• See Also
  1. Benzodiazepine
  • Class
  1. Long acting Benzodiazepine
  • Indications
  1. Anxiety Disorder
  2. Tic Disorder or Tourette's Syndrome
  3. Seizure Disorder
    1. Lennox-Gastaut Syndrome
    2. Akinetic Seizure
    3. Myoclonic Seizure
  • Contraindications
  1. Hepatic Failure
  2. Narrow Angle Glaucoma
  • Dosing
  • Adults
  1. Panic Disorder or Generalized Anxiety Disorder
    1. Start 0.25 orally twice daily
    2. Titrate: Increase by 0.125 to 0.25 every 3 days to typical target dose of 1 mg/day divided
    3. Maximum Daily Dose: 4 mg (1.5 mg/day in elderly)
      1. No evidence of benefit for total daily dose above 1 to 2 mg
  2. Akinetic or Myoclonic Seizures or Lennox-Gestaut Syndrome (type of Petit Mal Seizures)
    1. Start 0.5 mg orally three times daily
    2. May increase dose by 0.5 to 1 mg orally every 3 days as needed to typical 2 to 8 mg/day in divided doses
    3. Maximum: 20 mg/day
  3. REM Sleep Behavior Disorder (Not FDA approved)
    1. Dose 1 to 2 mg orally at bedtime
  • Dosing
  • Children (age <10 years or weight <30 kg)
  1. Akinetic or Myoclonic Seizures or Lennox-Gestaut Syndrome (type of Petit Mal Seizures)
    1. Start 0.01 to 0.03 mg/kg/day orally divided 2 to 3 times daily
    2. May increase dose by 0.25 to 0.5 mg orally every 3 days as needed
    3. Maximum: 0.1 to 0.2 mg/day divided 2 to 3 times daily
  1. Valium = Clonazepam Dose x2.5
  2. Phenobarbital = Clonazepam Dose x7.5
  • Pharmacokinetics
  1. Half Life: 20-48 hours (up to 60 hours)
  2. Therapeutic Range: 20 to 80 ng/ml
  3. Rapidly and completely absorbed PO
  4. Metabolized via CYP3A4 to inactive metabolites
  • Safety
  1. Pregnancy Category D (esp. avoid in first trimester)
  2. Avoid in Lactation
  3. Schedule IV Controlled Substance
  • Adverse Effects
  1. Sedation
  2. Weight gain
  3. Impaired academic performance
  4. Social anxiety with School Refusal in children
  5. Worsening of attention in children with ADHD
  6. Hypersalivation
  • Resources
  1. Clonazepam Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=542f22e8-dad2-47a8-93b6-30936715d73b
  • References
  1. (2019) Med Lett Drugs Ther 61(1578): 121-6
  2. (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia