What are the side effects of clonazepam (Klonopin)?

From the Guidelines

Clonazepam can cause significant side effects, including morning sedation, gait imbalance/falls, depression, and cognitive disturbances, which can impact morbidity, mortality, and quality of life, and therefore, its use should be carefully considered and monitored. According to the most recent study 1, common side effects of clonazepam include morning sedation, gait imbalance/falls, depression, and cognitive disturbances, specifically delirium and amnesia. Additionally, clonazepam can exacerbate sleep-disordered breathing, which is a concern for patients with underlying respiratory conditions. The study also notes that clonazepam is often used in lower doses, starting at 0.25 mg, in patients with secondary RBD and neurodegenerative disease, due to the risk of gradual intolerance and cognitive decline.

Some of the key side effects of clonazepam include:

• Morning sedation
• Gait imbalance/falls
• Depression
• Cognitive disturbances, such as delirium and amnesia
• Exacerbation of sleep-disordered breathing
• Potential for physical dependence and withdrawal symptoms if stopped abruptly

It is essential to weigh the benefits and risks of clonazepam use, particularly in older adults and those with neurodegenerative disease, as it is listed on the American Geriatrics Society Beers Criteria list of potentially inappropriate medications in older adults 1. Patients should be closely monitored for any concerning side effects, and the medication should be tapered under medical supervision if necessary. Alternative treatments, such as melatonin or rivastigmine, may be considered for patients who experience significant side effects or are at high risk of adverse events.

From the FDA Drug Label

The most frequently occurring side effects of clonazepam are referable to CNS depression. Experience in treatment of seizures has shown that drowsiness has occurred in approximately 50% of patients and ataxia in approximately 30% The most common side effects of clonazepam tablets include:

• Drowsiness
• Problems with walking and coordination
• Dizziness
• Depression
• Fatigue
• Problems with memory Adverse events during exposure to clonazepam were obtained by spontaneous report and recorded by clinical investigators using terminology of their own choosing
• Somnolence
• Depression
• Dizziness
• Nervousness
• Ataxia
• Intellectual Ability Reduced

The side effects of clonazepam include drowsiness, ataxia, dizziness, depression, fatigue, and problems with memory. Other side effects may include somnolence, nervousness, and intellectual ability reduced. 2 2 2

From the Research

Side Effects of Clonazepam

• Clonazepam can lead to unwanted effects on health, such as motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders 3
• Prolonged use of clonazepam may lead to physical dependence and tolerance 3
• Common side effects of clonazepam include drowsiness, dizziness, and ataxia 4
• The incidence of side effects was significantly lower in the clonazepam group compared to other benzodiazepines, with an incidence of adverse events of 26.7% 4

Comparison with Other Benzodiazepines

• Clonazepam was found to be as efficacious as other benzodiazepines for the treatment of various anxiety disorders 4
• The safety profile of clonazepam was superior to other benzodiazepines, with a lower incidence of adverse events 4

Long-term Use and Dependence

• Long-term use of clonazepam can lead to physical dependence and tolerance 3
• Clonazepam can be used for treatment-resistant and/or protracted depression, as well as for acceleration of response to conventional antidepressants, but its long-term use should be monitored closely 5