytoin, rifampin, St. John’s wort) may lower clonazepam levels—adjust doses based on clinical response.

Practice Notes

Expectations for time-limited use and taper plans are commonly documented at initiation. For catatonia, daily reassessment and escalation to lorazepam challenge or electroconvulsive therapy are common when response is inadequate.

Prescription monitoring data review and screening for substance use disorders are common at follow-up encounters.
Abrupt discontinuation is generally avoided; patient counseling often includes reporting emergent cognitive changes or imbalance.

References

Klonopin (clonazepam) prescribing information — DailyMed (2025)
Evidence Based Pharmacological Treatment OF Anxiety Disorders — Depression and Anxiety (2014)
Benzodiazepines FOR Catatonia: Systematic Review AND Meta Analysis — Schizophrenia Research (2018)
ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
Evidence Based Consensus Guidelines FOR THE Management OF Catatonia: Recommendations From THE British Association FOR Psychopharmacology — Journal of Psychopharmacology (2023)