From the Guidelines
Clonazepam can cause altered mental status, specifically delirium and amnesia, as a side effect, particularly in older patients or those with neurodegenerative diseases. This is evident from the 2023 American Academy of Sleep Medicine clinical practice guideline, which highlights the potential cognitive disturbances associated with clonazepam use 1. The guideline notes that clonazepam can exacerbate sleep-disordered breathing and cause morning sedation, gait imbalance, falls, depression, and cognitive disturbances, including delirium and amnesia.
When considering the use of clonazepam, it is essential to weigh the potential benefits against the risks, particularly in vulnerable populations such as older adults or those with neurodegenerative diseases. 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 this population 1.
Key points to consider when prescribing clonazepam include:
- Starting with a low dose, such as 0.25 mg, and gradually increasing as needed and tolerated
- Monitoring for signs of cognitive disturbances, such as delirium and amnesia
- Being aware of the potential for clonazepam to exacerbate sleep-disordered breathing and other sleep-related problems
- Considering alternative treatment options, such as melatonin or rivastigmine, which may have a more favorable side effect profile in certain patient populations 1.
Overall, while clonazepam can be an effective treatment for certain conditions, such as secondary REM sleep behavior disorder, its potential to cause altered mental status and other cognitive disturbances must be carefully considered and monitored in clinical practice.
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.