The combination will increase the sedative effects of Klonopin and could be life-threatening. The most common side effects of KLONOPIN include: These are not all the possible side effects of KLONOPIN. Clonazepam has the potential to influence concentrations of phenytoin. I could gradually increase my dose, (0.5 mg then 1 mg in an hour if no sleep) or hit hard early (1.5 or 2 mg) 02 Jun 2023 19:21:33 Klonopin is available as a generic drug, and is prescribed for the treatment of anxiety and seizure disorders. The maximum dosage (highest dose) of Klonopin for seizure disorders in adults is a total of 20 mg per day. This study was conducted in three phases: a 1-week placebo lead-in, a 6-week optimal-dose, and a 6-week discontinuance phase. Periodic blood counts and liver function tests are advisable during long-term therapy with Klonopin. That means that it takes the body 3040 hours to eliminate half the drug from the body. Usual maintenance dose: 2 to 8 mg daily in 1 to 2 divided doses (Brodie 1997); do not exceed 20 mg/day. The risk did not vary substantially by age (5100 years) in the clinical trials analyzed. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses and investigators. These include carboxamides such as carbamazepine, barbiturates such as phenobarbital, valproates such as valproic acid, hydantoins such as phenytoin, succinimides such as ethosuximide, triazines such as lamotrigine, and many others. Do not stop taking Klonopin suddenly. It is also used to treat panic disorder. Doses will start low0.25 mg taken two times per dayand steadily increase by 0.25 mg every one or two days until an effective dose is reached, but the daily dose never exceeds 4 milligrams. Breastfeeding while taking Klonopin is not recommended. It has a molecular weight of 315.72 and the following structural formula: Klonopin is useful alone or as an adjunct in the treatment of the Lennox-Gastaut syndrome (petit mal variant), akinetic, and myoclonic seizures. Then they'll. Body as a Whole: weight increase, accident, weight decrease, wound, edema, fever, shivering, abrasions, ankle edema, edema foot, edema periorbital, injury, malaise, pain, cellulitis, inflammation localized, Cardiovascular Disorders: chest pain, hypotension postural, Central and Peripheral Nervous System Disorders: migraine, paresthesia, drunkenness, feeling of enuresis, paresis, tremor, burning skin, falling, head fullness, hoarseness, hyperactivity, hypoesthesia, tongue thick, twitching, Gastrointestinal System Disorders: abdominal discomfort, gastrointestinal inflammation, stomach upset, toothache, flatulence, pyrosis, saliva increased, tooth disorder, bowel movements frequent, pain pelvic, dyspepsia, hemorrhoids, Hearing and Vestibular Disorders: vertigo, otitis, earache, motion sickness, Heart Rate and Rhythm Disorders: palpitation, Metabolic and Nutritional Disorders: thirst, gout, Musculoskeletal System Disorders: back pain, fracture traumatic, sprains and strains, pain leg, pain nape, cramps muscle, cramps leg, pain ankle, pain shoulder, tendinitis, arthralgia, hypertonia, lumbago, pain feet, pain jaw, pain knee, swelling knee, Platelet, Bleeding and Clotting Disorders: bleeding dermal, Psychiatric Disorders: insomnia, organic disinhibition, anxiety, depersonalization, dreaming excessive, libido loss, appetite increased, libido increased, reactions decreased, aggression, apathy, disturbance in attention, excitement, anger, hunger abnormal, illusion, nightmares, sleep disorder, suicide ideation, yawning, Reproductive Disorders, Female: breast pain, menstrual irregularity, Reproductive Disorders, Male: ejaculation decreased, Resistance Mechanism Disorders: infection mycotic, infection viral, infection streptococcal, herpes simplex infection, infectious mononucleosis, moniliasis, Respiratory System Disorders: sneezing excessive, asthmatic attack, dyspnea, nosebleed, pneumonia, pleurisy, Skin and Appendages Disorders: acne flare, alopecia, xeroderma, dermatitis contact, flushing, pruritus, pustular reaction, skin burns, skin disorder, Special Senses Other, Disorders: taste loss, Urinary System Disorders: dysuria, cystitis, polyuria, urinary incontinence, bladder dysfunction, urinary retention, urinary tract bleeding, urine discoloration, Vascular (Extracardiac) Disorders: thrombophlebitis leg, Vision Disorders: eye irritation, visual disturbance, diplopia, eye twitching, styes, visual field defect, xerophthalmia. In mild to moderate cases, symptoms can include drowsiness, confusion, dysarthria, lethargy, hypnotic state, diminished reflexes, ataxia, and hypotonia. Healthcare providers are encouraged to recommend that pregnant women taking Klonopin enroll in the NAAED Pregnancy Registry by calling 1-888-233-2334 or online at http://www.aedpregnancyregistry.org/. 73, 75 One study reported that . SingleCare Services LLC ('SingleCare') is the vendor of the prescription discount plan, including theirwebsite.websiteat www.singlecare.com. Monitor neonates exposed to Klonopin during pregnancy for signs of withdrawal. Taking KLONOPIN with certain other medicines can cause side effects or affect how well KLONOPIN or the other medicines work. However, Klonopins therapeutic effects tend to wear off in eight to 12 hours, so Klonopin is typically taken three times a day. Table 1 shows absolute and relative risk by indication for all evaluated AEDs. All reported events are included except those already listed in Table 3 or elsewhere in labeling, those events for which a drug cause was remote, those event terms which were so general as to be uninformative, and events reported only once and which did not have a substantial probability of being acutely life-threatening. Because Klonopin is not approved to help with sleep, there's no recommended dosage for this use. SingleCare Services LLC ('SingleCare') is the vendor of the prescription discount plan, including their. Experience in treatment of seizures has shown that drowsiness has occurred in approximately 50% of patients and ataxia in approximately 30%. Acute withdrawal signs and symptoms associated with benzodiazepines have included abnormal involuntary movements, anxiety, blurred vision, depersonalization, depression, derealization, dizziness, fatigue, gastrointestinal adverse reactions (e.g., nausea, vomiting, diarrhea, weight loss, decreased appetite), headache, hyperacusis, hypertension, irritability, insomnia, memory impairment, muscle pain and stiffness, panic attacks, photophobia, restlessness, tachycardia, and tremor. Inform patients that in some cases, patients taking benzodiazepines have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months. Patients, their caregivers, and families should be counseled that AEDs, including Klonopin, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Klonopin is taken as a tablet one to three times a day with or without food. An event was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. Do not take more KLONOPIN than prescribed or take KLONOPIN for longer than prescribed. If Klonopin is discontinued abruptly after long term use, it may lead to seizures, tremors, muscle cramping, vomiting, and/or sweating. The dose may need to be changed several times, so make sure you understand how much to take. Keep all follow-up visits with your healthcare provider as scheduled. Placebo Patients with Events Per 1000 Patients, Drug Patients with Events Per 1000 Patients, Relative Risk: Incidence of Events in Drug Patients/Incidence in Placebo Patients, Risk Difference: Additional Drug Patients with Events per 1000 Patients, pounding heartbeats or fluttering in your chest, and. Klonopin has a half-life of 3040 hours in healthy patients. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. 66% of reviewers reported a positive experience, while 22% reported a negative experience. It is a light yellow crystalline powder. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue Klonopin or reduce the dosage (see DOSAGE AND ADMINISTRATION: Discontinuation or Dosage Reduction of Klonopin and WARNINGS: Dependence and Withdrawal Reactions). Respiratory: Chest congestion, rhinorrhea, shortness of breath, hypersecretion in upper respiratory passages. Should this occur, the use of the drug should be discontinued gradually (see WARNINGS: Dependence and Withdrawal Reactions and Drug Abuse And Dependence: Dependence). Maximum dose: 4 mg/day Comments: An increase to the target dose for most patients of 1 mg/day may be made after 3 days. Even taking benzodiazepines as prescribed may put patients at risk for abuse and misuse of their medication. Standard Klonopin dosage for panic disorder: 0.5-2 mg taken orally two times per day. Instruct patients to inform their healthcare provider if they are breastfeeding or intend to breastfeed. 14 Studies have reported minimal dosage tolerance and medication abuse with clonazepam for management of RBD. Child 1-11 months Initially 250 micrograms once daily for 4 nights, dose to be increased over 2-4 weeks, usual dose 0.5-1 mg daily, dose to be taken at night; may be given in 3 divided doses if necessary. Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. | Get Klonopin discounts. The tablets should be administered with water by swallowing the tablet whole. If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. Clonazepam is highly metabolized, with less than 2% unchanged clonazepam being excreted in the urine. Abrupt discontinuation or rapid dosage reduction of benzodiazepines or administration of flumazenil, a benzodiazepine antagonist, may precipitate acute withdrawal reactions, including seizures, which can be life-threatening. Both medications are benzodiazepines, CNS depressants, and ways of treating anxiety or panic attacks. Stopping KLONOPIN suddenly can cause serious problems. Published data from observational studies on the use of benzodiazepines during pregnancy do not report a clear association with benzodiazepines and major birth defects. Monitor neonates exposed to Klonopin during pregnancy or labor for signs of sedation, respiratory depression, hypotonia, and feeding problems. It may harm them. For approved indications, Klonopin is typically taken two to three times daily. Physical dependence is a state that develops as a result of physiological adaptation in response to repeated drug use, manifested by withdrawal signs and symptoms after abrupt discontinuation or a significant dose reduction of a drug. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You are fully responsible for paying your prescriptions at the pharmacy at the time of service, but you will be entitled to receive a discount from the pharmacy in accordance with the specific pre-negotiated discounted rate schedule. If doses are not equally divided, the largest dose should be given before retiring. Consider contacting the Poison Help line (1-800-222-1222) or a medical toxicologist for additional overdosage management recommendations. By using the SingleCare prescription discount card or app, you agree to the SingleCare Terms and Conditions found at. Scan the code with your camera phone to download the free SingleCare app, Medically reviewed by Anne Jacobson, MD, MPH. Klonopin use during pregnancy may cause adverse effects in the fetus and it is secreted in breast milk. The medication is started to control seizures. Dosage may be increased in increments of 0.5 to 1 mg every 3 days until seizures are adequately controlled or until side effects preclude any further increase. Proper Disposal Klonopin (clonazepam) is a medication indicated for the treatment of panic disorder and seizure disorders. By using the SingleCare prescription discount card or app, you agree to the SingleCare Terms and Conditions found athttps://www.singlecare.com/terms-and-conditions, By clicking 'Subscribe', I agree to SingleCare's, 0.010.03 mg/kg per day divided into 2 or 3, 0.10.2 mg/kg per day divided into 2 or 3. nor a Medicare prescription drug plan. Clonazepam is present in breast milk in very small amounts and is sometimes detectable in an infants blood, but this is uncommon. Klonopin may cause serious side effects including: Get medical help right away, if you have any of the symptoms listed above. Protracted withdrawal syndrome associated with benzodiazepines is characterized by anxiety, cognitive impairment, depression, insomnia, formication, motor symptoms (e.g., weakness, tremor, muscle twitches), paresthesia, and tinnitus that persists beyond 4 to 6 weeks after initial benzodiazepine withdrawal. You may report side effects to FDA at 1-800-FDA-1088. The relative risk for suicidal thoughts or behavior was higher in clinical trials for epilepsy than in clinical trials for psychiatric or other conditions, but the absolute risk differences were similar for the epilepsy and psychiatric indications. Some nursing infants have been reported to experience common side effects of clonazepam such as drowsiness and slow breathing. Following the short-term treatment of patients with panic disorder in Studies 1 and 2 (see CLINICAL PHARMACOLOGY: Clinical Trials), patients were gradually withdrawn during a 7-week downward-titration (discontinuance) period. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Clonazepam is only approved for use in children to treat seizure disorders, but healthcare providers may prescribe clonazepam to children off-label for medical conditions such as sleep disorders or Tourette syndrome. To help prevent adverse reactions, a healthcare provider will discontinue Klonopin using a gradually tapering dose. So far, there is no evidence that Klonopin will harm a fetus or affect a pregnancy. So the only med I have is clonazepam. Others, listed by system, including those identified during postapproval use of Klonopin are: Dermatologic: Hair loss, hirsutism, skin rash, ankle and facial edema, Gastrointestinal: Anorexia, coated tongue, constipation, diarrhea, dry mouth, encopresis, gastritis, increased appetite, nausea, sore gums, Genitourinary: Dysuria, enuresis, nocturia, urinary retention, Hematopoietic: Anemia, leukopenia, thrombocytopenia, eosinophilia, Hepatic: Hepatomegaly, transient elevations of serum transaminases and alkaline phosphatase, Miscellaneous: Dehydration, general deterioration, fever, lymphadenopathy, weight loss or gain, Neurologic: Abnormal eye movements, aphonia, choreiform movements, coma, diplopia, dysarthria, dysdiadochokinesis, glassy-eyed'' appearance, headache, hemiparesis, hypotonia, nystagmus, respiratory depression, slurred speech, tremor, vertigo. * Events reported by at least 1% of patients treated with Klonopin and for which the incidence was greater than that for placebo. For younger children, the dose will be determined by the childs body weight, and the starting dose will be very low to minimize drowsiness. Maximum plasma concentrations are reached within 1-4 hours after oral administration. Do not drive or operate heavy machinery until you know how taking KLONOPIN and opioids affects you. Both are central nervous system depressants and slow down the brain. . Rarely, paradoxical or disinhibitory reactions (including agitation, irritability, impulsivity, violent behavior, confusion, restlessness, excitement, and talkativeness) may occur. Klonopin is contraindicated in patients with the following conditions: The precise mechanism by which clonazepam exerts its antiseizure and antipanic effects is unknown, although it is believed to be related to its ability to enhance the activity of gamma aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system. The only people who cant take Klonopin are people with severe liver disease, acute narrow-angle glaucoma, or who have had an allergic reaction to drugs similar to Klonopin called benzodiazepines, such as Valium (diazepam), Xanax (alprazolam), or Ativan (lorazepam). Our Klonopin Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. Before prescribing KLONOPIN and throughout treatment, assess each patients risk for abuse, misuse, and addiction (e.g., using a standardized screening tool). Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. KLONOPIN can pass into breast milk. These adverse events were reported infrequently, which is defined as occurring in 1/100 to 1/1000 patients. The use of benzodiazepines, including KLONOPIN, exposes users to the risks of abuse, misuse, and addiction, which can lead to overdose or death. Clonazepam (Klonopin), National Alliance on Mental Illness (NAMI), Clonazepam compound summary, U.S. National Library of Medicine, Alprazolam oral solution prescribing information, U.S. National Library of Medicine, Anxiety disorders, National Institute of Mental Health, Clonazepam tablet, orally disintegrating prescribing information, U.S. National Library of Medicine, Klonopin prescribing information, U.S. National Library of Medicine. If a decision is made to prescribe Klonopin concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation. Concomitant use of benzodiazepines, including Klonopin, and opioids may result in profound sedation, respiratory depression, coma, and death. Treatment should be discontinued gradually, with a decrease of 0.125 mg twice daily every 3 days, until the drug is completely withdrawn. Because Klonopin can cause physical dependence, suddenly stopping the medicine can produce withdrawal symptoms including sleeplessness, anxiety, irritability, depression, tremors, headache, excessive sweating, confusion, delirium, and hallucinations. The dose amount will be based on body weight, but doses are typically larger for epilepsy than they are for anxiety problems. In the U.S. general population, the estimated risk of major birth defects and of miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Clonazepam is used alone or together with other medicines to treat certain seizure disorders (eg, Lennox-Gastaut syndrome, akinetic, myoclonic, and absence seizures). The CNS-depressant action of the benzodiazepine class of drugs may be potentiated by alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, antianxiety agents, the phenothiazines, thioxanthene and butyrophenone classes of antipsychotic agents, monoamine oxidase inhibitors and the tricyclic antidepressants, and by other anticonvulsant drugs. Some healthcare providers, however, may prescribe Klonopin off-label to children with sleep disorders or Tourette syndrome. (clonazepam) tablets, for oral use. acting aggressive, being angry, or violent, an extreme increase in activity and talking (, other unusual changes in behavior or mood. Clinical studies of Klonopin did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Information For Patients. It is not known if KLONOPIN is safe or effective in treating panic disorder in children younger than 18 years old. Your . For panic disorder: AdultsAt first, 0.25 milligram (mg) 2 times per day. Store at 25C (77F); excursions permitted to 15 to 30C (59 to 86F). RxList does not provide medical advice, diagnosis or treatment. These include kidney impairment, mild to moderate liver impairment, depression, alcohol abuse, sleep apnea, lung disease, and porphyria. Some loss of effect may occur during the course of clonazepam treatment (see PRECAUTIONS: Loss of Effect). The adverse experiences for Klonopin are provided separately for patients with seizure disorders and with panic disorder. At endpoint, 62% of patients receiving clonazepam were free of full panic attacks, compared to 37% of placebo-treated patients. The following adverse reactions have occurred with benzodiazepine abuse and/or misuse: abdominal pain, amnesia, anorexia, anxiety, aggression, ataxia, blurred vision, confusion, depression, disinhibition, disorientation, dizziness, euphoria, impaired concentration and memory, indigestion, irritability, muscle pain, slurred speech, tremors, and vertigo. Data for other benzodiazepines suggest the possibility of adverse developmental effects (long-term effects on neurobehavioral and immunological function) in animals following prenatal exposure to benzodiazepines. Study 1 was a 9-week, fixed-dose study involving Klonopin doses of 0.5, 1, 2, 3 or 4 mg/day or placebo. RELATED: What is Klonopin? Dosage forms: oral tablet (0.5 mg; 1 mg; 2 mg), oral tablet, disintegrating (0.125 mg; 0.25 mg; 0.5 mg; 1 mg; 2 mg) Drug classes: Benzodiazepine anticonvulsants, Benzodiazepines Medically reviewed by Kaci Durbin, MD. Never take extra medicine to make up for a missed dose. For adults, the maximum daily dose of Klonopin for seizure disorders is 20 milligrams. See the flumazenil injection Prescribing Information. sleep disorders; tremor; vision disorders . More severe acute withdrawal signs and symptoms, including life-threatening reactions, have included catatonia, convulsions, delirium tremens, depression, hallucinations, mania, psychosis, seizures, and suicidality. The maximum daily dose should not exceed 1 to 4 mg. Ask your healthcare provider if you are not sure if you have any of the problems listed above. Benzodiazepines cross the placenta and may produce respiratory depression, hypotonia and sedation in neonates. Inform patients that the continued use of KLONOPIN may lead to clinically significant physical dependence and that abrupt discontinuation or rapid dosage reduction of KLONOPIN may precipitate acute withdrawal reactions, which can be life-threatening. Because of these risks, reserve concomitant prescribing of benzodiazepines and opioids for patients for whom alternative treatment options are inadequate. The maximum dose is 20 mg daily. 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. Subsequently decrease the dosage more slowly (see WARNINGS: Dependence and Withdrawal Reactions and Drug Abuse And Dependence: Dependence). drugs a-z list If you become pregnant while taking KLONOPIN, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. Do not stop taking KLONOPIN without first talking to your healthcare provider. You may also report side effects to the Safety Call Center at 1-866-788-3904. Panic disorder (DSM-V) 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. Doses will be given two or three times per day depending on the veterinarian. Pill Identifier Tool Quick, Easy, Pill Identification, Drug Interaction Tool Check Potential Drug Interactions, Pharmacy Locator Tool Including 24 Hour, Pharmacies. The absolute bioavailability of clonazepam is about 90%. Reductions in maternal weight gain occurred at doses of 5 mg/kg/day or greater and reduction in embryofetal growth occurred in one study at a dose of 10 mg/kg/day. Treatment should start at a dose of 0.25 mg tablets, taken twice a day orally for three days, after which the dose should be increased to 0.5 mg tablets twice daily. Klonopin should be taken as prescribed. The risk of suicidal thoughts or behavior was generally consistent among drugs in the data analyzed. Breastfeeding during treatment with KLONOPIN may cause your baby to have sleepiness, feeding problems, and decreased weight gain. So my lips are feeling uncomfortable and I really want to stay away from antipsychotics unless I feel like psychosis is imminent. This is a prescription discount plan. In order to minimize drowsiness, the initial dose for infants and children (up to 10 years of age or 30 kg of body weight) should be between 0.01 and 0.03 mg/kg/day but not to exceed 0.05 mg/kg/day given in two or three divided doses. Paradoxical reactions are more likely to occur in children and in the elderly. For additional information, including an up-to-date list of pharmacies, or assistance with any problems related to this prescription drug discount plan, please contact customer service toll free at 844-234-3057, 24 hours a day, 7 days a week (except major holidays). Klonopin is indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-V. 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. In severe overdosage cases, patients may develop respiratory depression and coma. If a substance use disorder is suspected, evaluate the patient and institute (or refer them for) early treatment, as appropriate. In a two-generation fertility study in which clonazepam was given orally to rats at 10 and 100 mg/kg/day, there was a decrease in the number of pregnancies and in the number of offspring surviving until weaning. Drug interactions include alcohol, barbiturates, and narcotics. Abuse is the intentional, non-therapeutic use of a drug, even once, for its desirable psychological or physiological effects. At first glance, Xanax and clonazepam are very similar. The range of prescription discounts provided under this discount plan will vary depending on the prescription and pharmacy where the prescription is purchased and can be up to 80% off the cash price. Antiepileptic drugs (AEDs), including Klonopin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. The lowest dose tested is approximately 5 and 24 times the maximum recommended human dose (MRHD) of 20 mg/day for seizure disorders and 4 mg/day for panic disorder, respectively, on a body surface area (mg/m) basis. Klonopin may cause respiratory depression and should be used with caution in patients with compromised respiratory function (e.g., chronic obstructive pulmonary disease, sleep apnea). The dose is usually 0.01 to 0.03 mg per kg of body weight per day, given in 2 or 3 divided doses. No adverse maternal or embryofetal effects were observed in mice or rats following oral administration of clonazepam during organogenesis of doses up to 15 or 40 mg/kg/day, respectively (4 and 20 times the MRHD of 20 mg/day for seizure disorders and 20 and 100 times the MRHD of 4 mg/day for panic disorder, respectively, on a mg/m basis). Licensed by: CHEPLAPHARM Arzneimittel GmbH , Ziegelhof 24, 17489 Greifswald Germany. The recommended dose of 1 mg/day is based on the results from a fixed dose study in which the optimal effect was seen at 1 mg/day. To get better control of your seizures, the doctor may increase the dosage by 0.5 to 1 mg every 3 to 7 days. The effect is to slow down and calm the central nervous system, helping to prevent seizures, quiet anxiety, and induce sleepiness. Clonazepam Maximum Daily Dose <1 mg n=96 %: 1- <2 mg n=129 %: 2 <3mg n=113 %: 3mg n=235 %: All Klonopin Groups N=574 %: . KLONOPIN can also make your seizures happen more often or make them worse. While pharmacotherapy should not be the sole treatment for insomnia, medication may be part of an integrated approach that includes behavioral strategies and treatment of relevant comorbidities. In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months (see Drug Abuse And Dependence: Dependence). Metabolites of Klonopin are excreted by the kidneys; to avoid their excess accumulation, caution should be exercised in the administration of the drug to patients with impaired renal function. Abrupt discontinuation or rapid dosage reduction of KLONOPIN after continued use, or administration of flumazenil (a benzodiazepine antagonist) may precipitate acute withdrawal reactions, which can be life-threatening (e.g., seizures) (see Drug Abuse And Dependence: Dependence). In order to minimize drowsiness, the initial dose for infants and children (up to 10 years of age or 30 kg of body weight) should be between 0.01 and 0.03 mg/kg/day but not to exceed 0.05 mg/kg/day given in two or three divided doses. Although some conditions wont require dose adjustments, they will require closer monitoring for adverse effects or worsening of the condition. There is no evidence that clonazepam induces its own metabolism or that of other drugs in humans. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Klonopin and any potential adverse effects on the breastfed infant from Klonopin or from the underlying maternal condition. Porphyria. Please read it completely before taking Klonopin. 1 Lake and FD&C Blue No. Dosage may be increased by 0.5 to 1 mg daily every 3 days until seizures are controlled or side effects preclude further increases in dose. What Are the Best PsA Treatments for You? Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death (see WARNINGS). However, the standard dose and maximum doses are the same. Do not drive, operate heavy machinery, or do other dangerous activities until you know how KLONOPIN affects you. This should be considered before adding Klonopin to an existing anticonvulsant regimen. Clonazepam, the active ingredient in Klonopin, belongs to a class of drugs called benzodiazepines. Tolerance is a physiological state characterized by a reduced response to a drug after repeated administration (i.e., a higher dose of a drug is required to produce the same effect that was once obtained at a lower dose). The 16-night protocol consisted of 4 placebo-baseline nights, 7 nights of drug administration and 5 placebo-withdrawal nights. Call your healthcare provider right away if your seizures get worse while taking KLONOPIN. We can certainly provide some information for you on how each of the drugs that were prescribed to you ( trazodone and clonazepam) for insomnia affect REM sleep. How do they differ? These conditions are called contraindications by healthcare providers. There is no clinical trial experience with Klonopin in panic disorder patients 65 years of age and older. Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages (i.e., higher and/or more frequent doses) and those who have had longer durations of use (see WARNINGS: Dependence and Withdrawal Reactions). Metabolites of Klonopin are excreted by the kidneys; to avoid their excess accumulation, caution should be exercised in the administration of the drug to patients with impaired renal function. Klonopin, a benzodiazepine, is available as scored tablets with a K-shaped perforation containing 0.5 mg of clonazepam and unscored tablets with a K-shaped perforation containing 1 mg or 2 mg of clonazepam. Do not use KLONOPIN for a condition for which it was not prescribed. Prospective clinical trials are necessary to establish the evidence basis for melatonin and clonazepam as RBD therapies. Because clonazepam undergoes hepatic metabolism, it is possible that liver disease will impair clonazepam elimination. Maximum recommended daily dose is 20 mg. Clonazepam is administered orally. For additional information, including an up-to-date list of pharmacies, or assistance with any problems related to this prescription drug discount plan, please contact customer service toll free at 844-234-3057, 24 hours a day, 7 days a week (except major holidays). Ketogenic diet in children does not affect clonazepam concentrations. An increase to the target dose for most patients of 1 mg/day may be made after 3 days. Standard Klonopin dosage for seizure disorders: 0.55 mg taken orally three times per day, Maximum Klonopin dosage for seizure disorders: 20 mg per day. However, Klonopin is often prescribed off-label to treat several other medical conditions in both adults and children including anxiety disorders, Tourettes syndrome, restless legs syndrome, and insomnia, among others. The data currently available are not sufficient to determine the genotoxic potential of clonazepam. KLONOPIN KLONOPIN tablets should be taken with water and swallowed whole. In general, elderly patients should be started on low doses of Klonopin and observed closely (see PRECAUTIONS: Geriatric Use). In these same trials, adverse events classified under the preferred term depression were reported as leading to discontinuation in 4% of Klonopin-treated patients compared to 1% of placebo-treated patients. INTRODUCTION Insomnia is one of the most common symptoms for which adults seek medical advice. Before you take KLONOPIN, tell your healthcare provider if you: Tell your healthcare provider about all the medicines you take, including prescription and over-thecounter medicines, vitamins, and herbal supplements. For panic disorder, the maximum daily dose is 4 milligrams. About clonazepam Who can and cannot take it How and when to take it Side effects Pregnancy, breastfeeding and fertility Taking it with other medicines and herbal supplements Common questions Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. Sometimes, however, the doses will vary, and the strongest dose will be given at night to help minimize drowsiness during the day or improve sleep at night. This study was conducted in four phases: a 1-week placebo lead-in, a 3-week upward titration, a 6-week fixed dose, and a 7-week discontinuance phase. Klonopin dose depends on the condition being treated and how the patient responds. Limit dosage and duration of concomitant use of benzodiazepines and opioids, and follow patients closely for respiratory depression and sedation. In children, clearance values of 0.42 0.32 mL/min/kg (ages 2 18 years) and 0.88 0.4 mL/min/kg (ages 7 12 years) were reported; these values decreased with increasing body weight. It also has many off-label indications for its use, like restless leg syndrome, acute mania, insomnia, and tardive dyskinesia. Klonopin is used for the management of a broad range of seizure disorders including Lennox-Gastaut syndrome, atonic seizures (sudden loss of muscle strength), myoclonic seizures (brief muscle spasms), petit mal absence seizures (blanking out), infantile spasm, and non-convulsive status epilepticus (seizures without convulsions that last longer than five minutes). It's also used by epilepsy patients to help prevent seizures, muscle spasms, and RLS (restless leg syndrome) a leading cause of insomnia. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and with an increased risk of suicidal thoughts and behavior. Clonazepam is a benzodiazepine drug used for the acute management of the panic disorder, epilepsy, and non-convulsive status epilepticus. Filter by condition Clonazepam rating summary 7.2/10 average rating 180 ratings from 192 user reviews. 1. Sandoz-clonazePAM; Teva-clonazePAM; Zym-clonazePAM; Descriptions. If the decision is made to use flumazenil, it should be used as an adjunct to, not as a substitute for, supportive management of benzodiazepine overdosage. In some studies, up to 30% of patients who initially responded have shown a loss of anticonvulsant activity, often within 3 months of administration. Infants exposed to Klonopin through breast milk should be monitored for sedation, poor feeding and poor weight gain. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. adults The initial dose for adults with seizure disorders should not exceed 1.5 mg/day divided into three doses. Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day Maintenance dose: 1 to 2 mg orally 2 to 3 times a day Comments: The daily dosage may vary from 1 to 10 mg/day. Do not start or stop other medicines without talking to your healthcare provider. Both are short. 0.5 mg - KLONOPIN (front) No imprint (scored side), 1 mg - 1 KLONOPIN (front) No imprint (reverse side), 2 mg - 2 KLONOPIN (front) No imprint (reverse side). You can register by calling 1-888-233-2334. Your healthcare provider can tell you more about the differences between physical dependence and drug addiction. Behaviors of concern should be reported immediately to healthcare providers. Physical dependence is not the same as drug addiction. This derivative can be acetylated, hydroxylated and glucuronidated. Is clonazepam a controlled substance? The concomitant use of benzodiazepines and opioids increases the risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration. Misuse is the intentional use, for therapeutic purposes, of a drug by an individual in a way other than prescribed by a health care provider or for whom it was not prescribed. Klonopin tablets are available as scored tablets with a K-shaped perforation - 0.5 mg, orange (NDC 61269-605-10); and unscored tablets with a K-shaped perforation - 1 mg, blue (NDC 61269-610-10); 2 mg, white (NDC 61269-620-10) - bottles of 100. The most common events (1%) associated with discontinuation and a dropout rate twice or greater for Klonopin than that of placebo included the following: Table 2 : Most Common Adverse Events (1%) Associated with Discontinuation of Treatment. Last updated on Dec 13, 2021. However, Klonopin is used off-label for the treatment of many other medical conditions, including anxiety, insomnia, restless legs syndrome, mania, Tourette syndrome, and sleep disorders. What is Klonopin's dosage for sleep? In three studies in which clonazepam was administered orally to pregnant rabbits at doses of 0.2, 1, 5, or 10 mg/kg/day during the period of organogenesis, a similar pattern of malformations (cleft palate, open eyelid, fused sternebrae and limb defects) was observed at all doses, in a low, non-dose-related incidence. For panic disorder, healthcare providers can provide long-term treatment with tricyclic antidepressants such as imipramine, selective serotonin reuptake inhibitors (SSRIs) such as Zoloft (sertraline), and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Effexor (venlafaxine). In a study in which the 2 mg clonazepam orally disintegrating tablet was administered with and without propantheline (an anticholinergic agent with multiple effects on the GI tract) to healthy volunteers, the AUC of clonazepam was 10% lower and the Cmax of clonazepam was 20% lower when the orally disintegrating tablet was given with propantheline compared to when it was given alone. The prescriber should be aware that the figures in Table 3 cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. If thats the case, skip the missed dose and take the next dose as scheduled. In these trials, which had a median treatment duration of 12 weeks, the estimated incidence rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43% compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one case of suicidal thinking or behavior for every 530 patients treated. Usually, each dose is the same. Because clonazepam undergoes hepatic metabolism, it is possible that liver disease will impair clonazepam elimination. Behaviors of concern should be reported immediately to healthcare providers. Abuse and misuse of benzodiazepines often (but not always) involve the use of doses greater than the maximum recommended dosage and commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death. Benzodiazepines interact at GABAA sites, and opioids interact primarily at mu receptors. Klonopin is a brand-name prescription drug used as an anticonvulsant to manage certain types of seizures in adults and children with epilepsy or other seizure disorders. Psychiatric: Confusion, depression, amnesia, hysteria, increased libido, insomnia, psychosis (the behavior effects are more likely to occur in patients with a history of psychiatric disturbances). Chemically, clonazepam is 5-(2-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4- benzodiazepin-2-one. Following is a list of modified CIGY terms that reflect treatment-emergent adverse events reported by patients treated with Klonopin at multiple doses during clinical trials. Klonopin may have a porphyrogenic effect and should be used with care in patients with porphyria. Klonopin starts showing effects about 25 minutes after taking a dose and reaches peak concentration in the blood in about one to four hours. 6 Lake, 1 mg tablets contain lactose, magnesium stearate, microcrystalline cellulose, corn starch, FD&C Blue No. The mean clonazepam dose during the optimal dosing period was 2.3 mg/day. However, there are not sufficient data from adequate and well-controlled long-term clonazepam studies in patients with panic disorder to accurately estimate the risks of withdrawal symptoms and dependence that may be associated with such use. Klonopin may produce physical dependence from continued therapy. Klonopin is available as a tablet in three different dose strengths. 2 Lake, 2 mg tablets contain lactose, magnesium stearate, microcrystalline cellulose, corn starch. Stopping KLONOPIN suddenly can cause seizures that will not stop (status epilepticus). Inform patients that the use of KLONOPIN, even at recommended dosages, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose and death, especially when used in combination with other medications (e.g., opioid analgesics), alcohol, and/or illicit substances. In the tables and tabulations that follow, CIGY dictionary terminology has been used to classify reported adverse events, except in certain cases in which redundant terms were collapsed into more meaningful terms, as noted below. Use of Klonopin late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in the neonate (see PRECAUTIONS: Pregnancy). Monitoring of phenytoin concentration is recommended when clonazepam is co-administrated with phenytoin. There is no adequate research on how Klonopin affects pregnant women or the babies theyre carrying. The physician who elects to use Klonopin for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient (see DOSAGE AND ADMINISTRATION). Beta blockers can also be used as a long-term treatment option. Overdosage of benzodiazepines in combination with other CNS depressants (including alcohol and opioids) may be fatal (see WARNINGS: Abuse, Misuse, and Addiction). 2 Lake. You are encouraged to report negative side effects of prescription drugs to the FDA. home Do not drink alcohol when taking Klonopin. In general, healthcare providers prescribe Klonopin until theyve determined seizures or panic attacks are under control. The elimination half-life of clonazepam is typically 30 to 40 hours. Pooled analyses of 199 placebo-controlled clinical trials (mono-and adjunctive therapy) of 11 different AEDs showed that patients randomized to one of the AEDs had approximately twice the risk (adjusted Relative Risk 1.8, 95% CI:1.2, 2.7) of suicidal thinking or behavior compared to patients randomized to placebo. Encourage patients to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry if they become pregnant while taking Klonopin. Patients should be instructed to take Klonopin only as prescribed. . The dose may be increased in increments of 0.125 mg to 0.25 mg 2 times per day every 3 days until panic disorder is controlled or until side effects make further increases undesired. The difference between Klonopin and placebo in reduction from baseline in the number of full panic attacks was approximately 1 panic attack per week. If you take too much KLONOPIN, call your healthcare provider or local Poison Control Center right away. Do not give KLONOPIN to other people, even if they have the same symptoms that you have. Taken too close to delivery, Klonopin can cause sedation, low body temperature, depressed breathing, and poor feeding in the newborn. Talk to your healthcare provider about the best way to feed your baby while you take KLONOPIN. All Rights Reserved. For example, how long a .25-milligram (mg) dose or a 0.5-mg dose of clonazepam lasts can vary. A significant difference from placebo was observed consistently only for the 1 mg/day group. Taking too much Klonopin can cause somnolence, confusion, diminished reflexes, muscle weakness, and coma. When starting Klonopin, however, these effects will be mild because initial doses are low and are only gradually increased every few days. 6 Lake; 1 mgFD&C Blue No. Each tablet also contains lactose, magnesium stearate, microcrystalline cellulose and corn starch, with the following colorants: 0.5 mgFD&C Yellow No. klonopin (clonazepam) drug. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. The following paradoxical reactions have been observed: irritability, aggression, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares, abnormal dreams, hallucinations. Taking KLONOPIN late in pregnancy may cause your baby to have symptoms of sedation (breathing problems, sluggishness, low muscle tone), and/or withdrawal symptoms (jitteriness, irritability, restlessness, shaking, excessive crying, feeding problems). For the same reason, avoid taking any other kind of CNS depressant when taking Klonopin including opioids or over-the-counter sleep aids. Inform patients about the signs and symptoms of benzodiazepine abuse, misuse, and addiction; to seek medical help if they develop these signs and/or symptoms; and on the proper disposal of unused drug (see WARNINGS: Abuse, Misuse, and Addiction and Drug Abuse And Dependence). Drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use (e.g., continuing drug use despite harmful consequences, giving a higher priority to drug use than other activities and obligations), and possible tolerance or physical dependence. In patients with absence seizures (petit mal) who have failed to respond to succinimides, Klonopin may be useful. The benzodiazepine class is a broad one containing over 10 different drugs including Valium (diazepam) and Ativan (lorazepam). It is important to emphasize that, although the events occurred during treatment with Klonopin, they were not necessarily caused by it. They should also be warned about the concomitant use of alcohol or other CNS-depressant drugs during Klonopin therapy (see PRECAUTIONS: DRUG INTERACTIONS and PRECAUTIONS: Information For Patients). For seizure disorders, significant improvement in symptoms may not be noticed for several days or even weeks. The effect of clonazepam on the metabolism of other drugs has not been investigated. A missed dose should be taken when remembered unless it is nearly time to take the next dose. The recommended dose by AASM is 0.25 mg to 2 mg clonazepam 30 minutes before bedtime. There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to AEDs, such as Klonopin, during pregnancy. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication. This medicine comes with a medication guide. In some cases, dosage adjustment may reestablish efficacy. Clonazepam Find out how clonazepam treats epileptic seizures or fits, muscle spasms, panic disorder and restless legs syndrome, and how to take it. As a result, there may be difficulty in differentiating withdrawal symptoms from potential re-emergence or continuation of symptoms for which the benzodiazepine was being used. Data for other benzodiazepines suggest the possibility of long-term effects on neurobehavioral and immunological function in animals following prenatal exposure to benzodiazepines at clinically relevant doses. 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. Maximum recommended daily dose is 20 mg. Pediatric Patients Klonopin is administered orally. Events are further categorized by body system and listed in order of decreasing frequency. But in general, each dose works for about 6 to 8 hours. A Klonopin Medication Guide must be given to the patient each time Klonopin is dispensed, as required by law. Insomnia is a very common disorder that is presented in a variety of ways. However, the dose is usually not more than 0.05 mg per kg of body weight. The effectiveness of Klonopin in the treatment of panic disorder was demonstrated in two double-blind, placebo-controlled studies of adult outpatients who had a primary diagnosis of panic disorder (DSM-IIIR) with or without agoraphobia. 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