Maximum Daily Dose of Clonazepam
The maximum daily dose of clonazepam is 20 mg for seizure disorders in adults and 4 mg for panic disorder. 1
Dosing for Seizure Disorders
Adults
- Initial dose 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 adequately controlled or side effects prevent further increases 1
- Maximum recommended daily dose is 20 mg 1
Pediatric Patients
- Initial dose for children up to 10 years or 30 kg: 0.01-0.03 mg/kg/day (not exceeding 0.05 mg/kg/day) given in 2-3 divided doses 1
- Maintenance dose: 0.1-0.2 mg/kg/day 1
- Increase by no more than 0.25-0.5 mg every third day 1
Dosing for Panic Disorder
Adults
- Initial dose: 0.25 mg twice daily 1
- Target dose: 1 mg/day (can be increased after 3 days) 1
- Maximum dose: 4 mg/day 1
- Clinical research shows that 1-2 mg/day offers the best balance of therapeutic benefit and tolerability 2
Elderly Patients
- Lower starting doses are recommended with close monitoring 1
- No specific clinical trial data exists for panic disorder patients over 65 years 1
Important Clinical Considerations
Efficacy
- For panic disorder, doses of 1.0 mg and higher are equally efficacious in reducing panic attacks 2
- In clinical practice, an average dose of 1.9 mg/day has shown effectiveness in 78% of patients with panic disorder or agoraphobia with panic attacks 3
Side Effects and Precautions
- Most common side effects include somnolence and ataxia, particularly at higher doses (3-4 mg) 2
- Other common side effects include depression, dizziness, fatigue, and irritability 2
- Use with caution in patients with:
Discontinuation
- Treatment should be discontinued gradually to avoid withdrawal symptoms 1
- For panic disorder: decrease by 0.125 mg twice daily every 3 days 1
- For long-term users (≥3 years): reduce by 0.5 mg per 2-week period until 1 mg/day is reached, then decrease by 0.25 mg per week 5
- Most patients experience mild withdrawal symptoms during tapering, but these are generally well-tolerated with a gradual approach 6, 5
Special Populations
REM Sleep Behavior Disorder
- Recommended dose: 0.25-2.0 mg 30 minutes before bedtime 4
- Doses as high as 4.0 mg have been reported 4
- Women may require higher dosing (average 1.4 mg) than men (average 0.68 mg) 4
Bipolar Disorder (Off-label Use)
- For depressive states: 3-6 mg/day 7
- For acute manic states: up to 10 mg/day in combination with other psychotropic drugs 7
Remember that clonazepam is a long-acting benzodiazepine with potential for tolerance and dependence. Regular reassessment of the need for continued treatment is essential, especially with long-term use 1.