From the Guidelines
Clonazepam can cause altered mental status, including confusion, delirium, and amnesia, particularly in older adults or those with neurodegenerative diseases, as reported in the most recent study 1. The severity of these effects can depend on various factors such as dosage, individual sensitivity, age, and liver function. According to the 2023 study 1, clonazepam is often used in lower doses, starting at 0.25 mg, in patients with secondary RBD and neurodegenerative diseases, due to the risk of progressive cognitive decline and age-related impairments in drug metabolism. Some key points to consider when prescribing clonazepam include:
- Morning sedation, gait imbalance, and falls are potential side effects, as noted in the study 1
- Clonazepam can exacerbate sleep-disordered breathing, as mentioned in the study 1
- The medication is listed on the American Geriatrics Society Beers Criteria list of potentially inappropriate medications in older adults, as stated in the study 1
- Alternative treatments, such as melatonin or rivastigmine, may be considered for patients with secondary RBD and neurodegenerative diseases, as suggested in the study 1 It is essential to closely monitor patients taking clonazepam, especially older adults or those with neurodegenerative diseases, for signs of altered mental status and adjust the dosage or switch to an alternative treatment if necessary, as recommended in the study 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.