Maximum Dose of Clonazepam Per Day
The maximum recommended dose of clonazepam is 20 mg per day for seizure disorders and 4 mg per day for panic disorder, according to FDA labeling. 1
Seizure Disorders
- For adults with seizure disorders, the maximum recommended daily dose is 20 mg 1
- Initial dosing should not exceed 1.5 mg/day divided into three doses, with increases of 0.5-1 mg every 3 days until seizures are controlled or side effects occur 1
- For pediatric patients, the target maintenance dose is 0.1-0.2 mg/kg/day, with a maximum initial dose not exceeding 0.05 mg/kg/day 1
Panic Disorder
- For panic disorder in adults, the maximum dose is 4 mg per day 1
- The optimal therapeutic dose is typically 1 mg/day, as higher doses (2-4 mg/day) in clinical trials were less effective and associated with more adverse effects 1
- Initial dosing starts at 0.25 mg twice daily, increasing to the target of 1 mg/day after 3 days 1
- Dose escalation beyond 1 mg/day should occur in increments of 0.125-0.25 mg twice daily every 3 days only if needed 1
Context-Specific Maximum Doses
For REM sleep behavior disorder (RBD), the usual recommended dose range is 0.5-2.0 mg taken 30 minutes before bedtime, though the range studied extends from 0.25-4.0 mg 2
For acute manic states, research suggests doses up to 10 mg/day may be used in combination with other psychotropic drugs, though this is not FDA-approved and represents off-label use 3
Important Clinical Caveats
- The use of multiple CNS depressants with clonazepam increases the risk of adverse effects, which should be considered before adding clonazepam to existing regimens 1
- Tolerance to anticonvulsant effects commonly develops with chronic administration, potentially requiring dose adjustments 4
- Elderly patients should be started on low doses and observed closely, as they are more susceptible to side effects 1
- Major dose-related side effects include drowsiness, ataxia, and behavioral changes, which tend to occur early in therapy 4