Clonazepam

The US label lists two uses. The first is seizure disorders, alone or as an add-on. It names Lennox-Gastaut syndrome, akinetic and myoclonic seizures, and absence seizures after other medicines failed.

The second is panic disorder, with or without agoraphobia, a condition of unexpected panic attacks with worry about more attacks.

The label says some loss of effect against seizures may occur during treatment.

• Seizure disorders (alone or as an add-on)
• Panic disorder, with or without agoraphobia

The label sections we reviewed do not describe how clonazepam works.

The label places it in the benzodiazepine class. Benzodiazepines slow brain activity and have calming and anti-seizure effects.

The dosing here comes from a US tablet label (clonazepam tablets, taken by mouth with water, swallowed whole). Other Indian pack forms exist, and the prescriber decides.

Seizure disorders, adults: the US label says the starting dose should not exceed 1.5 mg a day in three divided doses. It may be raised by 0.5 to 1 mg every 3 days. The label names a maximum of 20 mg a day.

Panic disorder, adults: the label says to start at 0.25 mg twice daily and raise to a target of 1 mg a day after 3 days. A small number may need up to 4 mg a day. One dose at bedtime may reduce daytime sleepiness.

The label says to stop gradually, not suddenly, because withdrawal can be severe and seizures can return.

This is label information, not a prescription. Indian pack labels may differ from the US label, and your prescriber's instruction always comes first.

Boxed warning: using benzodiazepines with opioids may cause profound sedation, slowed breathing, coma and death. The label also warns of abuse, misuse and addiction, and of dependence and withdrawal that can be life-threatening after sudden stopping.

Not for people with a history of sensitivity to benzodiazepines, significant liver disease, or acute narrow-angle glaucoma.

Kidney disease: the metabolites leave through the kidney, so the label says to take caution.

Elderly: the label says to start at the low end of the dose range because of weaker liver, kidney and heart function and the risk of confusion and over-sedation.

Pregnancy: late use may cause sedation or withdrawal in newborns. Animal studies showed fetal harm.

Breastfeeding: clonazepam passes into milk. Babies may show sedation, poor feeding and poor weight gain.

Children: long-term use in children with seizures needs careful benefit-risk thought because of effects on development.

• Opioids: serious breathing risk
• Alcohol and other sedatives: more sedation
• Phenytoin: monitoring advised
• Valproic acid: may produce absence status
• Opioids: using them together increases the risk of slowed breathing and sedation.
• The label says to limit dose and duration.
• Other medicines that slow the nervous system, and alcohol: the label links abuse and overdose with alcohol and other substances to serious outcomes.
• Phenytoin: clonazepam may influence its levels, so the label says to monitor them.
• Using several anticonvulsants together may add to nervous system effects.
• Valproic acid with clonazepam may produce absence status.

No match in this label text. Ask your pharmacist about any medicine you take.

The label says benzodiazepine overdose causes central nervous system depression, from drowsiness to coma. Severe cases can cause slowed breathing. With alcohol or opioids it may be fatal.

Treatment is supportive. Flumazenil carries risks, including seizures. Get emergency help.

The label says to store it at 20 to 25 degrees C (68 to 77 degrees F). Use a tight, light-resistant container. It should have a child-resistant closure.

In the Drugs Rules schedules we checked, clonazepam is listed under Schedule H (Schedule H, serial 125 (rules 65 and 97)). Schedule H medicines are sold only on a doctor's prescription. Clonazepam is a benzodiazepine, so treat it as a controlled medicine.

Clonazepam appears in the National List of Essential Medicines 2022 on page 103. Listed forms are 0.25 mg, 0.5 mg and 1 mg tablets, under anticonvulsants.

NPPA lists ceiling prices for several clonazepam formulations. The table shows the rows we found. Check NPPA directly for the current list.

Banned combinations: we found no mention of clonazepam in the banned-combination list we checked. Use the checker for your exact combination.

NPPA ceiling prices set the most a seller can charge per unit for the listed formulations, before local taxes. Check the pack and the seller.

Jan Aushadhi (PMBJP) lists clonazepam products in the file we checked. We have not shown a brand price here.

• Clonazepam Tablets IP 0.5 mg (pack 10's)
• Clonazepam Tablets IP 1mg (pack 10's)
• Clonazepam Mouth Dissolving Tablets 0.25 mg (pack 10's)
• Clonazepam + Propranolol Tablet (0.25/10 Mg) (pack 10's)
• Clonazepam + Propranolol Tablet (0.25/20 Mg) (pack 10's)
• Clonazepam + Propranolol Tablet (0.5/20 Mg) (pack 10's)