Can Clonazepine (Klonopin) cause altered mental status?

From the Guidelines

Clonazepam can cause altered mental status, particularly in elderly patients or those with pre-existing cognitive impairments, as evidenced by its potential to induce confusion, delirium, and amnesia, as noted in the most recent study 1. The severity of these effects typically depends on dosage, with higher doses more likely to cause significant mental status changes.

• Common side effects of clonazepam include morning sedation, gait imbalance/falls, depression, and cognitive disturbances, specifically delirium and amnesia.
• Clonazepam can also exacerbate sleep-disordered breathing, and its use is often limited by progressive cognitive decline combined with age-related impairments in drug metabolism, leading to gradual intolerance.
• The American Geriatrics Society Beers Criteria list clonazepam as a potentially inappropriate medication in older adults, highlighting the need for caution when prescribing this medication to elderly patients.
• The recommended dose of clonazepam for patients with secondary RBD is often lower, starting at 0.25 mg, to minimize the risk of adverse effects 1. Key considerations for clinicians include the patient's underlying disease and attendant symptoms, as well as the potential for clonazepam to worsen sleep-disordered breathing or exacerbate cognitive decline.
• Alternative treatments, such as melatonin or rivastigmine, may be considered for patients with secondary RBD, particularly those with neurodegenerative disease or cognitive impairment, as they may have a more favorable side effect profile 1.

From the FDA Drug Label

Psychiatric and Paradoxical Reactions: Paradoxical reactions, such as agitation, irritability, aggression, anxiety, anger, nightmares, hallucinations, and psychoses are known to occur when using benzodiazepines Interference with Cognitive and Motor Performance: Because benzodiazepines have the potential to impair judgment, thinking or motor skills, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that clonazepam therapy does not affect them adversely

Altered Mental Status can be caused by Clonazepine (Klonopin) due to its potential to impair judgment, thinking, or motor skills, and the risk of paradoxical reactions such as hallucinations and psychoses. 2

From the Research

Altered Mental Status and Clonazepine

• Clonazepam, a benzodiazepine, can lead to unwanted effects on health, such as motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders 3.
• The use of clonazepam, alone or in combination with other psychoactive substances, can result in altered mental status 3.
• However, the provided studies do not directly address the specific question of whether clonazepine (Klonopin) can cause altered mental status.
• A study on clozapine, a different medication, reported a case of altered mental status in a patient who had been on long-term use and was resumed on full standard doses without careful titration 4.
• Clonazepam has been used to treat various conditions, including anxiety disorders and epileptic seizures, and its misuse can lead to health problems, such as physical dependence and tolerance 3.
• The medication can also be used as a therapeutic adjunct to improve the management of depression, with a recommended dosage of 2.5-6.0 mg/day 5.
• Inter-individual variability in the incidence of adverse events in patients taking clonazepam partly originates from the differences in clonazepam metabolism due to genetic and nongenetic factors, which can increase the risk of adverse effects such as drowsiness, dizziness, and confusion 6.