From the FDA Drug Label
To provide information regarding the effects of in utero exposure to clonazepam, physicians are advised to recommend that pregnant patients taking clonazepam enroll in the NAAED Pregnancy Registry. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for clonazepam and any potential adverse effects on the breastfed infant from clonazepam or from the underlying maternal condition Administration of benzodiazepines immediately prior to or during childbirth can result in a syndrome of hypothermia, hypotonia, respiratory depression, and difficulty feeding In addition, infants born to mothers who have taken benzodiazepines during the later stages of pregnancy can develop dependence, and subsequently withdrawal, during the postnatal period.
Educating the patient:
- Inform the patient about the potential risks of taking Klonopin during pregnancy, including the possibility of dependence and withdrawal in the newborn.
- Discuss the importance of enrolling in the NAAED Pregnancy Registry to monitor the effects of in utero exposure to clonazepam.
- Consider the developmental and health benefits of breastfeeding, as well as potential adverse effects on the breastfed infant.
- Warn the patient about the potential for sedation and respiratory depression in the newborn if Klonopin is taken immediately prior to or during childbirth.
Documenting the patient:
- Document the patient's understanding of the potential risks and benefits of taking Klonopin during pregnancy.
- Record the patient's decision to enroll in the NAAED Pregnancy Registry.
- Note any discussions about breastfeeding and the potential risks to the infant.
- Monitor the patient's condition and adjust the treatment plan as necessary to minimize risks to the patient and the fetus 1.
From the Research
When educating and documenting a patient taking Klonopin (clonazepam) during pregnancy, it is essential to prioritize a thorough discussion about the risks and benefits, considering the potential risks of cleft lip/palate and withdrawal symptoms in the newborn. The patient should be informed that Klonopin is a benzodiazepine that has been used to treat seizures and conditions such as panic attacks and anxiety disorder, but its use during pregnancy requires careful consideration of the potential risks to the fetus 2. The medical records of 28,565 infants were surveyed as part of a hospital-based malformation surveillance program, and the study found that one infant had dysmorphic features, growth retardation, and a heart malformation (tetralogy of Fallot) out of 52 infants exposed to clonazepam, but this study did not observe an increase in major malformations in births exposed to clonazepam monotherapy 2. Some key points to consider when educating and documenting a patient taking Klonopin during pregnancy include:
- Documenting the patient's understanding of the risks and benefits of taking Klonopin during pregnancy
- Recording baseline anxiety or seizure frequency (depending on indication) and documenting regular follow-up appointments to reassess the need for continued therapy
- Including documentation of consultation with both psychiatry and obstetrics specialists to ensure coordinated care
- Educating the patient about monitoring for side effects and the importance of not stopping the medication abruptly
- Documenting the informed consent process, including discussion of alternative treatments that may have better safety profiles during pregnancy It is also important to note that other studies have investigated the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy, which may be relevant for patients taking Klonopin for anxiety or other conditions, and have found associations between SSRI use and increased risk of congenital malformations, such as septal heart defects 3. However, the primary concern for patients taking Klonopin during pregnancy is the potential risk of withdrawal symptoms in the newborn and the importance of using the lowest effective dose and monitoring for side effects 4. Overall, a comprehensive approach to educating and documenting patients taking Klonopin during pregnancy is essential to ensure that patients are fully informed and that their medical records reflect careful consideration of both maternal and fetal health.