From the Guidelines
For panic attacks, Klonopin (clonazepam) is typically prescribed at an initial dose of 0.25 to 0.5 mg twice daily, with a total daily dose not exceeding 4 mg, as supported by the most recent study 1. The medication begins working within 30-60 minutes and lasts about 8-12 hours.
- Most patients find relief at 1-2 mg per day, divided into two doses.
- Your doctor may start with a lower dose and gradually increase it to find the minimum effective dose that controls your symptoms. Klonopin works by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits excessive brain activity, thereby reducing anxiety and preventing panic attacks. It's essential to take Klonopin exactly as prescribed, as it can cause dependence and withdrawal symptoms if stopped abruptly, as noted in a previous study 2. Side effects may include drowsiness, dizziness, and impaired coordination, so avoid driving or operating machinery until you know how it affects you. This medication should be used as part of a comprehensive treatment plan that may include therapy and lifestyle modifications. The American Academy of Sleep Medicine clinical practice guideline 1 recommends clonazepam as a treatment option for isolated RBD, but its use in panic attacks is also well-established. However, it is crucial to consider the potential risks and benefits, as well as the patient's individual needs and medical history, when prescribing Klonopin for panic attacks.
From the FDA Drug Label
Clonazepam doses of 0. 5, 1, 2, 3 or 4 mg/day or placebo. A significant difference from placebo was observed consistently only for the 1 mg/day group The mean clonazepam dose during the optimal dosing period was 2. 3 mg/day.
The usual effective dose of Klonopin for panic attack is 1 mg/day as it showed a significant difference from placebo in reducing the number of full panic attacks, with 74% of patients receiving this dose being free of full panic attacks at endpoint 3. However, a flexible-dose study with a mean dose of 2.3 mg/day also showed efficacy in reducing panic attacks.
From the Research
Effective Dose of Klonopin for Panic Attacks
- The minimum effective dosage of clonazepam, the active ingredient in Klonopin, for panic disorder is 1.0 mg daily, as determined by the Williams' test 4.
- Dose-response analysis showed that daily dosages of 1.0 mg and higher were equally efficacious in reducing the number of panic attacks 4.
- Daily doses of 1.0 to 2.0 mg of clonazepam offered the best balance of therapeutic benefit and tolerability 4.
- Clonazepam, with its relatively long half-life, permits less frequent dosing than possible with benzodiazepines with shorter half-lives and more continuous control of anxiety 5.
Comparison with Other Medications
- Clonazepam was ranked as one of the most effective medications for panic disorder, along with diazepam and alprazolam 6.
- Benzodiazepines, including clonazepam, were associated with a lower dropout rate compared to placebo and were ranked as the most tolerated of all the medications examined 6.
- Clonazepam was found to have a strong reduction in the frequency of panic attacks compared to placebo, and was ranked highest along with alprazolam 6.
Safety and Efficacy
- Clonazepam is generally well tolerated, but can cause somnolence, ataxia, depression, dizziness, fatigue, and irritability 4, 5.
- The use of clonazepam in the treatment of panic disorder has been well established, and it remains an important therapeutic modality for the management of panic disorder 7.
- Clonazepam, alone or combined with selective serotonin reuptake inhibitors (SSRIs) and/or behavioral therapy, is an effective treatment for panic disorder 7.