From the Guidelines
Klonopin significantly increases fall risk in elderly patients and should generally be avoided in this population. This benzodiazepine medication causes sedation, dizziness, impaired balance, and cognitive slowing—all factors that directly contribute to falls, as highlighted in the context of multifactorial falls prevention interventions 1. Elderly patients are particularly vulnerable to these effects due to age-related changes in drug metabolism, decreased muscle strength, and often pre-existing balance issues. The complexity of falling is well-documented, with many factors contributing to its risk, including medication use 1.
Key Considerations
- The use of multifactorial falls prevention interventions, which can include medication management, is supported by evidence to reduce the rate of falls in community-dwelling older persons 1.
- A systematic review on strategies to implement these interventions underscores the importance of addressing individual fall-risk profiles, which may involve assessing and adjusting medications like Klonopin 1.
- Given the dose-dependent nature of fall risk with benzodiazepines like Klonopin, higher doses and longer durations of use are associated with greater fall risk, making this medication particularly problematic for long-term use in elderly patients.
Recommendations
- If an elderly person is currently taking Klonopin, a healthcare provider should supervise a gradual dose reduction to prevent withdrawal symptoms, rather than abrupt discontinuation.
- Alternative approaches for managing anxiety, insomnia, or seizures (common reasons Klonopin is prescribed) should be considered, including non-benzodiazepine medications with better safety profiles in the elderly, cognitive behavioral therapy, and fall prevention strategies such as physical therapy, home safety modifications, and strength training exercises.
- The implementation of effective falls prevention interventions, tailored to the individual's risk factors, can not only benefit the older person but also reduce the economic burden of society, as falls and their related injuries have a substantial impact on healthcare costs 1.
From the Research
Klonipine and Elderly Falls
- There is no direct evidence in the provided studies that specifically links klonipine (clonazepam) to elderly falls.
- However, it is known that benzodiazepines, a class of drugs that includes clonazepam, can cause psychomotor impairment, especially in the elderly 2.
- This psychomotor impairment can increase the risk of falls in elderly patients.
- Studies have shown that elderly patients are prone to develop adverse side-effects to usual dosages of medications, and the side-effects are even 7 times more frequent in elderly than in younger patients 3.
- Professional geriatric societies have developed lists of potentially inappropriate medications for the elderly, which may include benzodiazepines 3.
- When prescribing drugs for the elderly, healthcare practitioners should consider several issues, including pharmacokinetics, pharmacodynamics, adverse drug reactions, and drug interactions, to develop a safe and effective drug therapy plan 4.
- The risk of falls should be taken into account when using medications that may impair psychomotor function, such as benzodiazepines, in elderly patients 5.