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By Kajal Jain

M. Pharm

09 December 2022
Medically reviewed by
Sumayya Salam
Pharm D
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Table of Contents

Taking medication for a mental health problem can be life-changing, but knowing the side effects and risks of those medications is essential. Benzodiazepine prescriptions have increased by 67% and are now being prescribed to approx 13.5 million adults. Clonazepam is a significant contributor.

Clonazepam can help people control their symptoms and return to their daily life. However, some side effects and risks should be considered when taking this medication. 

The Controlled Substances Act was put in place in 1970 to protect the people of the United States from harm caused due to drug trafficking. This act was created to prevent the manufacture, importation, possession, and distribution of drugs that have the potential to be abused. 

Let us learn about the uses and side effects of Clonazepam that can help to avoid drug abuse, misuse, or dependence.

What is Clonazepam?

Clonazepam is marketed under the brand Klonopin, which is often prescribed to control seizures or help with the sleeping difficulty, anxiety, or panic attacks. Clonazepam is used for anxiety and also used as an anti-seizure drug. It’s also prescribed to manage extreme manic symptoms associated with bipolar disorder. 

Clonazepam is available as oral tablets and in three strengths, i.e., 0.5 mg, 1 mg, and 2 mg. It is approved by the FDA to treat the following conditions-

  • Panic disorder in adults (with or without agoraphobia)- Panic disorder is an anxiety disorder that causes repeated panic attacks.
  • Certain seizure disorders (in children of all ages and adults)- Seizure is a condition in which you have uncontrolled electrical disturbance in the brain. Clonazepam treats Myoclonic seizures, Atonic seizures, and Some absence seizures (used to be called petit mal seizures)

Off-label use (meaning not indicated on the U.S. Food and Drug Administration-approved packaging) includes sleepwalking, restless legs syndrome, and social phobia in adults.
Other off-label indications of Clonazepam include:

  • Major depression
  • Burning mouth syndrome
  • Tourette syndrome
  • Essential tremors
  • West syndrome (infantile spasms)
  • Multiple sclerosis
  • Periodic limb movement disorder
  • Tinnitus
  • Vertigo

How Does Clonazepam Work?

Clonazepam (Klonopin) belongs to the class of benzodiazepines that reduces overactivity in the CNS, which is associated with Anxiety, insomnia, seizures, and muscle spasms. Clonazepam shows its effect by enhancing the activity of the brain's natural chemical, Gamma-aminobutyric acid (GABA). GABA is a chief inhibitory neurotransmitter in the brain that serves to down-modulate the signaling activity in the brain, resulting in-

  1. Sedation
  2. Muscle relaxation
  3. Anxiety reduction

A benzodiazepine such as Clonazepam acts on GABA molecules, which calms down the central nervous system. This, in turn, helps lessen our anxiety. Depending on your health condition, this medication can relieve anxiety, stop seizures and convulsions or relax tense muscles. 

The more you consume a benzodiazepine, the more tolerance can develop for the drug. This is one reason benzos are addictive and often lead to drug abuse.

Clonazepam is associated with an increased risk of overthinking, depression, and suicidal thoughts and behavior. Thus, the patients taking Clonazepam should be carefully monitored for changes in mood or behavior or any symptoms of worsening depression or suicidal ideation.
Memory loss can be seen in all kinds of Clonazepam users. It has the ability to interfere with the activity of the brain, which can make remembering certain events or actions difficult.
Clonazepam begins to work between 20 and 60 minutes of administration. Its peak effects take 1-4 hours to reach.

How Does A Medicine Is Classified As A Controlled Substance?

Recognizing the potential that specific medicines have for misuse, abuse, and dependence, Congress established the Controlled Substances Act (CSA) in 1970. The CSA mandates that pharmacies, manufacturers, distributors, and healthcare professionals diligently ensure controlled substances' safe and effective delivery under this Act.

Drugs controlled by the CSA categorize into one of five schedules. Each schedule attempts to classify drugs based on their medical value, the potential for abuse, and Safety standards. Schedule I drugs are viewed as having the most serious misuse; Schedules II through V include drugs with decreasing order of potential for misuse.

  • Schedule I: drugs with no medical use in the United States that have a high abuse potential (Marijuana, heroin, Lysergic acid diethylamide)
  • Schedule II: drugs with a high abuse potential, high risk of dependence and addiction, and considered dangerous. These have accepted medical use in the United States (Adderall, OxyContin, Morphine, Ritalin)
  • Schedule III: drugs with "moderate to low" abuse potential, less risk of dependence and addiction than previous categories, and have medical use (Tylenol 3, Vicodin, Anabolic steroids)
  • Schedule IV: drugs with low abuse potential, and low risk of dependence and addiction compared to other schedules, but the risk does remain. These scheduled drugs have medical uses; many are common treatments for anxiety and similar medical conditions. (Klonopin, Ativan, Xanax, Valium)
  • Schedule V: substances with low abuse potential that does not contain much of the active drug and the risk of dependence is very low (cough medicines with codeine, analgesics)

Is Clonazepam A Controlled Substance?

Though some people abuse prescription drugs, many are considered safe to use as directed and can benefit health and well-being. To find a balance between mental health and public Safety, the U.S. government passed the Controlled Substances Act to categorize drugs of abuse and make clear regulations.

The United States passed the Controlled Substances Act (CSA) in 1971. According to the CSA, all regulated drugs are placed into the five schedules based on abuse potential, medical uses, and risk of dependence or addiction. You can view a complete list of controlled substances on the Drug Enforcement Administration (DEA) website. 

Clonazepam and other benzodiazepines are classified as Schedule IV controlled substances with a low risk of abuse and dependence but are still considered dangerous. Many people abuse Clonazepam because of its sedative effects. Drug Abuse increases an individual's risk of adverse effects, overdose, and long-term health consequences. It can also lead someone to develop an addiction and physical dependence.

Like many benzodiazepines that are also Schedule IV controlled substances, Klonopin is generally prescribed for short-term use. This is because most individuals develop a tolerance to the drug within a few weeks, requiring them to increase their dosage—the higher and more frequent the dose, the greater the risk of physical dependence.

When Was Clonazepam Considered A Controlled Substance?

Until the 1950s, barbiturates were the first choice for treating anxiety and related conditions. However, these drugs had a higher potential for accidental overdose and addiction. Thus, there was a market need for a safer class of drugs. Clonazepam is classified as a Schedule IV drug under the CSA. Out of the "War on Drugs" in the 1970s came the recognition that certain drugs had the potential for dependence and abuse.

What Does Clonazepam Addiction Look Like?

The FDA, or U.S. Food and Drug Administration, warns that taking Clonazepam can be addictive, and users may become physically or psychologically dependent on this drug. People should not stop taking Clonazepam abruptly without any medical supervision.

Clonazepam and other benzodiazepine drugs are often abused and even taken with alcohol or other drugs, which might increase the withdrawal side effects. The Drug Abuse Warning Network reported that over 61,000 people sought emergency department treatment for an adverse reaction involving the non-medical or recreational of Clonazepam in 2011.

Clonazepam can produce chemical changes in the brain when abused for any length of time. Parts of the brain that are normally suppressed by the drug stop functioning normally without it. When Clonazepam is washed out of the body, a kind of rebound may occur, and drug dependence can be formed.  

Clonazepam Withdrawal

Benzodiazepines act as central nervous system depressants or sedatives and tranquilizers. Acute withdrawal symptoms peak two weeks after stopping the use of Clonazepam, but subtle signs can last anywhere from a few days to a month. Usually, mild withdrawal symptoms such as insomnia and dysphoria have been reported after the abrupt discontinuation of benzodiazepines when taken continuously at therapeutic levels for several months. 

More severe symptoms have usually been limited to patients who have received excessive doses over an extended period. Consequently, after the extended therapy, abrupt discontinuation should be avoided, and a gradual dosage tapering schedule should be followed after formulating the same with your doctor.

Addiction-prone individuals such as alcoholics or drug addicts should be under proper surveillance while receiving Clonazepam or other psychotropic agents because of the pre-disposition of such patients to dependence. Possible signs of withdrawal include:

  • Convulsions
  • Hallucinations
  • Seizures
  • Behavioral changes
  • Sweating
  • Muscle or Abdominal cramps
  • Tremors or uncontrollable shaking
  • Anxiety
  • Insomnia

Possible Side Effects Of Clonazepam

The sedative effects of Klonopin can reduce panic attacks and control seizures, but there are also risks involved with taking medicine. People using this medication can experience short and long-term side effects that may vary with the conditions it is being used to treat. The experience of side effects can depend on an individual's tolerance to the drug. These include-

Common Side Effects

Severe Side Effects

Drowsiness,

Memory problems,

Allergic reactions, 

Tremors,

Lightheadedness,

Physical dependence,

Sleep issues,

Thrombocytopenia, 

Constipation,

Difficulty urinating,

Dizziness,

Respiratory depression.

These side effects can impact a person's ability to drive or operate heavy machinery safely, and these activities should be avoided. In this case, medical assistance should be contacted immediately. 

Precautions Of Clonazepam

Drug misuse can have various short- and long-term adverse effects, including legal consequences, physical and mental health problems, impairment in many areas of an individual's life, and interpersonal functioning. 
Talk to your pharmacist or doctor if-

  1. You are allergic to Clonazepam or benzodiazepines (such as Lorazepam or diazepam), or if you have other reactions. Inactive ingredients in this product can trigger allergic reactions or other issues.
  2. You have a specific eye problem (narrow-angle glaucoma), a specific blood disorder (porphyria), kidney disease, liver disease, lung/breathing issues, personal or family history of a drug use disorder (such as overuse), or mental problems (such as depression, thoughts of suicide).
  3. The effects of this medication, especially confusion and drowsiness, may be more pronounced in older adults. 
  4. This medicine will pass into breast milk and negatively affect a nursing baby. Consult with your doctor.
  5. This drug should only be taken during pregnancy if necessary. It can injure an unborn child. If you are about to get pregnant or believe you may be, consult your doctor immediately about the advantages and risks of taking this drug while pregnant.

Drug Interactions

Like other anxiolytic medications, Clonazepam interacts with various drugs, that includes-

  • Clozapine: causing an increased risk of toxicity.
  • Cimetidine: inhibits liver enzymes, leading to a decrease in metabolism.
  • Omeprazole inhibits the CYP450 enzyme system, leading to an increase in the effects of this drug.
  • Saquinavir, Ritonavir, and Voriconazole: their metabolism is reduced by the Protease inhibitors.
  • Drugs such as Ketoconazole, Fluconazole, Itraconazole, Indinavir, and Nelfinavir increase the effects of Clonazepam by decreasing its metabolism.
  • MAO Inhibitors: These drugs reduce blood pressure and increase the sedative effect; the respiratory system is also depressed.
  • Oral contraceptives: They decrease the metabolism of Clonazepam leading to an increase in its adverse and therapeutic action.
  • Telithromycin: it reduces the metabolism of Clonazepam and increases the severity of adverse effects.
  • Vigabatrin: it increases the plasma concentration of Clonazepam by 30% and decreases the peak concentration time by around 45%.
  • Triprolidine: This drug and Klonopin both depress the central nervous system.
  • Alcohol and caffeine: Alcohol and excessive caffeine intake should be avoided when taking this medication.
  • Sedatives or sleeping pills: These medications may cause severe sedation and be fatal when taken with this medication.
  • Tricyclic antidepressants (TCAs): these drugs might increase sedation when co-administered with Clonazepam
  • Carbamazepine, Phenytoin, and Theophylline: these drugs can decrease the effectiveness of this medication. 

Bottom Line From Practical Anxiety Solutions

Clonazepam (Klonopin) is a controlled drug classified as a Schedule IV by the FDA. This means that this drug has accepted medical uses, but it has the risks of Abuse and dependence involved at the same time. 

Having a proper treatment plan that includes aftercare and complete surveillance can improve your quality of life and help you sustain long-term recovery. You must consult a doctor for every drug you take and get the necessary information before consuming.

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