Maximum Recommended Dose of Clonazepam (Klonopin)
The maximum recommended daily dose of clonazepam (Klonopin) for adults with seizure disorders is 20 mg per day, though most patients require much lower doses for optimal therapeutic effect. 1
Adult Dosing by Indication
Seizure Disorders
- Initial dose: Should not exceed 1.5 mg/day divided into three doses
- Titration: Increase by 0.5-1 mg every 3 days until seizures are controlled or side effects occur
- Maximum dose: 20 mg/day 1
Panic Disorder
- Initial dose: 0.25 mg twice daily
- Target dose: 1 mg/day (shown to be optimal in clinical studies)
- Maximum dose: 4 mg/day, though doses above 1 mg/day showed less effectiveness and more side effects 1
- Dosing strategy: May administer one dose at bedtime to reduce daytime somnolence 1
Pediatric Dosing
Seizure Disorders (children up to 10 years or 30 kg)
- Initial dose: 0.01-0.03 mg/kg/day (not to exceed 0.05 mg/kg/day) divided into 2-3 doses
- Maintenance dose: 0.1-0.2 mg/kg/day 1
Panic Disorder
- No clinical trial data for patients under 18 years 1
Special Populations
Geriatric Patients
- Should be started on lower doses with close monitoring
- No specific clinical trial data for patients 65 years and older with seizure or panic disorders 1
Important Considerations
Safety and Toxicity
- Clonazepam toxicity manifests in a dose-dependent manner with symptoms including:
- Excessive sedation
- Ataxia
- Cognitive impairment
- Respiratory depression
- Hypotension 2
Risk Factors for Toxicity
- Concurrent use of other CNS depressants (opioids, alcohol, other benzodiazepines)
- Advanced age
- Hepatic impairment
- Respiratory conditions 2
Duration of Treatment
- For panic disorder: Treatment should be periodically reevaluated for long-term usefulness 1
- Guidelines recommend limiting benzodiazepine use to ≤4 weeks due to risk of tolerance and dependence 2
Discontinuation
- Gradual tapering is essential to minimize withdrawal symptoms
- For panic disorder: Decrease by 0.125 mg twice daily every 3 days until completely withdrawn 1
- For long-term use: Longer tapering periods may be needed 2
- Clinical studies have shown successful discontinuation with gradual tapering at 0.25 mg/week 3
Clinical Pearls
- Clonazepam is approximately 20 times more potent than diazepam on a milligram-per-milligram basis (0.5 mg clonazepam ≈ 10 mg diazepam) 2
- Has a long half-life of 30-40 hours with high bioavailability (90%) 2
- Multiple anticonvulsants may increase CNS depressant effects 1
- For optimal efficacy in insomnia, administer on an empty stomach 2
Remember that while the maximum FDA-approved dose is 20 mg/day for seizure disorders, most patients respond to much lower doses, and the risk of adverse effects increases with higher doses.