From the Guidelines
Klonopin (clonazepam) is recommended for the treatment of isolated REM sleep behavior disorder (RBD) at a starting dose of 0.25-1.0 mg administered at bedtime, with higher doses considered if well tolerated and necessary 1. The use of Klonopin in RBD is based on its ability to promote GABAergic inhibition, reducing dream enactment and REM sleep motor tone.
Key Considerations
- The medication is typically used for long-term treatment, as RBD is a relentless and lifelong condition.
- Patients should be aware of the potential risks of dependence and withdrawal, as well as the negative stigma associated with benzodiazepines.
- Clonazepam is considered a controlled substance and is listed on the American Geriatrics Society Beers Criteria list of potentially inappropriate medications in older adults.
Alternative Treatments
- Melatonin is also suggested for the treatment of RBD, with a starting dose of 3 mg taken at bedtime, which can be titrated up to 15 mg as needed 1.
- Combination therapy using clonazepam and melatonin may be considered if response to monotherapy is inadequate, although there is limited data on this approach.
Important Safety Information
- Patients should avoid alcohol and other central nervous system depressants while taking Klonopin, as these combinations can cause dangerous respiratory depression.
- A gradual tapering schedule under medical supervision is necessary when discontinuing Klonopin to avoid withdrawal symptoms. The most recent and highest quality study 1 supports the use of clonazepam for RBD, and its recommendations should be prioritized in clinical practice.
From the FDA Drug Label
Clonazepam tablets is a prescription medicine used alone or with other medicines to treat:
- certain types of seizure disorders (epilepsy) in adults and children
- panic disorder with or without fear of open spaces (agoraphobia) in adults Seizure Disorders: Clonazepam is useful alone or as an adjunct in the treatment of the Lennox-Gastaut syndrome (petit mal variant), akinetic, and myoclonic seizures. Panic Disorder: Clonazepam is indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-V
The use of Klonopin (clonazepam) is for the treatment of:
- Seizure disorders (epilepsy) in adults and children
- Panic disorder with or without agoraphobia in adults 2 2
From the Research
Uses of Klonopin (Clonazepam)
- Klonopin (clonazepam) is used to treat various conditions, including:
- Panic disorder with agoraphobia, as it has been shown to be clinically effective in treating panic disorder symptoms 3, 4, 5
- Anxiety disorders, such as generalized anxiety 4
- Epileptic seizures, as it was initially marketed for the treatment of minor motor epilepsy 5
- Depression, particularly treatment-resistant and/or protracted depression, as well as for acceleration of response to conventional antidepressants 6
- Clonazepam has several advantages over other benzodiazepines and can be considered a first-line agent for panic disorder 3
- It is also used in combination with SSRIs as an antidepressant, and should be used at a dosage of 2.5-6.0 mg/day 6
Therapeutic Effects
- Clonazepam has a rapid and maintained therapeutic effect without dose increase over a 7- to 8-month period 3
- It exhibits a prophylactic effect against recurrence of depression with low-dose, long-term treatment 6
- The mechanism of action of clonazepam is not yet established, but it may involve enhancement of anti-anxiety effects, anticonvulsant effects, and regulation of GABA activity 6
Potential Risks and Misuse
- Clonazepam has a potential for nonmedical use and misuse, particularly due to its low price and easy availability 7
- Prolonged use of clonazepam may lead to physical dependence and tolerance 7
- It can lead to unwanted effects on health, such as motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders, especially when used in combination with other psychoactive substances 7