Clonazepam dosage, forms, and strengths

Clonazepam is a generic prescription drug that treats certain types of seizures in adults and children and controls panic attacks in adults diagnosed with panic disorder. Clonazepam belongs to a class of drugs called benzodiazepines. These drugs slow down brain activity by mirroring the effects of a chemical in the brain called gamma-aminobutyric acid (GABA), a neurotransmitter that blocks nerve signals. Clonazepam is taken by mouth as a tablet or orally disintegrating tablet with or without food up to three times a day. 

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Clonazepam forms and strengths

Clonazepam is taken as a tablet or orally disintegrating tablet. Klonopin, the brand-name version of clonazepam, is only sold as a tablet. 

• Tablets: 0.5 milligrams (mg), 1 mg, 2 mg

• Orally disintegrating tablets: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg

Clonazepam dosage for adults

Clonazepam is FDA approved to treat seizure disorders and panic disorder with or without agoraphobia (fear of certain places or situations). However, the drug is widely prescribed off-label to treat a broad spectrum of medical conditions including anxiety, sleep disorders, restless legs syndrome, Tourette syndrome, involuntary eye movements (nystagmus), and movement disorders such as tardive dyskinesia and ataxia. For seizure disorders and panic attacks, clonazepam is taken in two to three daily doses.

Source: Epocrates

Clonazepam dosage for seizure disorders

In patients with epilepsy or other seizure disorders, clonazepam helps manage a broad range of seizures including akinetic seizures (seizures that produce a sudden loss of muscle strength), myoclonic seizures (seizures characterized by brief muscle spasms), petit mal absence seizures (seizures in which people temporarily “blank out”), infantile spasm, Lennox Gastaut syndrome, and non-convulsive status epilepticus (seizures that last longer than five minutes but don’t involve convulsions). Because of adverse effects and the risks of drug abuse and withdrawal, healthcare providers typically prescribe clonazepam as a short-term therapy until seizures are under control.

• Standard clonazepam dosage for seizure disorders: 0.5–5 mg taken orally three times per day

• Maximum clonazepam dosage for seizure disorders: 20 mg per day

Clonazepam dosage for panic disorder

Panic disorder is a type of anxiety disorder characterized by “panic attacks.” These are sudden, uncontrollable, and often unprovoked periods of overwhelming fear that can severely impair daily functioning. Because people being treated for panic disorder eventually develop a tolerance for the drug, mental health professionals prescribe clonazepam only for the short-term treatment of panic disorder. For panic disorder, clonazepam will be started at a low dose (0.25 mg taken two times per day) which will be gradually increased every one or two days until an effective dose is reached. However, some healthcare providers may prescribe clonazepam off-label to be taken on an as-needed basis to manage individual panic attacks.

• Standard clonazepam dosage for panic disorder: 0.5–2 mg taken orally two times per day

• Maximum clonazepam dosage for panic disorder: 4 mg per day

Clonazepam dosage for children

Clonazepam is only approved for use in children to treat seizure disorders, but healthcare providers may prescribe clonazepam to children off-label for medical conditions such as sleep disorders or Tourette syndrome. Doses are determined by the child’s body weight for young children, but older children receive adult doses. In some cases, a healthcare provider may prescribe a dosing schedule in which the last dose, taken near bedtime, is larger than the other daily doses. This is to help minimize drowsiness during the day and promote sleep at night.

Source: Epocrates

Clonazepam dosage restrictions

Some people may not be able to take clonazepam because of pre-existing conditions. These contraindications are limited to:

• Severe liver disease

• Acute narrow-angle glaucoma

• Hypersensitivity to clonazepam or other benzodiazepines

Some people, though, can take clonazepam but will be given lower doses. Healthcare providers are advised to start seniors on a lower dose than younger adults, but they will still raise the dose gradually until an effective dose is reached.

Some medical conditions will require more vigilant monitoring for side effects or any worsening of those conditions including:

• Kidney impairment

• Mild to moderate liver impairment

• Depression

• Lung disease

• Sleep apnea

• Alcohol or drug abuse

• Porphyria

Clonazepam dosage for pets

Veterinarians use clonazepam for the short-term treatment for epilepsy in dogs and, combined with other medications, for the long-term treatment for epilepsy in cats. Dogs quickly develop a tolerance for clonazepam—usually in just a few weeks—so the drug soon becomes ineffective as an antiepileptic. Some veterinarians may use clonazepam as an anxiety treatment in both dogs and cats. 

Doses will be calculated based on the pet’s body weight and given one, two, or three times a day. There are different dosage guidelines that veterinarians can follow. In general, though, you can expect a dog’s dose to be between 1-2 milligrams per kilogram of body weight to treat seizure disorders. Cats will be prescribed a 0.5 mg dose for seizures. The doses will be smaller for anxiety disorders. For some pets, you may have to split up tablets in as much as eight pieces to administer doses.

How to take clonazepam

Clonazepam is taken as a tablet or orally disintegrating tablet two to three times a day with or without food.

• Take this medicine as directed by a healthcare provider. The dose may need to be changed several times during treatment.

• This medication may come with a medication guide with important information to know. If it doesn’t, a pharmacist can provide a copy.

• Do not stop taking clonazepam suddenly. Doing so may cause serious side effects. If the medicine does not seem to be working or side effects are a problem, get medical advice from the prescribing healthcare provider about discontinuing this medication.

• Store clonazepam tablets or orally disintegrating tablets at room temperature (59°–86°F) in a child-proof, closed container out of the reach of children.

TABLET

• Swallow the tablet whole with water.

ORALLY DISINTEGRATING TABLET

• Do not open the carton until ready to take the tablets.

• Dry your hands.

• Do not push the tablet through the foil on the blister pack.

• Peel back the foil to expose the tablet.

• Take the tablet from the blister pack using your hands.

• Place the tablet in the mouth. It will dissolve quickly.

Clonazepam dosage FAQs

How long does it take clonazepam to work?

Clonazepam starts working about 25 minutes after taking a dose. Peak effects are reached in about one to four hours. Clonazepam, however, is started at a low dose and only gradually raised to an effective dose. Patients may not experience a significant improvement in symptoms for days or weeks.

How long does clonazepam stay in your system?

Clonazepam has a half-life of 30–40 hours, so it takes several days to a week to clear a clonazepam dose from the body. Clonazepam’s therapeutic effects, however, wear off in about half a day, so clonazepam has to be taken two or three times a day to control seizures or panic attacks. 

What happens if I miss a dose of clonazepam?

If a clonazepam dose is missed, take it when remembered. If it’s almost time for the next dose, skip the missed dose and take the next dose on time. Do not take extra medicine or a double dose to make up for a missed dose.

How long can you take clonazepam?

Clonazepam is intended for short-term treatment. The body develops a physical dependence on the drug within a few weeks. This decreases the effectiveness of the drug and increases the risk of drug abuse and withdrawal symptoms. While there are no set time limits for taking clonazepam, healthcare providers typically prescribe it until seizures or panic attacks are under control. 

How do I stop taking clonazepam?

Do not stop taking clonazepam without talking to a healthcare provider first. Doing so—especially if the medicine has been taken for four weeks or longer—could provoke withdrawal. Symptoms of clonazepam withdrawal include insomnia, irritability, headache, anxiety, depression, tremors, sweating, confusion, delirium, and hallucinations. Rapid discontinuation of clonazepam after chronic, long-term use can produce severe withdrawal symptoms that may be life-threatening. When it’s time to stop clonazepam, a healthcare provider will prescribe a gradually decreasing dose to prevent adverse reactions caused by withdrawal.

Some people, however, may need to stop taking clonazepam. Allergic reactions, respiratory depression (trouble breathing or slow breathing), drug interactions, or serious side effects may require the medicine to be discontinued quickly. 

If clonazepam can’t be taken, people with seizure disorders can turn to a wide spectrum of highly effective anticonvulsants. The most commonly prescribed classes of anticonvulsants are:

• Valproates (such as valproic acid)

• Hydantoins (such as phenytoin) 

• Carboxamides (such as carbamazepine) 

• Barbiturates (such as phenobarbital)

• Succinimides (such as ethosuximide) 

• Triazines such as lamotrigine

All these and several other types of anticonvulsants are highly effective and many have a better side effects profile than clonazepam. For many of these drugs, patients have fewer problems with sleepiness, mental impairment, physical tolerance, withdrawal, orthostatic hypotension (low blood pressure when standing up), suicidal thoughts, or slowed breathing.

Clonazepam and other benzodiazepines are only intended to treat panic disorder for a short time. Eventually, the drug will be discontinued and a mental health professional will turn to long-term treatment options such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, or beta blockers.

Can you overdose on clonazepam?

Do not exceed the recommended dose. An overdose of clonazepam is a medical emergency. Symptoms of an overdose include somnolence, confusion, diminished reflexes, muscle weakness, and coma. If too much clonazepam is taken, immediately call a poison helpline and seek emergency medical care. 

What happens when you mix clonazepam and alcohol?

Avoid combining clonazepam with any other type of central nervous system depressant such as alcohol, opioid pain relievers, or over-the-counter sleeping pills. CNS depressants like alcohol and clonazepam slow down the brain, so combining them increases the sedative effects and mental impairment caused by both chemicals. CNS depressants also slow down breathing. If the combination is excessive—say, too much alcohol is consumed when taking clonazepam—the result could be life-threatening. 

Is it safe to take clonazepam during pregnancy?

There is not enough research or evidence to determine if clonazepam is harmful to a fetus. Even so, healthcare providers are cautious about the use of benzodiazepines during the last trimester of a pregnancy. When benzodiazepines are taken in the late stages of a pregnancy, there’s a risk that infants will be born dependent on the drug and experience withdrawal symptoms, sedation, or slowed breathing after they’re born. 

Breastfeeding women are able to take clonazepam if needed, but are asked to monitor their baby carefully for unusual changes such as sedation or trouble breathing. Clonazepam is present in breast milk in very small amounts and is sometimes detectable in an infant’s blood. Some infants have experienced common side effects of clonazepam such as drowsiness when the mother is taking clonazepam.

Related resources for Clonazepam dosages:

• Clonazepam, Drugs and Lactation Database

• Clonazepam, National Alliance on Mental Illness (NAMI)

• Clonazepam, StatPearls

• Clonazepam compound summary, U.S. National Library of Medicine

• Anxiety disorders, National Institute of Mental Health

• Clonazepam tablet, orally disintegrating prescribing information, U.S. National Library of Medicine

• Clonazepam tablet prescribing information, U.S. National Library of Medicine

• Clonazepam, Epocrates

• Clonazepam prescribing information, U.S. National Library of Medicine

• Klonopin prescribing information, U.S. National Library of Medicine

• Medications for ataxia symptoms, National Ataxia Foundation