From the Guidelines
Clonazepam is contraindicated in patients with significant respiratory depression, sleep apnea syndrome, severe liver disease, acute narrow-angle glaucoma, or a history of sensitivity to benzodiazepines. According to the most recent and highest quality study 1, clonazepam can exacerbate sleep-disordered breathing and is listed on the American Geriatrics Society Beers Criteria list of potentially inappropriate medications in older adults. The medication should be used with caution in patients with neurodegenerative disorders, obstructive sleep apnea, and underlying liver disease, as noted in 1.
Some key points to consider when prescribing clonazepam include:
- Patients with myasthenia gravis should avoid clonazepam as it may exacerbate muscle weakness
- The medication should not be combined with opioids except in specific circumstances under close medical supervision, as this combination increases the risk of severe sedation, respiratory depression, coma, and death
- Pregnant women should generally avoid clonazepam, especially in the first trimester, as it may cause fetal harm
- Caution is needed in elderly patients and those with kidney impairment, as they may be more sensitive to the drug's effects
- Patients with a history of substance abuse require careful monitoring due to the medication's potential for dependence and abuse, as mentioned in 1 and 1.
It is essential to weigh the benefits and risks of clonazepam therapy, considering the patient's underlying disease and attendant symptoms, as well as potential side effects such as morning sedation, gait imbalance/falls, depression, and cognitive disturbances.
From the FDA Drug Label
Contraindications Clonazepam is contraindicated in patients with the following conditions: History of sensitivity to benzodiazepines Clinical or biochemical evidence of significant liver disease Acute narrow angle glaucoma (it may be used in patients with open angle glaucoma who are receiving appropriate therapy).
The contraindications for clonazepam are:
- History of sensitivity to benzodiazepines
- Clinical or biochemical evidence of significant liver disease
- Acute narrow angle glaucoma 2
From the Research
Clonazepam Contraindications
- Clonazepam, a benzodiazepine, has several potential contraindications and precautions to be considered when prescribing or taking the medication 3.
- One of the main concerns is the risk of acute angle-closure glaucoma (AACG), which has been reported in patients taking clonazepam 4, 5.
- A case-control study found that patients who took clonazepam had a higher risk of developing AACG compared to those who did not take the medication 5.
- Another study reported two cases of bilateral acute angle closure secondary to the use of clonazepam and alprazolam, highlighting the importance of monitoring for ocular side effects in patients taking benzodiazepines 4.
- Additionally, clonazepam can lead to physical dependence and tolerance, and its use should be carefully considered in patients with a history of substance abuse or dependence 3, 6.
- The medication can also exacerbate underlying health conditions, such as mood and anxiety disorders, and can cause unwanted effects on health, including motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders 3.