From the Guidelines
Clonazepam can cause altered mental status, including confusion, delirium, and amnesia, particularly in older patients or those with neurodegenerative diseases. This is supported by the most recent study from 2023 1, which highlights the potential cognitive disturbances associated with clonazepam use. The study notes that clonazepam can exacerbate sleep-disordered breathing and is often used in lower doses, starting at 0.25 mg, in patients with secondary RBD and neurodegenerative diseases.
Some key points to consider when prescribing clonazepam include:
- The risk of altered mental status is higher with larger doses or in combination with other central nervous system depressants
- Clonazepam is listed on the American Geriatrics Society Beers Criteria list of potentially inappropriate medications in older adults
- Alternative treatments, such as melatonin or rivastigmine, may be considered in patients with secondary RBD and neurodegenerative diseases
- Patients should be closely monitored for signs of altered mental status, and dosage adjustments or medication changes should be made as necessary
It is essential to weigh the potential benefits of clonazepam against the risks of altered mental status, particularly in vulnerable populations. As noted in the 2023 study 1, clinicians should consider the patient's underlying disease and attendant symptoms when choosing a medication for RBD. By prioritizing the patient's overall health and well-being, healthcare providers can minimize the risks associated with clonazepam use and optimize treatment outcomes.
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
- There is no direct evidence in the provided studies that Clonazepine (Klonopin) can cause altered mental status 3, 4, 5, 6, 7.
- However, a study on neurological complications of psychiatric drugs mentions that serotonin toxicity can comprise altered mental state, but this is usually associated with the co-prescription of drugs that increase serotonergic transmission, such as a monoamine oxidase inhibitor (MAOI) and a selective serotonin reuptake inhibitor (SSRI) 6.
- Another study on the safety of Gabapentin prescribed for any indication found that Gabapentin is associated with altered mental status, but this is not directly related to Clonazepine 7.
- The studies on Clonazepine focus on its use as a therapeutic adjunct to improve the management of depression, and do not mention altered mental status as a side effect 4, 5.
- A study on Clozapine intoxication mentions altered mental status as a symptom, but this is a different medication from Clonazepine 3.