From the Guidelines
Clonazepam can cause altered mental status, particularly in the form of cognitive disturbances, delirium, and amnesia, as noted in a 2023 clinical practice guideline by the American Academy of Sleep Medicine 1. This is a significant concern, especially in older patients or those with neurodegenerative diseases, as clonazepam is often used in lower doses due to progressive cognitive decline and age-related impairments in drug metabolism. Some key points to consider when prescribing clonazepam include:
- Starting with a low dose of 0.25 mg to minimize side effects
- Monitoring for signs of cognitive disturbances, delirium, and amnesia
- Being aware of the potential for clonazepam to exacerbate sleep-disordered breathing
- Considering alternative treatments, such as melatonin or rivastigmine, which may have fewer cognitive side effects
- Recognizing that clonazepam is listed on the American Geriatrics Society Beers Criteria list of potentially inappropriate medications in older adults, and using it with caution in this population. As clonazepam enhances the action of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the brain, it can slow down brain activity, leading to cognitive effects including confusion, drowsiness, impaired concentration, and memory problems 1. If significant mental status changes occur while taking clonazepam, it is essential to contact a healthcare provider immediately to discuss potential dosage adjustments or medication changes, and to avoid abrupt cessation of the medication, which can lead to withdrawal symptoms, including worsened mental status changes.
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 can result in adverse effects including psychomotor impairment, especially in the elderly, and occasionally paradoxical excitement 4.
- There have been reports of psychosis associated with clonazepam therapy, including visual, auditory, and tactile hallucinations as well as paranoid delusions 5.
- Major side effects of clonazepam include drowsiness, ataxia, and behavior changes, which tend to be dose-related and may subside with chronic administration 6.
- Clonazepam can also cause altered mental status, as evidenced by its potential to induce hallucinations, paranoia, and other psychotic symptoms, particularly in certain individuals or at high doses 5.