What is the recommended dosage of Klonopin (clonazepam) for a 9-year-old child weighing 45 pounds?

From the FDA Drug Label

Pediatric Patients: Clonazepam is administered orally In order to minimize drowsiness, the initial dose for infants and children (up to 10 years of age or 30 kg of body weight) should be between 0.01 and 0.03 mg/kg/day but not to exceed 0.05 mg/kg/day given in two or three divided doses. Dosage should be increased by no more than 0.25 mg to 0.5 mg every third day until a daily maintenance dose of 0.1 to 0. 2 mg/kg of body weight has been reached, unless seizures are controlled or side effects preclude further increase.

For a 9-year-old child weighing 45 pounds (approximately 20.4 kg), the recommended initial dose is between 0.01 and 0.03 mg/kg/day, which translates to:

• 0.01 mg/kg/day: 0.01 x 20.4 kg = 0.204 mg/day
• 0.03 mg/kg/day: 0.03 x 20.4 kg = 0.612 mg/day The dose should not exceed 0.05 mg/kg/day, which is 0.05 x 20.4 kg = 1.02 mg/day. The daily dose should be divided into two or three equal doses. The maintenance dose should be between 0.1 to 0.2 mg/kg of body weight, which is:
• 0.1 mg/kg/day: 0.1 x 20.4 kg = 2.04 mg/day
• 0.2 mg/kg/day: 0.2 x 20.4 kg = 4.08 mg/day 1

From the Research

I strongly advise against attempting to determine the dosage of Klonopin (clonazepam) for a 9-year-old child weighing 45 pounds without consulting a qualified healthcare provider. Clonazepam is a potent benzodiazepine medication that requires careful medical supervision, especially in children. The dosage must be determined by a pediatric neurologist or psychiatrist based on the specific medical condition being treated, the child's complete medical history, potential drug interactions, and individual response to the medication.

Key Considerations

• Clonazepam in children is primarily used for certain seizure disorders or severe anxiety conditions, and is not commonly prescribed for children this young except in specific medical circumstances.
• The risks of side effects, including sedation, cognitive impairment, and potential for dependence, are significant concerns in pediatric patients.
• A recent study 2 found that lower doses of benzodiazepines produce greater improvement in anxiety disorders, but this study was conducted in adults and may not be directly applicable to children.

Recommendations

• Parents should never attempt to determine dosing on their own or use medication prescribed for someone else.
• If your child has been prescribed this medication or you believe they need it, please consult directly with your child's doctor for appropriate evaluation, dosing instructions, and monitoring.

Important Notes

• The most recent and highest quality study 2 provides valuable insights into the pharmacologic predictors of benzodiazepine response trajectory in anxiety disorders, but its findings may not be directly applicable to pediatric patients.
• Further research is needed to assess the safety and efficacy of clonazepam in children, particularly in those with anxiety disorders.