What is the maximum recommended daily dose of Klonopin (clonazepam)?

Maximum Daily Dose of Clonazepam (Klonopin)

The maximum recommended daily dose of clonazepam is 20 mg/day for seizure disorders in adults and 4 mg/day for panic disorder, according to FDA labeling. 1

Indication-Specific Maximum Doses

Seizure Disorders

• Adults: Maximum of 20 mg/day 1

  • Initial dosing starts at 1.5 mg/day divided into three doses 1
  • Dosage increased in 0.5-1 mg increments every 3 days until seizures are controlled 1
  • Maintenance dosing must be individualized based on response and tolerability 1

• Pediatric patients (up to 10 years or 30 kg): Maximum of 0.2 mg/kg/day 1

  • Initial dose: 0.01-0.03 mg/kg/day (not exceeding 0.05 mg/kg/day) 1
  • Increase by 0.25-0.5 mg every third day until reaching maintenance of 0.1-0.2 mg/kg/day 1

Panic Disorder

• Adults: Maximum of 4 mg/day 1
  • Initial dose: 0.25 mg twice daily 1
  • Target dose for most patients: 1 mg/day (shown to be optimal in fixed-dose studies) 1
  • Higher doses (2-4 mg/day) were less effective and associated with more adverse effects in clinical trials 1, 2
  • Research demonstrates that 1-2 mg/day offers the best balance of therapeutic benefit and tolerability 2

REM Sleep Behavior Disorder

• Typical range: 0.5-2 mg taken 30 minutes before bedtime 3, 4
• Clinical practice range: Up to 4 mg has been reported 3
• Women may require higher doses (mean 1.4 mg) compared to men (mean 0.68 mg) 3

Critical Safety Considerations

Dose-Related Risks

• Doses ≥2 mg significantly increase risk of:

  • Falls, confusion, and subdural hematoma 3
  • Morning sedation and cognitive impairment (up to 58% of patients) 3
  • Somnolence and ataxia (particularly at 3-4 mg/day) 2

• Even lower doses (0.5-1 mg) can worsen sleep apnea 3

Pharmacokinetic Context

• Clonazepam has a long elimination half-life of 30-40 hours 3
• Accumulation occurs with repeated dosing due to this long half-life 3
• This allows for less frequent dosing compared to shorter-acting benzodiazepines 3

Special Populations

Geriatric Patients

• Should be started on low doses and observed closely 1
• No specific maximum dose established, but lower doses are prudent given increased fall risk 3

Older Adults with Pain

• When used as a muscle relaxant: 0.25-0.5 mg at bedtime 5
• Monitor for sedation, memory impairment, and complete blood count 5

Common Pitfalls to Avoid

1. Do not exceed 4 mg/day for panic disorder - higher doses showed decreased efficacy in controlled trials 1, 2

2. Avoid abrupt discontinuation - taper by 0.25 mg/week after intermediate-term use to prevent withdrawal symptoms 6

3. Monitor for tolerance - anticonvulsant effects may diminish with chronic administration 7

4. Consider CNS depressant effects when using multiple anticonvulsants, as this increases adverse effects 1

5. Recognize that optimal dosing varies by indication - what works for seizures (up to 20 mg/day) differs dramatically from panic disorder (1-2 mg/day optimal) 1, 2