AdultPediatricDosage Forms & Strengths tablet dispersible: Schedule IV 0.125mg 0.25mg 0.5mg 1mg 2mg tablet: Schedule IV 0.5mg 1mg 2mg Panic Disorder 0.25 mg PO q12hr initially; may increase to 1 mg/day after 3 days (up to 4 mg/day in some patients) Seizure Disorders 1.5 mg/day PO divided q8hr; increase by 0.5-1 mg q3Days until desired effect achieved; not to exceed 20 mg/day Maintenance: 2-8 mg PO; not to exceed 20 mg/day Essential Tremor (Off-label) 0.5 mg PO at bedtime; increase dose by 0.5 mg q3-4days; not to exceed 6 mg/day REM Sleep Behavior Disorder (Off-label) 0.25-2 mg PO 30 min prior to bedtime; not to exceed 4 mg Burning Mouth Syndrome (Off-label) 0.25 mg PO at bedtime for 1 week; increase dose by up to 0.25 mg qweek; not to exceed 3 mg daily in 3 divided doses Alternatively, 1 mg topirally three times daily after each meal; suck on the tablet, retain salive in mouth near pain sites without swallowing for 3 min, then expectorate saliva Tardive Dyskinesia (Off-label) The American Academy of Neurology guidelines includes use of clonazepam for short-term treatment (~3 mo) to decrease tardive dyskinesia symptoms Initial: 1 mg/day PO; adjust dose based on response and tolerability by 1 mg/day increments q3-4 days; not to exceed 4.5 mg/day Dosage Modifications Renal impairment: Supplemental dose in hemodialysis not necessary Dosing Considerations Discontinuation of treatment: Withdraw treatment gradually; decrease the dose q3Days by 0.125 mg PO q12hr until completely withdrawn Hyperekplexia (Orphan) Orphan indication sponsor Hoffmann-La Roche, Inc; 340 Kingsland Street; Nutley, NJ 07110 Recurrent, Acute, Repetitive Seizures (Orphan) Administration: Intranasal spray Orphan indication sponsor Jazz Pharmaceuticals, Inc; 3180 Porter Drive; Palo Alto, CA 94304 Tardive Dyskinesia (Off-label) The American Academy of Neurology guidelines includes use of clonazepam for short-term treatment (~3 mo) to decrease tardive dyskinesia symptoms Initial: 1 mg/day PO; adjust dose based on response and tolerability by 1 mg/day increments q3-4 days; not to exceed 4.5 mg/dayDosage Forms & Strengths tablet: Schedule IV 0.125mg 0.25mg 0.5mg 1mg 2mg Seizure Disorders <6 years Potential toxic dose: 0.05 mg/kg <10 years or <30 kg 0.01-0.03 mg/kg/day PO divided q8hr; increase by 0.25-0.5 mg/day q3Days to maximum 0.1-0.2 mg/kg/day PO divided q8hr Maintenance dose: 0.1-0.2 mg/kg/day PO divided q8hr; not to exceed 0.2 mg/kg/day ≥10 years or ≥30 kg 1.5 mg/day PO divided q8hr; increase by 0.5-1 mg q3Days until desired effect achieved; not to exceed 20 mg/day Maintenance: 2-8 mg PO; not to exceed 20 mg/day Dosing Considerations Discontinuation of treatment <10 years: Treatment should be withdrawn gradually, as necessary ≥10 years: Withdraw treatment gradually; decrease the dose q3Days by 0.125 mg PO q12hr until completely withdrawn Interaction CheckerEnter a drug name and clonazepamNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (0)Serious - Use Alternative (22)abametapirabametapir will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.apalutamideapalutamide will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.benzhydrocodone/acetaminophen and clonazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine subdermal implantbuprenorphine subdermal implant and clonazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalbuprenorphine transdermal and clonazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionbuprenorphine, long-acting injection and clonazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatecalcium/magnesium/potassium/sodium oxybatesclonazepam, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.carbamazepinecarbamazepine will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.conivaptanconivaptan will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.fexinidazolefexinidazole will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.hydrocodonehydrocodone, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.idelalisibidelalisib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substratesivosidenibivosidenib will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.lonafarniblonafarnib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.metoclopramide intranasalclonazepam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.olopatadine intranasalclonazepam and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. selinexorselinexor, clonazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.sodium oxybateclonazepam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.sufentanil SLsufentanil SL, clonazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.tucatinibtucatinib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.valerianvalerian and clonazepam both increase sedation. Avoid or Use Alternate Drug.voxelotorvoxelotor will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.Monitor Closely (255)acrivastineacrivastine and clonazepam both increase sedation. Use Caution/Monitor.albuterolclonazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.alfentanilclonazepam and alfentanil both increase sedation. Use Caution/Monitor.alprazolamalprazolam and clonazepam both increase sedation. Use Caution/Monitor.amisulprideamisulpride and clonazepam both increase sedation. Use Caution/Monitor.amitriptylineclonazepam and amitriptyline both increase sedation. Use Caution/Monitor.amobarbitalamobarbital and clonazepam both increase sedation. Use Caution/Monitor.amobarbital will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.amoxapineclonazepam and amoxapine both increase sedation. Use Caution/Monitor.apomorphineclonazepam and apomorphine both increase sedation. Use Caution/Monitor.arformoterolclonazepam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.aripiprazoleclonazepam and aripiprazole both increase sedation. Use Caution/Monitor.armodafinilclonazepam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.asenapineasenapine and clonazepam both increase sedation. Use Caution/Monitor.asenapine transdermalasenapine transdermal and clonazepam both increase sedation. Use Caution/Monitor.atazanaviratazanavir increases levels of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.avapritinibavapritinib and clonazepam both increase sedation. Use Caution/Monitor.azelastineazelastine and clonazepam both increase sedation. Use Caution/Monitor.baclofenclonazepam and baclofen both increase sedation. Use Caution/Monitor.belladonna and opiumclonazepam and belladonna and opium both increase sedation. Use Caution/Monitor.belzutifanbelzutifan will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. benperidolclonazepam and benperidol both increase sedation. Use Caution/Monitor.benzphetamineclonazepam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.bosentanbosentan will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.brexanolonebrexanolone, clonazepam. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazolebrexpiprazole and clonazepam both increase sedation. Use Caution/Monitor.brimonidinebrimonidine and clonazepam both increase sedation. Use Caution/Monitor.brivaracetambrivaracetam and clonazepam both increase sedation. Use Caution/Monitor.brompheniraminebrompheniramine and clonazepam both increase sedation. Use Caution/Monitor.buprenorphineclonazepam and buprenorphine both increase sedation. Use Caution/Monitor.buprenorphine buccalclonazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantclonazepam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.buprenorphine, long-acting injectionclonazepam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.butabarbitalbutabarbital and clonazepam both increase sedation. Use Caution/Monitor.butalbitalbutalbital and clonazepam both increase sedation. Use Caution/Monitor.butorphanolclonazepam and butorphanol both increase sedation. Use Caution/Monitor.caffeineclonazepam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.carbinoxaminecarbinoxamine and clonazepam both increase sedation. Use Caution/Monitor.carisoprodolclonazepam and carisoprodol both increase sedation. Use Caution/Monitor.cenobamatecenobamate will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.cenobamate, clonazepam. Either increases effects of the other by sedation. Use Caution/Monitor.ceritinibceritinib will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.chloral hydrateclonazepam and chloral hydrate both increase sedation. Use Caution/Monitor.chlordiazepoxidechlordiazepoxide and clonazepam both increase sedation. Use Caution/Monitor.chlorpheniraminechlorpheniramine and clonazepam both increase sedation. Use Caution/Monitor.chlorpromazineclonazepam and chlorpromazine both increase sedation. Use Caution/Monitor.chlorzoxazoneclonazepam and chlorzoxazone both increase sedation. Use Caution/Monitor.cimetidinecimetidine increases levels of clonazepam by decreasing metabolism. Use Caution/Monitor.cinnarizinecinnarizine and clonazepam both increase sedation. Use Caution/Monitor.clarithromycinclarithromycin will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.clemastineclemastine and clonazepam both increase sedation. Use Caution/Monitor.clobazamclonazepam, clobazam. Other (see comment). Use Caution/Monitor. Comment: