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Klonopin

SIDE EFFECTS

The adverse experiences for Klonopin are provided separately for patients with seizure disorders and with panic disorder.

Seizure Disorders

The most frequently occurring side effects of Klonopin are referable to CNS depression. Experience in treatment of seizures has shown that drowsiness has occurred in approximately 50% of patients and ataxia in approximately 30%. In some cases, these may diminish with time; behavior problems have been noted in approximately 25% of patients. Others, listed by system, including those identified during postapproval use of Klonopin are:

Cardiovascular: Palpitations

Dermatologic: Hair loss, hirsutism, skin rash, ankle and facial edema

Gastrointestinal: Anorexia, coated tongue, constipation, diarrhea, dry mouth, encopresis, gastritis, increased appetite, nausea, sore gums

Genitourinary: Dysuria, enuresis, nocturia, urinary retention

Hematopoietic: Anemia, leukopenia, thrombocytopenia, eosinophilia

Hepatic: Hepatomegaly, transient elevations of serum transaminases and alkaline phosphatase

Musculoskeletal: Muscle weakness, pains

Miscellaneous: Dehydration, general deterioration, fever, lymphadenopathy, weight loss or gain

Neurologic: Abnormal eye movements, aphonia, choreiform movements, coma, diplopia dysarthria, dysdiadochokinesis, ‘‘glassy-eyed’’ appearance, headache, hemiparesis, hypotonia, nystagmus, respiratory depression, slurred speech, tremor, vertigo

Psychiatric: Confusion, depression, amnesia, hysteria, increased libido, insomnia, psychosis (the behavior effects are more likely to occur in patients with a history of psychiatric disturbances).

The following paradoxical reactions have been observed: irritability, aggression, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares, abnormal dreams, hallucinations.

Respiratory: Chest congestion, rhinorrhea, shortness of breath, hypersecretion in upper respiratory passages

Panic Disorder

Adverse events during exposure to Klonopin were obtained by spontaneous report and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. In the tables and tabulations that follow, CIGY dictionary terminology has been used to classify reported adverse events, except in certain cases in which redundant terms were collapsed into more meaningful terms, as noted below.

The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation.

Adverse Findings Observed In Short-Term, Placebo-Controlled Trials

Adverse Events Associated With Discontinuation Of Treatment

Overall, the incidence of discontinuation due to adverse events was 17% in Klonopin compared to 9% for placebo in the combined data of two 6- to 9-week trials. The most common events (≥1%) associated with discontinuation and a dropout rate twice or greater for Klonopin than that of placebo included the following:

Table 2 Most Common Adverse Events (≥1%) Associated with Discontinuation of Treatment

Adverse Events Occurring At An Incidence Of 1% Or More Among Klonopin-Treated Patients

Table 3 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse events that occurred during acute therapy of panic disorder from a pool of two 6- to 9-week trials. Events reported in 1% or more of patients treated with Klonopin (doses ranging from 0.5 to 4 mg/day) and for which the incidence was greater than that in placebo-treated patients are included.

The prescriber should be aware that the figures in Table 3 cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contribution of drug and nondrug factors to the side effect incidence in the population studied.

Table 3 Treatment-Emergent Adverse Event Incidence in 6- to 9-Week Placebo-Controlled Clinical Trials*

Clonazepam Maximum Daily Dose
Adverse Event by Body System <1mg
n=96
%
1- <2mg
n=129
%
2- <3mg
n=113
%
≥3mg
n=235
%
All Klonopin Groups
N=574
%
Placebo
N=294
%
Central & Peripheral Nervous System
Somnolence† 26 35 50 36 37 10
Dizziness 5 5 12 8 8 4
Coordination Abnormal† 1 2 7 9 6 0
Ataxia† 2 1 8 8 5 0
Dysarthria† 0 0 4 3 2 0
Psychiatric
Depression 7 6 8 8 7 1
Memory Disturbance 2 5 2 5 4 2
Nervousness 1 4 3 4 3 2
Intellectual Ability Reduced 0 2 4 3 2 0
Emotional Lability 0 1 2 2 1 1
Libido Decreased 0 1 3 1 1 0
Confusion 0 2 2 1 1 0
Respiratory System
Upper Respiratory Tract Infection† 10 10 7 6 8 4
Sinusitis 4 2 8 4 4 3
Rhinitis 3 2 4 2 2 1
Coughing 2 2 4 0 2 0
Pharyngitis 1 1 3 2 2 1
Bronchitis 1 0 2 2 1 1
Gastrointestinal System
Constipation† 0 1 5 3 2 2
Appetite Decreased 1 1 0 3 1 1
Abdominal Pain† 2 2 2 0 1 1
Body as a Whole
Fatigue 9 6 7 7 7 4
Allergic Reaction 3 1 4 2 2 1
Musculoskeletal
Myalgia 2 1 4 0 1 1
Resistance Mechanism Disorders
Influenza 3 2 5 5 4 3
Urinary System
Micturition Frequency 1 2 2 1 1 0
Urinary Tract Infection† 0 0 2 2 1 0
Vision Disorders
Blurred Vision 1 2 3 0 1 1
Reproductive Disorders‡
Female Dysmenorrhea 0 6 5 2 3 2
Colpitis 4 0 2 1 1 1
Male Ejaculation Delayed 0 0 2 2 1 0
Impotence 3 0 2 1 1 0
* Events reported by at least 1% of patients treated with Klonopin and for which the incidence was greater than that for placebo.
† Indicates that the p-value for the dose-trend test (Cochran-Mantel-Haenszel) for adverse event incidence was ≤0.10.
‡ Denominators for events in gender-specific systems are: n=240 (clonazepam), 102 (placebo) for male, and 334 (clonazepam), 192 (placebo) for female.

Commonly Observed Adverse Events

Table 4 Incidence of Most Commonly Observed Adverse Events* in Acute Therapy in Pool of 6- to 9-Week Trials

Adverse Event Clonazepam
(N=574)
Placebo
(N=294)
Somnolence 37% 10%
Depression 7% 1%
Coordination Abnormal 6% 0%
Ataxia 5% 0%
* Treatment-emergent events for which the incidence in the clonazepam patients was ≥5% and at least twice that in the placebo patients.

Treatment-Emergent Depressive Symptoms

In the pool of two short-term placebo-controlled trials, adverse events classified under the preferred term “depression” were reported in 7% of Klonopin-treated patients compared to 1% of placebo-treated patients, without any clear pattern of dose relatedness. In these same trials, adverse events classified under the preferred term “depression” were reported as leading to discontinuation in 4% of Klonopin-treated patients compared to 1% of placebo-treated patients. While these findings are noteworthy, Hamilton Depression Rating Scale (HAM-D) data collected in these trials revealed a larger decline in HAM-D scores in the clonazepam group than the placebo group suggesting that clonazepamtreated patients were not experiencing a worsening or emergence of clinical depression.

Other Adverse Events Observed During The Premarketing Evaluation Of Klonopin In Panic Disorder

Following is a list of modified CIGY terms that reflect treatment-emergent adverse events reported by patients treated with Klonopin at multiple doses during clinical trials. All reported events are included except those already listed in Table 3 or elsewhere in labeling, those events for which a drug cause was remote, those event terms which were so general as to be uninformative, and events reported only once and which did not have a substantial probability of being acutely life-threatening. It is important to emphasize that, although the events occurred during treatment with Klonopin, they were not necessarily caused by it.

Events are further categorized by body system and listed in order of decreasing frequency. These adverse events were reported infrequently, which is defined as occurring in 1/100 to 1/1000 patients.

Body as a Whole: weight increase, accident, weight decrease, wound, edema, fever, shivering, abrasions, ankle edema, edema foot, edema periorbital, injury, malaise, pain, cellulitis, inflammation localized

Cardiovascular Disorders: chest pain, hypotension postural

Central and Peripheral Nervous System Disorders: migraine, paresthesia, drunkenness, feeling of enuresis, paresis, tremor, burning skin, falling, head fullness, hoarseness, hyperactivity, hypoesthesia, tongue thick, twitching

Gastrointestinal System Disorders: abdominal discomfort, gastrointestinal inflammation, stomach upset, toothache, flatulence, pyrosis, saliva increased, tooth disorder, bowel movements frequent, pain pelvic, dyspepsia, hemorrhoids

Hearing and Vestibular Disorders: vertigo, otitis, earache, motion sickness

Heart Rate and Rhythm Disorders: palpitation

Metabolic and Nutritional Disorders: thirst, gout

Musculoskeletal System Disorders: back pain, fracture traumatic, sprains and strains, pain leg, pain nape, cramps muscle, cramps leg, pain ankle, pain shoulder, tendinitis, arthralgia, hypertonia, lumbago, pain feet, pain jaw, pain knee, swelling knee Platelet, Bleeding and Clotting Disorders: bleeding dermal

Psychiatric Disorders: insomnia, organic disinhibition, anxiety, depersonalization, dreaming excessive, libido loss, appetite increased, libido increased, reactions decreased, aggression, apathy, disturbance in attention, excitement, anger, hunger abnormal, illusion, nightmares, sleep disorder, suicide ideation, yawning

Reproductive Disorders, Female: breast pain, menstrual irregularity

Reproductive Disorders, Male: ejaculation decreased

Resistance Mechanism Disorders: infection mycotic, infection viral, infection streptococcal, herpes simplex infection, infectious mononucleosis, moniliasis

Respiratory System Disorders: sneezing excessive, asthmatic attack, dyspnea, nosebleed, pneumonia, pleurisy

Skin and Appendages Disorders: acne flare, alopecia, xeroderma, dermatitis contact, flushing, pruritus, pustular reaction, skin burns, skin disorder

Special Senses Other, Disorders: taste loss

Urinary System Disorders: dysuria, cystitis, polyuria, urinary incontinence, bladder dysfunction, urinary retention, urinary tract bleeding, urine discoloration Vascular (Extracardiac) Disorders: thrombophlebitis leg

Vision Disorders: eye irritation, visual disturbance, diplopia, eye twitching, styes, visual field defect, xerophthalmia

Read the entire FDA prescribing information for Klonopin (Clonazepam)

Clonazepam

Generic Name: clonazepam (kloe NAZ e pam)
Brand Names: KlonoPIN

Medically reviewed by Kaci Durbin, MD Last updated on Dec 15, 2018.

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What is clonazepam?

Clonazepam is a benzodiazepine. It affects chemicals in the brain that may be unbalanced to treat seizures and certain types of anxiety disorders.

Clonazepam, a type of anti-epileptic drug, is used to treat certain seizure disorders (including absence seizures or Lennox-Gastaut syndrome) in adults and children.

Clonazepam is also used to treat panic disorder (including agoraphobia) in adults.

Important information

You should not use clonazepam if you have narrow-angle glaucoma or severe liver disease, or if you are allergic to diazepam (Valium), lorazepam (Ativan) or a similar medicine.

Call your doctor if you have any new or worsening symptoms of depression, unusual changes in behavior, or thoughts about suicide or hurting yourself.

Do not drink alcohol while taking this medicine. Clonazepam may be habit-forming. Never share clonazepam with another person. Keep the medication in a place where others cannot get to it. Selling or giving away clonazepam is against the law.

Before taking this medicine

You should not take clonazepam if you have:

  • narrow-angle glaucoma;

  • severe liver disease; or

  • a history of allergic reaction to any benzodiazepine, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), chlordiazepoxide, flurazepam, and others.

To make sure clonazepam is safe for you, tell your doctor if you have ever had:

  • kidney or liver disease;

  • glaucoma;

  • porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system);

  • asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;

  • depression or suicidal thoughts or behavior;

  • mental illness, psychosis, or addiction to drugs or alcohol; or

  • if you use a narcotic (opioid) medication.

Some people have thoughts about suicide when taking seizure medication. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Follow your doctor’s instructions about taking seizure medication if you are pregnant. Do not start or stop taking this medicine without your doctor’s advice, and tell your doctor right away if you become pregnant. Clonazepam may cause harm to an unborn baby, and may cause breathing or feeding problems in a newborn. But having seizures during pregnancy could harm both mother and baby.

If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of clonazepam on the baby.

Clonazepam can pass into breast milk, but effects on the nursing baby are not known. Tell your doctor if you are breast-feeding

Do not give this medicine to a child without medical advice. Clonazepam is not approved to treat panic disorder in anyone younger than 18 years old.

How should I take clonazepam?

Take clonazepam exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Clonazepam may be habit-forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

Misuse of habit-forming medicine can cause addiction, overdose, or death. Selling or giving away this medicine is against the law.

Clonazepam should be used for only a short time. Do not take this medication for longer than 9 weeks without your doctor’s advice.

Swallow the tablet whole, with a full glass of water.

If you use this medicine long-term, you may need frequent medical tests.

Do not stop using clonazepam suddenly or you could have unpleasant withdrawal symptoms, including a seizure (convulsions). Ask your doctor how to safely stop using this medicine.

Call your doctor if this medicine seems to stop working as well in treating your seizures or anxiety symptoms.

Seizures are often treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor’s advice.

Store clonazepam at room temperature away from moisture, heat, and light.

Keep track of the amount of medicine used from each new bottle. Clonazepam is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, fainting, or coma.

What should I avoid while taking clonazepam?

Avoid drinking alcohol. Dangerous side effects could occur. Avoid taking similar medications, such as lorazepam (Ativan) or diazepam (Valium) as well as narcotics.

Clonazepam may impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Clonazepam side effects

Get emergency medical help if you have signs of an allergic reaction to clonazepam: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • new or worsening seizures;

  • severe drowsiness;

  • unusual changes in mood or behavior;

  • confusion, aggression, hallucinations;

  • thoughts of suicide or hurting yourself;

  • weak or shallow breathing;

  • pounding heartbeats or fluttering in your chest; or

  • unusual or involuntary eye movements.

The sedative effects of clonazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking clonazepam.

Common clonazepam side effects may include:

  • feeling tired or depressed;

  • drowsiness, dizziness;

  • memory problems; or

  • problems with balance or coordination.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect clonazepam?

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, an opioid medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with clonazepam, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use clonazepam only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 8.01.

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Other brands: Klonopin, Klonopin Wafer

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The Effects of Clonazepam Use

Table of Contents Authored By American Addiction Centers Editorial Staff Reviewed By Eric Patterson, MSCP, NCC, LPC

What is Clonazepam?

Clonazepam, commonly known by its brand name Klonopin, is a prescription medication commonly used for its anti-anxiety and anti-convulsant benefits.

How Worried Should We Be About Benzos?

This medication is part of a larger group of substances called benzodiazepines. This group includes substances like:

  • Alprazolam (Xanax).
  • Lorazepam (Ativan).
  • Diazepam (Valium).
  • Temazepam (Restoril).

These substances all share similar chemical properties and effects with the major difference being the speed of action and total time that the positive effects last. Some of these can affect the user for up to 24 hours.

All benzodiazepines have depressant effects that result in a net slowing of various physical and mental processes. In some situations, benzodiazepines are prescribed for their sedative-hypnotic effects, for their muscle relaxing benefits, and to manage the precarious withdrawal from substances like alcohol.

Because of its desirable anxiolytic, or anti-anxiety effects, this drug is prescribed as a pharmaceutical treatment for anxiety disorders—including panic attacks, agoraphobia and others. Despite its benefits, caution must be taken when using clonazepam. Even if the medication is taken as prescribed, both dependency and addiction may easily develop.

Clonazepam abuse becomes an issue in those taking this drug for a long period of time, in higher than recommended doses, or those that use the medication for reasons other than those prescribed.

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Short Term Effects of Clonazepam

“Even those taking clonazepam with a legitimate prescription can experience tolerance, dependency and, eventually, find themselves struggling with an addiction.”

In the short term, clonazepam can have several positive therapeutic effects. The drug works by interacting with GABA receptors in the brain. This inhibitory neurotransmitter serves to slows brain activity. This is helpful since many theorize that anxiety may be caused by an overabundance of brain activity. The common short-term effects of this clonazepam:

Clonazepam Effects Quiz question 2

  • Relaxation of the mind and reduction of anxiety. People with sped-up or racing thoughts will report slowed thinking and increased feelings of calm. Worries that were previously problematic will have less of a detrimental impact.
  • Relaxation of the body. With the mind being slowed, the physical symptoms of anxiety will be reduced as well. People with anxiety commonly feel tense, restless, or agitated. Clonazepam has the effect of calming the body and relieving these physical symptoms when used appropriately. Some report feeling very relaxed and heavy while using the substance.
  • Mild euphoria. Many users initially feel a mild sense of euphoria when taking clonazepam. Although users may not intend to get high on this medication, the sensation can be extremely pleasurable and rewarding—leading to continued use of the drug and eventually addiction.
  • Drowsiness. Since clonazepam acts to relax you, it can cause drowsiness. Many users are unable to drive safely while on clonazepam, especially at the beginning of prescribed treatment.

It’s important to understand that even those taking clonazepam with a legitimate prescription may develop tolerance to the drug effects. This can result in individuals taking more and more of the drug, leading soon to chemical dependency. Compulsive drug-seeking and using behavior maybe next and may signal the presence of a substance use disorder. Use should be closely monitored by a doctor to help prevent this dangerous sequence of events from occurring.

Side Effects of Clonazepam

Clonazepam can cause dangerous central nervous system depression, leading to markedly impaired alertness and slowed bodily functions, especially when taken recreationally or in doses higher than recommended.

There are a number of side effects of clonazepam, especially if you take it for a long period of time or at high doses. You may experience:

  • Vertigo or dizziness.
  • Syncope or fainting.
  • Heaviness or numbness of the extremities.
  • Impaired cognition.
  • Failure to form new memories.
  • Confusion.
  • Reduced judgment and slowed reaction time.*
  • Reduced sex drive.

In addition, clonazepam is reported to increase suicidal ideation, or suicidal thoughts in some people taking the drug. If you feel depressed, restless or suicidal soon after starting clonazepam, you should immediately alert your doctor.

*It is important not to drive or operate machinery due to these effects, as you could significantly endanger yourself and others.

Effects of Clonazepam Overdose

Taking a higher dosage than prescribed, more frequently than prescribed, or taking a substance that is prescribed to someone else is an ill-advised, dangerous course of action that can lead to overdose. Because of the substance’s depressant effects, many of the symptoms involve slowed bodily functions.

Effects of benzodiazepine overdose can include:

  • Slurred speech.
  • Loss of muscular coordination.
  • Delirium or profound confusion.
  • Respiratory depression.
  • Loss of consciousness.
  • Coma.

As mentioned, using other drugs and/or alcohol in combination with a benzodiazepine like clonazepam can greatly increase the intensity of symptoms and compound the risk of overdose.

Clonazepam Effects Quiz question 4

Long-Term Effects of Clonazepam

Clonazepam is not generally recommended for long-term use because it is known to be a habit-forming substance. Over time, the patient’s body tends to build a tolerance to clonazepam. This means that the body adapts to the presence of clonazepam in its system, and the patient’s usual dose of clonazepam ceases to be as effective.

Users who have developed a tolerance may need to take higher or more frequent doses of clonazepam to get the relaxation and anti-anxiety effects they were getting when they originally began taking it.

Once someone builds a tolerance to clonazepam, it is likely that a physiologic dependency has also arisen. If doses aren’t increased, or if an individual stops taking the drug suddenly, they will at heightened risk of experiencing a resurgence of the symptoms they were treating with the medication—symptoms like anxiety, panic, insomnia and other effects may rebound.

Clonazepam Dependency

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As mentioned, in parallel with the phenomenon of tolerance, patients often experience physical dependence to clonazepam. The body begins to essentially require the drug for normal function. Patients who do not continue to take clonazepam may grow violently ill as they experience the onset of a debilitating benzodiazepine withdrawal syndrome. Shakiness, shortness of breath, nausea and other physical effects may occur along with psychological effects such as mood swings, increased anxiety, agitation, and depression if a person abruptly stops taking clonazepam. Abrupt cessation of benzodiazepines is never recommended, as seizure and convulsion may be the result—placing one’s life in peril.

Rebound Symptoms

When someone stops taking clonazepam they will experience a rebound effect. This means that the problems that the medication is designed to treat will present with great intensity and duration. If someone is using the medication to manage anxiety, anxious symptoms will reappear with increased worry, agitation, and nervousness.

Clonazepam Withdrawal Treatment

Supervised Detox

Sudden withdrawal from clonazepam can be potentially life threatening due to the unwanted withdrawal symptoms. Medically supervised detox takes this into account. Sudden cessation of long-term clonazepam use can lead to marked agitation, neural excitation, and withdrawal seizure activity, so medical supervision is essential for someone looking to cease use of this drug.

Usually, patients go to a detox center for a period of time to gradually withdraw from the drug in a safe environment. Doctors at the detox center may give patients other medications or treatments to help with the uncomfortable physical effects of withdrawal from this drug. Medical supervision may also help manage psychological symptoms such as mood swings, hallucinations, and depression.

Addiction Treatment

After detox is complete, patients may transition to a residential program or inpatient rehab center for further treatment. Rehab is usually focused on the psychological reasons for addiction and planning ways to live a happier life without use of the substance. Patients may receive individual and group therapy sessions as well become active participants in support group sessions, benefiting from the camaraderie and encouragement of others working through similar recovery issues. Patients live at the rehab facility with other people who are learning how to live without addictive substances. Rehab may last anywhere from 30 days to one year, depending on a number of factors including severity of the addiction, progress in treatment, and outside supports.

Recovering addicts who have attended an inpatient rehab program often benefit from an outpatient program after inpatient program completion. Outpatient programs allow the patient to return home and resume his or her normal activities while continuing to get treatment that could be daily, weekly, or less frequently (based on their stage in recovery). Outpatient programs are also options for those who are unable to attend an inpatient facility due to cost or other obligations.

Rather than moving to an outpatient setting after rehab, some patients may choose to live in a sober living facility or halfway house upon completing treatment. These homes give patients some freedom. Patients usually have to work during the day and be home by a certain hour at night. They also have to follow house rules and submit to random drug testing to prove they are clean.

If you or someone you love is addicted to clonazepam, seek out the needed help. It is possible to get off clonazepam and live a productive and happy life without the drug.

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Long-Term Use of Klonopin and Risk of Severe Addiction

Content Overview

What Are Some Long Term Side Effects of Klonopin Use?

Long-term use and abuse of Klonopin have been linked to:

  • Overdose
  • Poly-drug abuse
  • Drowsiness
  • Poor concentration
  • Muscle weakness
  • Mental confusion
  • Vertigo
  • Episodic memory loss
  • Aggression
  • Hostility
  • Antisocial behavior
  • Depression
  • Emotional blunting
  • Birth defects in unborn babies
  • Short-term withdrawal symptoms, including seizures
  • Protracted withdrawal symptoms
  • Infection
  • Insomnia

To understand how Klonopin — also known as clonazepam — impacts someone after a prolonged period of use or abuse, it’s important to comprehend how it works. This benzodiazepine takes effect by altering the levels of chemical impulses in the brain that can inflict anxiety and distress when low.

Even though doctors wrote 26.9 million prescriptions for this drug in 2011, per the Drug Enforcement Administration, and some of these prescriptions are abused, others are abusing the drug by way of street dealers. Some may purposely seek prescriptions through several doctors just to sell it. Others buy, borrow, or steal pills from friends or family members. In fact, over 70 percent of those who abuse prescription medications get them from family members, according to Reuters.

What Happens to Abusers?

What starts out as typical use of Klonopin can quickly turn into full-blown addiction. Klonopin should not be relied on for prolonged periods of time, and it is safest when used for short durations of time – less than two weeks. If people have been using or abusing the drug for longer and exhibit some of the symptoms of addiction, they are probably dependent on it.

Tolerance to benzodiazepines occurs even for regular users who are prescribed the drug. For abusers, it can set in even sooner, particularly if they started using the drug in copious amounts or are using other substances at the same time. Other warning signs include bailing on loved ones to stay home and get high, spending abnormal amounts of time obsessing over drug use, and trying to cut back on use but not managing to do so. If people are fully aware of the detrimental impact their drug abuse has caused in their lives, but they keep using anyway, it’s time to ask for help.

Withdrawal can be difficult for many who have been habitually abusing Klonopin. For the majority who are dependent, once they start feeling nauseous or having headaches, they’ll reach for another dose to stave it off.

Physical Consequences

Physical consequences of long-term use include:

  • Weakened immune system
  • Lowered sex drive
  • Brain atrophy
  • Tremors

The specific withdrawal symptoms experienced vary from person to person, but given that there are so many potential effects, it’s likely that most users encounter their fair share. Discomfort comes in the form of body aches and pains, as well as fluid in the ears that can develop into infection, a burning sensation when urinating and urinary tract infections, joint pain, tightness and pain in the chest, and more. Psychology Today states cerebral ventricular enlargement — which can cause further neurological impairment — has been noted as a side effect of long-term benzodiazepine use.

Over time, long-term users have less control over their weight, often due to the way benzodiazepines are metabolized and how they impact appetite. The fatigue that Klonopin causes also comes with disorientation that can make users clumsy and prone to falling. Warning labels caution users of Klonopin not to drive until they know how the drug affects them. In regard to substance abuse, how the drug affects a person is constantly changing, so even something as simple as driving to work or the grocery store isn’t safe when abusing Klonopin.

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  • Ketamine
  • Vyvanse
  • Xanax

Psychological Impacts

Psychological impacts of Klonopin abuse include:

  • Increased risk of Alzheimer’s disease
  • Milder forms of memory impairment
  • Depression
  • Anxiety that no longer responds to the drug treatment
  • Reduced inhibition

Long-term use of benzodiazepines like Klonopin has been linked to an increased likelihood of developing Alzheimer’s disease later in life.

CBS News reports the increased risk is as high as 51 percent. Less intense forms of memory loss are very common, as well.

Over time, the brain will become tolerant to even higher — albeit unsafe — doses of the drug, and the anxiety it once effectively treated may return with a vengeance. Some long-term abusers of clonazepam end up suffering from prolonged, sometimes endless, bouts of depression. People may also be left with lowered inhibitions that cause them to act more impulsively and make irrational decisions.

Psychological issues stemming from using or abusing Klonopin may include mild anxiety and paranoid thoughts. Many people write these factors off as not being an issue and a lot of them find out otherwise the hard way. The depths of paranoia caused by this drug can lead to serious outcomes, such as attempts at suicide — some of which are successful. Of the 22,134 pharmaceutical drug-related overdose deaths the Journal of the American Medical Association reported on in 2010, 29.4 percent involved benzodiazepines and 17.1 percent were suicides.

Sometimes harm is due to irrational thoughts users believe to be true, like everyone is against them and judging their behavior.

People who are addicted to Klonopin may experience full-blown hallucinations and even have conversations with people who aren’t really there.

Abusing this drug may lead to feeling quite angry toward others without just cause, which can lead to abusive and destructive behavior.

Many started using Klonopin with a legitimate reason — to treat anxiety. As a result, they fear their anxious and paranoid symptoms will return if they stop using it; however, substance abuse can worsen pre-existing anxiety. This type of substance abuse can severely intensify the symptoms of mental health disorders and make them quite complicated to treat. Others may suffer from substance-induced psychotic disorders when abusing this type of drug.

All too often, people relapse due to an inability to cope with the ineffectively treated symptoms of a mental health disorder that they’re trying to escape. For this reason, a tandem approach must be used to ensure that the transition from Klonopin to another method of treatment for existing anxiety is managed correctly.

The Silver Lining

With the right support and a strong medical detox program on your side that includes therapy, family support structures like systemic family interventions, and group therapy, you can come back from Klonopin dependency. Help is available.

What should I discuss with my healthcare provider before taking clonazepam (KlonoPIN, KlonoPIN Wafer)?

You should not take clonazepam if you have:

  • narrow-angle glaucoma;
  • severe liver disease; or
  • a history of allergic reaction to any benzodiazepine, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), chlordiazepoxide, flurazepam, and others.

To make sure clonazepam is safe for you, tell your doctor if you have ever had:

  • kidney or liver disease;
  • glaucoma;
  • asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;
  • porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system);
  • depression or suicidal thoughts or behavior;
  • mental illness, psychosis, or addiction to drugs or alcohol; or
  • if you use a narcotic (opioid) medication.

Some people have thoughts about suicide when taking seizure medication. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Follow your doctor’s instructions about taking seizure medication if you are pregnant. Do not start or stop taking this medicine without your doctor’s advice, and tell your doctor right away if you become pregnant. Clonazepam may cause harm to an unborn baby, and may cause breathing or feeding problems in a newborn. But having seizures during pregnancy could harm both mother and baby.

If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of clonazepam on the baby.

Clonazepam can pass into breast milk, but effects on the nursing baby are not known. Tell your doctor if you are breast-feeding.

Do not give this medicine to a child without medical advice. Clonazepam is not approved to treat panic disorder in anyone younger than 18 years old.

How should I take clonazepam (KlonoPIN, KlonoPIN Wafer)?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Clonazepam may be habit-forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

Misuse of habit-forming medicine can cause addiction, overdose, or death. Selling or giving away this medicine is against the law.

Clonazepam should be used for only a short time. Do not take this medication for longer than 9 weeks without your doctor’s advice.

Swallow the regular clonazepam tablet whole, with a full glass of water.

To take the orally disintegrating tablet:

  • Keep the tablet in its blister pack until you are ready to take it. Open the package and peel back the foil. Do not push a tablet through the foil or you may damage the tablet.
  • Use dry hands to remove the tablet and place it in your mouth.
  • Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.
  • Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.

If you use this medicine long-term, you may need frequent medical tests.

Do not stop using clonazepam suddenly or you could have unpleasant withdrawal symptoms, including a seizure (convulsions). Ask your doctor how to safely stop using this medicine.

Call your doctor if this medicine seems to stop working as well in treating your seizures or anxiety symptoms.

Seizures are often treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor’s advice.

Store at room temperature away from moisture, heat, and light.

Keep track of the amount of medicine used from each new bottle. Clonazepam is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Klonopin Dosage: The Definite Guide to Safe and Effective Amount

Clonazepam, better known by its brand name Klonopin, is a drug which belongs to the group of medications called benzodiazepines. These drugs are known to be useful in the treatment of panic attacks and anxiety disorders, such as social anxiety disorder (SAD). Klonopin works by reducing abnormal electrical activity in the brain – it can be helpful in controlling anxiety and prevention of panic attacks. Klonopin dosage will depend on several factors including the patient’s age and medical condition. Therefore, one’s average Klonopin dose varies significantly, according to these influencing factors. This article will outline the correct dosage of Klonopin and its safest and most effective practices.

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Table of Contents

  • About Klonopin Dosage in General
  • Lowest, Average and Highest Dosage
  • The Dosage of Klonopin by Age and Condition
  • Occasional and Preventative Use

About Klonopin Dosing


Klonopin most often comes in a tablet form. Regular tablets are to be taken orally with water while disintegrating ones (wafers) can be swallowed without water. The prescribed dose is usually taken one to three times daily, on a full or empty stomach. Interestingly enough, higher doses don’t necessarily mean better efficiency. In fact, higher doses are associated with more adverse side effects.
However, that is not to say titration is out of the question. Some patients may benefit from an exponential increase of their Klonopin dosage. The recommended amount for adults is 0.25 mg twice a day, with the dosage usually jumping to 1mg per day after three days of usage. This is considered a safe amount. In patients who undergo titration, the dosage may be increased by 0.125mg to 0.25mg twice a day, every three days until the symptoms of the patient’s condition are under control or until intolerance appears.
Maintaining one’s dosage properly is essential for a sustainable treatment. Going ‘cold turkey’ and deciding to get off clonazepam, or any other benzodiazepine, in fact, should never be an option. Doing so could lead to severe Klonopin withdrawal symptoms and potentially harmful adverse effects. Instead, stopping the usage should be achieved by a controlled, gradual decrease in Klonopin dosing, instructed by one’s doctor.

Lowest, Average and Highest Klonopin Dose

To medicate with Klonopin safely, one should be taking the smallest effective quantity of the drug consistently. This, together with good patient management, will ensure the user has the lowest chances of developing dependence or overdosing on the drug.

  • The lowest dose of Klonopin is 0.25mg twice daily. This is also the amount which is advised at the beginning of one’s treatment.
  • The normal amount then increases to 1.5mg per day, divided into three doses.
  • The highest dose of Klonopin should never exceed 20mg per day when it comes to treating seizures. In geriatric and pediatric cases (elderly and children) the dose should be lower.

Addiction to the drug may result in the overdose of Klonopin as tolerance, and irresponsible usage comes into play. Abusers who combine alcohol and this potent central nervous system depressant are more exposed to additive CNS depression.

The joined effects of alcohol and other depressants slow down brain activity which could lead to dangerous outcomes if one performs a task which requires mental alertness. Apart from external dangers, this combination may lead to respiratory depression, profound sedation, coma, or even death. That is why there is no time to wait for Klonopin addiction treatment.

The Dosage of Klonopin by Age and Condition


Children, infants, in particular, should never take more than 0.2mg per one kilogram of their body mass for seizures. It’s also worth mentioning safe and effective use hasn’t been fully established when it comes to panic disorders people from these age groups experience.
The average Klonopin dose for adults 1.5mg a day unless the seizures are adequately controlled. It is important that the dosage is increased in small increments (0.5 – 1mg) every three days until the symptoms fade away, or the adverse effects worsen. Either way, the highest dose of Klonopin should never exceed 20mg.
For seizure patients who are 65 years of age or older, there is no set average dose. Patients from this age group should be observed and start on low doses of the drug.
As for panic disorders, adults should medicate with lower amounts. The lowest dose of Klonopin is 0.25mg and an increase to the target dose of 1mg per day may be made three days later. Again, it is still uncertain what the safety measure is for elderly and children with panic disorders.

Occasional and Preventative Use

Some people may choose to tackle their seizures or anxiety disorders as they appear. This occasional use may help better manage their symptoms. However, it is important to keep in mind that this way of usage comes with side effects, too.
Withdrawal symptoms can be quite harsh and are different for everyone. Some people reported side effects appearing months after taking the medication. To limit dangers of adverse effects and addiction the Klonopin recreational dose is 0.25-0.5mg three times daily. The highest dose of Klonopin for anxiety should never exceed 20mg per day, in three increments.
There is not one, universal Klonopin dosage. The best results this drug can offer depend on several factors, including one’s age, condition, and medical history. It is important to go above the minimum amount to feel the effects. Equally, it is important not to exceed the maximum quantity which could lead to severe health complications.
One’s doctor will determine the patient’s correct dosage. Thus, he or she will ensure the patient has the lowest chances of developing a dependency to the drug or overdosing on it. Some practices are ubiquitous; for example, one should never stop taking the drug out of the blue. Similarly, a patient shouldn’t miss or increase the prescribed dose before first talking to the doctor. The key to a safe and effective Klonopin dosage is in respecting and following the doctor’s instructions.

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    What Are Xanax Bars?

    Author: Amy Keller, RN, BSN | Last Updated: 11/12/18 | 12 sources

    A Xanax bar is a street name for alprazolam, a prescription medication that’s used to relieve anxiety.

    Like other benzodiazepines, Xanax calms a person by slowing the central nervous system. Because the drug works quickly and effectively, it can be a godsend for individuals suffering from panic attacks and other debilitating types of anxiety.

    But the drug’s relaxing effects have also made it a popular recreational drug, contributing to high rates of Xanax addiction and abuse.

    How Many Milligrams Are in a Bar of Xanax?

    Xanax, which is a name brand of alprazolam manufactured by Pfizer, comes in several different strengths. Xanax bars usually refer to 2-milligram-strength tablets of the drug.

    Name brand Xanax bars are white and rectangular tablets imprinted with “XANAX” on one side and the number “2” on the other side. They are scored, or indented, in three places, so one pill can be broken into four 0.25-mg pieces.

    There are also a number of similar looking generic versions of the drug. Par Pharmaceuticals distributes pale green Xanax bars. The 2-mg rectangular pills — which are imprinted with “S 90 3” — have two scores, instead of three, so they can be broken into three equal 0.66mg squares.

    Actavis Pharma markets a yellow version of the drug. The 2-mg tablets are sometimes referred to as “yellow school buses” on the street. Other common slang terms for Xanax bars include: “sticks,” “planks,” “bricks,” “bars,” “zbars,” “handlebars,” “totem poles” and “zanies.”

    What Color Xanax Pill Is the Strongest?

    Color, along with the shape of a tablet, can provide some clues about the strength of alprazolam tablets — but it’s not a perfect indicator. That’s because different manufacturers use different colors for their formulations.

    The lowest dose of alprazolam, 0.25 mg, usually comes as an oblong, white pill that is scored down the middle — and most manufacturers pills look relatively the same, according to a search of the U.S. National Library of Medicine’s pill identification database.

    But while most 0.5-mg alprazolam tablets, for instance, are football-shaped and pink or peach in color, some manufacturers sell 0.5-mg tablets that are yellow. And although 1-mg tablets are usually blue, some are green. As mentioned above, 2-mg Xanax bars are usually white, yellow or light green.

    The highest strength dose of Xanax is a 3-mg extended-release tablet. That pill is triangular — not bar-shaped — and green.

    Because of the wide variety of strengths and manufacturers, you should never take alprazolam unless it’s been specifically prescribed to you and came from its original prescription pill bottle.

    What Does a Bar of Xanax Do to You?

    Most people take alprazolam for its relaxing and euphoric effects, otherwise known as a Xanax high. But reactions Xanax can differ from person to person, depending on the dose taken and whether they have taken it before.

    The 2-mg dose of alprazolam in a Xanax bar is a heavy dose of the drug. A person who uses alprazolam regularly and has built up a tolerance to it, might feel euphoric or extremely mellow, but someone who is not used to the drug may become heavily sedated.

    Other common Xanax side effects include:

  • Difficulty speaking
  • Problems with coordination
  • Drowsiness
  • Depression
  • Memory problems

Dangers of Xanax Bars

Overdosing on Xanax only is rare. But mixing alcohol and Xanax or combining the drug with other central nervous system depressants increases the risk of a fatal Xanax overdose.

Signs and symptoms of a Xanax overdose include:

  • Extreme sleepiness
  • Confusion
  • Impaired coordination
  • Diminished reflexes
  • Coma and death

Counterfeit Xanax tainted with fentanyl and carfentanil is also cropping up the street. One dose of the fake drug could kill a person.

Using Xanax regularly can also lead to physical dependence and addiction. Xanax withdrawal can be uncomfortable and often requires a medical detox.

Rap References to Xanax Bars

Abuse of Xanax is so widespread that references to the drug have invaded popular culture and the rap music scene in particular.

In 2013, rapper Ricky Hil, Tommy Hilfiger’s son, came out with a song about Xanax addiction called “Xanax Bars.” And when South Florida rapper Lil Pump reached one million followers on Instagram in 2017, he celebrated by slicing a “Xan cake” make to look like a green Xanax bar.

California rap artist Diego Leanos, who goes by the stage name Lil Xan, had a breakout hit with his 2017 song “Betrayed,” about his two-year addiction to Xanax. The artist’s music video has garnered more than 211 million hits on YouTube.

Lil Xan says he decided to give up Xanax following the 2017 death of his friend and fellow rap artist Lil Peep, who died after overdosing on a combination of Xanax and fentanyl.

AuthorContent Writer, DrugRehab.com As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference. @DrugRehabAmy editorEditor, DrugRehab.com

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