From the Guidelines
Yes, Klonopin (clonazepam) can cause altered mental status as a side effect, particularly in elderly patients or those with neurodegenerative disorders, as evidenced by the most recent study from 2023 1. This benzodiazepine medication commonly produces cognitive effects including confusion, drowsiness, impaired concentration, memory problems, and in some cases, paradoxical reactions like agitation or increased anxiety. The severity of mental status changes typically depends on dosage, individual sensitivity, age, liver function, and whether it's combined with other substances like alcohol or other medications that affect the central nervous system. Some key points to consider when prescribing clonazepam include:
- Starting with lower doses, such as 0.25 mg, especially in older patients or those with neurodegenerative diseases 1
- Monitoring for side effects like morning sedation, gait imbalance/falls, depression, and cognitive disturbances, specifically delirium and amnesia 1
- Being aware of the potential for clonazepam to exacerbate sleep-disordered breathing 1
- Considering alternative treatments, such as melatonin or rivastigmine, for patients with secondary RBD or those who experience significant side effects from clonazepam 1 If someone experiences significant mental status changes while taking Klonopin, they should contact their healthcare provider immediately, as dosage adjustment or medication change may be necessary. Never stop taking Klonopin suddenly as this can trigger withdrawal symptoms including severe altered mental status. It's also important to note that clonazepam is listed on the American Geriatrics Society Beers Criteria list of potentially inappropriate medications in older adults, highlighting the need for careful consideration and monitoring when prescribing this medication to elderly patients 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.
- There is no direct evidence in the provided studies that Clonazepine (Klonopin) can cause altered mental status.
- However, a study on Clozapine, a different medication, reported a case of a patient who presented with an altered mental status after resuming full standard doses of Clozapine without careful titration after a short period of medication noncompliance 4.
- Another study discussed the neurological complications of psychiatric drugs, including altered mental state, which can occur due to serotonin toxicity or other mechanisms 5.
- Clonazepam has been used to treat various conditions, including anxiety disorders and epileptic seizures, and has been found to be useful in treating depression, particularly treatment-resistant and/or protracted depression 6, 7.