Clonazepam is a medication that belongs to a class of drugs called benzodiazepines. The Food and Drug Administration (FDA) approved the use of clonazepam in 1975 for the pharmaceutical company Roche under the brand name of Klonopin. It is marketed under the trade name Rivotril in Australia by Roche. Now, many other drug companies are also making generic clonazepam.

Clonazepam is used to control or treat different mental disorders such as anxiety, panic attacks, epilepsy and seizures as well as some muscle disorders.

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Clonazepam 2mg



Rivotril 2mg

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The half-life of clonazepam is about 30 to 40 hours. The half life is the time taken by the body to reduce the amount of clonazepam by half. So, after two half lives about three quarters of the drug will be out of the system. Clonazepam works by increasing the effect of Gamma Aminobutyric Acid (GABA), a neurotransmitter in the brain. Neurotransmitters are certain chemicals in the brain that transmit nerve signals in the nervous system. GABA is a natural nerve-calming agent that is responsible for transmitting messages between nerve cells and balancing their activity.

Muscle Disorders

Clonazepam is used to treat the following muscle disorders:

  • Rapid eye movement behaviour disorder is controlled by low doses of clonazepam
  • The restless legs syndrome can be treated with clonazepam as the third line of treatment because its use here is still under investigation
  • Bruxism also responds well to clonazepam, but only in the short term
  • Acute and chronic akathisia can also be treated by clonazepam
  • The spasticity associated with amyotrophic lateral sclerosis (death of neurons in brain that control the movement of voluntary muscles) can also be controlled with the use of clonazepam

Anxiety Disorders

Other than this, clonazepam is also used to treat panic disorders in adults. Panic attacks are sudden attacks of tremendous fear, making the person worry about these unexpected attacks. Clonazepam is not used to treat panic disorders in children younger than 18 years of age.

Epilepsy and Seizures

Often called as an anti-epileptic drug, this seizure medication is used either alone or in combination with other drugs to control different types of seizures, such as Lennox-Gastaut syndrome or absence seizures in children and adults.

Special Precautions

Before starting the use of clonazepam, tell your doctor the following:

  • Whether you are allergic to clonazepam or other benzodiazepines such as diazepam (Valium), alprazolam (Xanax), flurazepam, estazolam (Dalmane) or any other medications.
  • About any other prescription or non prescription drug or supplements that you are currently taking or planning to take such as vitamins, minerals, certain antibiotics, sleeping pills, sedatives or tranquilizers.
  • About any herbal products that you are taking or are planning to take.
  • If you are 65 years of age or older and talk about the benefits and risks of taking clonazepam. Older people should take Rivotril in low doses because high doses may cause serious side effects.
  • If you are having any surgery or planning to have surgery.
  • If you drink and talk to your doctor about the safe use of alcohol during the course of your treatment with clonazepam.
  • If you have or have had alcohol or drug abuse, or difficulty swallowing

Pregnant Women

It is quite dangerous for pregnant women to take clonazepam. If taken while pregnant, there is an increased risk of birth defects. You need to tell your doctor immediately if you become pregnant while on clonazepam.

This medication is unsafe for use by breastfeeding women too. Do talk to your doctor if you are considering taking Rivotril while breastfeeding.

Recreational Use

The sedative-hypnotic drug clonazepam is also abused by recreational users as it’s a long acting tranquilizer. Being a prescription medication, it is often misunderstood by recreational users to be less dangerous than other drugs like heroin or cocaine. But the misuse of clonazepam can result in serious complications such as:

  • Dependence
  • Loss of consciousness
  • Addiction
  • Extreme sedation
  • Fatal drug overdose

Clonazepam is a slow acting benzodiazepine and takes an hour or more to take effect. But its sedative effects last for much longer. The overuse and misuse of this drug to get a high often threatens the life of its users. On top of it all, recreational users also use it in combination with other drugs and alcohol, which can slow down brain activity to a dangerously low level, leading to unconsciousness, coma or even death.

Adverse Effects

Clonazepam may cause the following side effects:

  • Coordination problems and muscle aches
  • Blurred vision
  • Dizziness
  • Drowsiness
  • Loss of libido
  • Increased secretion of saliva
  • Memory problems; difficulty in remembering or thinking
  • Constipation
  • Loss of appetite
  • Fatigue
  • Confusion
  • Depression
  • Infection or congestion of the upper respiratory

If the above adverse effects do not go away, you need to immediately consult with your doctor. In addition to the above adverse effects, clonazepam may also cause the following serious side effects:

  • Difficulty in breathing
  • Hoarse voice
  • Swelling of the throat, tongue, lips, eyes or face
  • Hives
  • Rash

The above side effects may be in response to an allergic reaction. If you suffer from any of the symptoms, consult your doctor immediately.

Overdose, Tolerance and Withdrawal Effects

The overuse of clonazepam can cause coma, diminished reflexes, confusion and sleepiness. Call a poison centre or emergency if overdose occurs.

The process through which the brain receptors become habitual to a drug is called as tolerance. Tolerance requires more amount of the drug to achieve the same effect. With the class of benzodiazepines, tolerance is almost always associated with dependency of the drug. After continued regular used of clonazepam, following symptoms depict tolerance:

  • Long term use may aggravate anxiety disorders
  • Panic attacks and agoraphobia may occur for the first time after chronic use of the drug
  • Sleep patterns (deep sleep and dreaming) return to pre-treatment state, which were initially suppressed by the action of the drug
  • Daytime users of the drug do not feel sleepy

So, once you have been on clonazepam for a significant amount of time, there is a chance that you are dependent on the drug. If this occurs, it is quite dangerous to stop the use of clonazepam suddenly. If you do so, it can cause seizures and withdrawal symptoms, such as hallucinations, trouble sleeping, cramps, shaking, sweating, headaches and anxiety.

Interactions

There are many drugs that may affect the working of clonazepam, and clonazepam may also affect other drugs that you are taking. So, it is crucial to tell your doctor about all the drugs that you are taking (including over the counter or illegal drugs, as well as any supplements or drugs). Clonazepam interacts with drugs that work in your nervous system such as:

  • Drugs that are used to treat seizures such as phenytoin (Dilantin), Phenobarbital (Luminal, Solfoton) and carbamazepine (Tegretol).
  • Medications that cure depression such as triyclic antidepressants, monoamine oxidase inhibitors and some selective serotonin reuptake inhibitors.
  • Anti-anxiety drugs
  • Drugs that treat mental disorders such as butyrophenones, thioxanthenes and phenothiazines.
  • Drugs that treat fungal infections such as ketoconazole (Nizoral) and itraconazole (Sporanox).
  • Antibiotics such as erythromycin (E-mycin, Erythrocin) and clarithromycin (Biaxin, Prevpac).
  • Drugs for irregular heartbeat such as amiodarone (Pacerone, Cordarone)
  • Medications for HIV/AIDS that include ritonavir (Norvir, Kaletra), nelfinavir (Viracept) and indinavir (Crixivan)
  • Drug used to treat heartburn, cimetidine (Tagamet)
  • John’s wort
  • Calcium channel blockers such as verapamil (Verelan, Isoptin, Calan) and diltiazem (Tiazac, Dilacor, Cardizem)
  • Narcotic pain medications
  • Muscle relaxants

Warnings

Drowsiness is a common side effect of using clonazepam. Therefore, refrain from driving and using any machinery until you are completely aware of the effects of the drug on your body.

It has also been reported that clonazepam increases the risk for suicidal thoughts and behaviour when people start on clonazepam, as soon as within a week into the medication. Thus, it is quite important to tell your doctor if you have any thoughts of harming yourself or if you experience any unusual changes in your behaviour or mood such as depression, anxiety, agitation, panic attacks or restlessness.

You might not be able to take clonazepam if you are suffering from severe liver disease or untreated open angle glaucoma. If you have suffered from any liver or kidney disease, make it a point to tell your doctor.

Conclusion

Clonazepam is a powerful drug which encourages sleep and helps you feel calm and peaceful. It is used as a treatment for muscle and mental disorders, such as panic attacks and epilepsy. Due to its effect as a long lasting tranquilizer, the drug is abused by recreational users, who often use it in combination with other drugs. Belonging to a class of medications called benzodiazepines, this drug has many side and serious effects, as well as many interactions with other drugs that might be dangerous for the user. So, if you are starting on Rivotril, make sure to talk to your doctor about your health and other medicines, supplements or herbal products that you are using. If you have any more questions about clonazepam, talk to your doctor, nurse or pharmacist.