From the Guidelines
Yes, Klonopin (clonazepam) can cause altered mental status as a side effect, with concerns including morning sedation, gait imbalance/falls, depression, and cognitive disturbances, specifically delirium and amnesia, as noted in the most recent study 1. This benzodiazepine medication commonly produces cognitive effects including confusion, impaired concentration, drowsiness, and slowed thinking. These effects occur because clonazepam enhances the activity of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the brain, which slows down brain activity. The risk of altered mental status is higher with larger doses, in elderly patients, when combined with other central nervous system depressants like alcohol or opioids, or in those with liver impairment. Some key points to consider when prescribing clonazepam include:
- Starting with lower doses, such as 0.25 mg, especially in patients with neurodegenerative disorders or older adults, as recommended in the 2023 study 1
- Monitoring for signs of cognitive decline, delirium, or amnesia, and adjusting the dose or switching to an alternative medication if necessary
- Being aware of the potential for clonazepam to exacerbate sleep-disordered breathing, as noted in the 2023 study 1
- Considering alternative treatments, such as melatonin or rivastigmine, which may have a more favorable side effect profile in certain patient populations, as discussed in the 2023 study 1 Altered mental status can range from mild drowsiness to severe confusion or even delirium in some cases. These effects typically begin shortly after taking the medication and may persist throughout treatment. If you experience significant mental status changes while taking Klonopin, contact your healthcare provider immediately, as dosage adjustment or medication change may be necessary. Never abruptly stop taking Klonopin as this can cause withdrawal symptoms including worsened mental status changes, as warned in the 2010 study 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.
- Adverse effects of clonazepam include drowsiness, dizziness, and confusion, which can increase the risk of falls 4.
- While the provided studies do not directly address altered mental status as a specific side effect of clonazepam, they do mention that clonazepam can cause confusion and cognitive impairment 3, 4.
- A study on gabapentin, a different medication, found an association between high doses and an increased risk of hospitalization with altered mental status in older adults, but this may not be directly applicable to clonazepam 5.
- Clonazepam has been reported to cause behavioral side effects, including agitation, aggression, hyperactivity, irritability, property destruction, and temper tantrums, in individuals with mental retardation 6.
- Serotonin toxicity, which can be caused by certain medications, including some antidepressants, can lead to altered mental state, including agitation, excitement, and confusion 7.
Clonazepam Side Effects
- Common side effects of clonazepam include motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders 3.
- Clonazepam can cause physical dependence and tolerance with prolonged use 3.
- The risk of adverse reactions to clonazepam can be higher in certain individuals, such as those with low CYP3A4 expression 4.