What are the effects of long-term Clonazepam (clonazepam) use?

From the Guidelines

Long-term clonazepam use should be avoided due to significant risks of physical dependence, tolerance, withdrawal symptoms, cognitive impairment, and increased fall risk, as evident from recent studies 1. The effects of long-term clonazepam use are multifaceted and can have severe consequences on a patient's morbidity, mortality, and quality of life. Clonazepam, a benzodiazepine medication, is commonly prescribed for anxiety disorders, seizures, and panic attacks. However, its use for extended periods, typically beyond 2-4 weeks, carries significant risks. These risks include:

• Physical dependence
• Tolerance, requiring higher doses for the same effect
• Withdrawal symptoms upon discontinuation, which can be severe and include seizures
• Cognitive impairment
• Increased fall risk, especially in older adults
• Potential for abuse

If a patient is currently taking clonazepam long-term, it is crucial not to stop abruptly, as this can trigger severe withdrawal symptoms. Instead, working with a healthcare provider to develop a gradual tapering schedule is recommended, which might take weeks to months depending on the current dose and duration of use. Alternative treatments for anxiety or seizure disorders might include:

• SSRIs
• SNRIs
• Buspirone
• Non-benzodiazepine anticonvulsants
• Cognitive behavioral therapy

The most recent and highest quality study 1 emphasizes the importance of caution when using benzodiazepines like clonazepam, especially in older adults, and highlights the need for gradual tapering and alternative treatments to mitigate the risks associated with long-term use. Key considerations for managing long-term clonazepam use include:

• Educating patients about the risks and benefits of benzodiazepine use
• Developing a gradual tapering schedule to minimize withdrawal symptoms
• Exploring alternative treatments for anxiety and seizure disorders
• Monitoring patients closely for signs of dependence, tolerance, and withdrawal symptoms.

From the FDA Drug Label

Loss of Effect: In some studies, up to 30% of patients who initially responded have shown a loss of anticonvulsant activity, often within 3 months of administration. Laboratory Testing During Long-Term Therapy: Periodic blood counts and liver function tests are advisable during long-term therapy with clonazepam. Psychiatric and Paradoxical Reactions: Paradoxical reactions, such as agitation, irritability, aggression, anxiety, anger, nightmares, hallucinations, and psychoses are known to occur when using benzodiazepines Withdrawal Reactions: Inform patients that the continued use of clonazepam may lead to clinically significant physical dependence and that abrupt discontinuation or rapid dosage reduction of clonazepam may precipitate acute withdrawal reactions, which can be life-threatening.

The effects of long-term Clonazepam use include:

• Loss of efficacy: Up to 30% of patients may experience a loss of anticonvulsant activity within 3 months of administration.
• Laboratory testing requirements: Periodic blood counts and liver function tests are recommended during long-term therapy.
• Psychiatric and paradoxical reactions: Patients may experience agitation, irritability, aggression, anxiety, and other psychiatric symptoms.
• Withdrawal reactions: Long-term use can lead to physical dependence, and abrupt discontinuation or rapid dosage reduction may cause acute withdrawal reactions, which can be life-threatening 2.
• Dependence and addiction: Long-term use can lead to dependence and addiction, especially when used in combination with other medications or substances 2.

From the Research

Effects of Long-Term Clonazepam Use

• Prolonged use of clonazepam may lead to physical dependence and tolerance 3
• Long-term use can result in unwanted effects on health, such as:
  • Motor and cognitive impairment
  • Sleep disorders
  • Aggravation of mood and anxiety disorders 3
• Discontinuation of clonazepam after long-term treatment can lead to:
  • Transitory exacerbation of seizure frequency in some patients 4
  • Discontinuation symptoms, which are more likely to occur in patients with higher clonazepam doses and longer treatment durations 4
• Some studies suggest that clonazepam can be an effective treatment for panic disorder, with stable doses over time and no significant development of tolerance 5, 6
• However, the use of clonazepam for long-term treatment of anxiety disorders may not be ideal, as first-line treatments typically include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as cognitive behavioral therapy 7