Clonazepam Dosage Options

Clonazepam is available in doses ranging from 0.25 mg to 4.0 mg, with the most commonly prescribed range being 0.5-2.0 mg for most indications. 1

Available Dosages for Different Indications

Initial dose for adults should not exceed 1.5 mg/day divided into three doses 1
Dosage may be increased in increments of 0.5-1 mg every 3 days until seizures are controlled or side effects prevent further increases 1
Maximum recommended daily dose is 20 mg 1
For children (up to 10 years or 30 kg): 0.01-0.03 mg/kg/day initially, not exceeding 0.05 mg/kg/day, given in 2-3 divided doses 1

Initial dose for adults is 0.25 mg twice daily 1
Target dose for most patients is 1 mg/day, which can be reached after 3 days 1
Maximum dose is 4 mg/day, though doses above 1 mg/day may have more adverse effects 1, 2
Dose-response studies show that daily dosages of 1.0-2.0 mg offer the best balance of therapeutic benefit and tolerability 2

Recommended dose range is 0.5-2.0 mg taken 30 minutes before bedtime 3
Doses as high as 4.0 mg have been reported in some cases 3
One study noted that women required higher dosing (1.4 ± 0.4 mg) than men (0.68 ± 0.4 mg) to control RBD symptoms 3

Clonazepam is a long-acting benzodiazepine with an elimination half-life of 30-40 hours 3
It is rapidly absorbed after oral administration with 90% bioavailability 3
Maximum plasma concentrations are reached within 1-4 hours after oral administration 3
Tablets should be administered with water by swallowing whole 1

Most common side effects include drowsiness, ataxia, and behavior changes 4
Side effects tend to be dose-related and may subside with continued administration 4
For panic disorder patients, somnolence and ataxia are more common at higher doses (3.0-4.0 mg) 2
In RBD treatment, reported side effects include morning sedation, impotence, early morning motor incoordination, confusion, and memory dysfunction 3
Caution is advised in patients with neurodegenerative disorders, obstructive sleep apnea, and liver disease 3

Treatment should be discontinued gradually to avoid withdrawal symptoms 1, 5
For panic disorder, a decrease of 0.125 mg twice daily every 3 days is recommended until the drug is completely withdrawn 1
For long-term users (3+ years), tapering by 0.5 mg per 2-week period until reaching 1 mg/day, followed by 0.25 mg per week has been successful 5
Withdrawal symptoms are typically mild when tapered properly and include anxiety, tremor, nausea, insomnia, sweating, and headache 5

When initiating therapy, start with a low dose and increase gradually to minimize side effects 4
For most indications, tolerance to the therapeutic effects may develop with chronic administration 4
In RBD treatment, clonazepam does not normalize REM atonia but appears to act on locomotor systems 3
Periodic reevaluation of long-term use is recommended 1