From the Guidelines
Clonazepam can cause altered mental status, particularly in elderly patients or those with neurodegenerative disorders, as evidenced by its potential to induce confusion, delirium, and amnesia, as reported in the most recent study 1. The severity of these effects typically depends on dosage, with higher doses more likely to cause significant mental status changes.
- Clonazepam enhances the effect of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the brain, which slows down brain activity.
- Elderly patients, those with liver impairment, or individuals taking other central nervous system depressants are at higher risk for experiencing altered mental status.
- The American Geriatrics Society Beers Criteria list clonazepam as a potentially inappropriate medication in older adults due to its potential for causing cognitive disturbances, including delirium and amnesia 1.
- 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 stop taking Klonopin abruptly as this can lead to withdrawal symptoms including severe altered mental status. The most recent study 1 highlights the importance of considering the patient's underlying disease and attendant symptoms when choosing a medication for the treatment of secondary RBD, and clonazepam is often used in lower doses, starting at 0.25 mg, in these patients.
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) 5.
- Another study discusses the use of clonazepam in various psychiatric disorders, including panic disorder, social phobia, and acute mania, but does not mention altered mental status as a side effect 6.
- The provided studies focus on the therapeutic uses of clonazepam, its efficacy, and potential benefits, rather than its potential to cause altered mental status 4, 6, 7.
- It is worth noting that the study on clozapine intoxication highlights the importance of careful titration of medication to avoid adverse effects, but this study is related to clozapine, not clonazepam 3.