Klonopin (clonazepam) is a Schedule IV benzodiazepine designed to treat seizure disorders and panic attacks. The drug has hypnotic, sedative, anxiety-reducing, anticonvulsant, muscle relaxant and amnesic properties. It is available as oral tablets, liquid solutions and injectable solutions.
People usually achieve the maximum benefit from Klonopin three to four weeks after intake, according to Stanford Medicine. It takes only two to four weeks to develop a dependence on the drug. If taken every day for several weeks, clonazepam can cause addiction.
Misusing Klonopin may lead to psychological and physical dependence, acute depression, sleep disorders and aggression. People can develop a tolerance for the substance and experience withdrawal symptoms if they do not appropriately wean themselves off the drug.
According to a 2016 FDA report, the body quickly absorbs clonazepam after the tablets are swallowed. The drug reaches peak plasma concentrations, which is the highest level the drug can reach in the blood, within one to four hours after intake. The body almost completely metabolizes Klonopin, only excreting up to 2 percent of the drug in the urine.
A study published in Fundamental and Clinical Pharmacology stated that clonazepam had the second-highest addiction potential of all benzodiazepines. The report found that alprazolam (Xanax) was the most addictive.
But Dr. Berney Wilkinson, a licensed psychologist based in Central Florida, told DrugRehab.com that Klonopin can be just as addictive as Xanax or Valium.
“It is recommended for benzos — all benzos — to only be used short term.”
“All benzos are addictive for the same reasons — their impact on GABA [receptors],” said Wilkinson, referring to a class of central nervous system receptors that influence cognition. “For this reason, it is recommended for benzos — all benzos — to only be used short term.”
Wilkinson said that Xanax users may feel the medication’s effects within an hour, whereas Klonopin users may not feel its effects for several hours. Because people experience the effects of Klonopin for longer periods of time, physicians may prescribe the drug instead of other benzodiazepines.
Among people aged 12 or older, Klonopin is not as popular as some other benzodiazepines, according to the latest National Survey on Drug Use and Health. In 2015, people in this demographic used alprazolam (Xanax), lorazepam (Ativan) and diazepam (Valium) at higher rates in the past year when compared with clonazepam products.
However, people aged 12 or older were more likely to misuse clonazepam products than lorazepam products in 2015, the survey found. That year, clonazepam products were misused nearly as often as diazepam products among this age group.
Clonazepam products were not highly misused among adolescents. People aged 18 to 25 used and misused these products at the highest rate in 2015 when compared with other age demographics in the national survey.
Misusing Klonopin has led to a number of hospital visits. From 2005 to 2011, more than 943,000 emergency department visits involved benzodiazepines such as Klonopin, according to the Substance Abuse and Mental Health Services Administration.
Because of the depressant properties of benzodiazepines, Klonopin slows down brain activity and reduces mental alertness. When taken as prescribed, Klonopin users may experience side effects such as drowsiness and dizziness within a few hours of intake.
Other side effects of clonazepam include:
Klonopin may have serious side effects that warrant immediate medical attention. These include rashes, hives, swelling of the face, eyes, lips, tongue or throat, breathing and swallowing difficulties and hoarseness.
Clonazepam is one of several antiepileptic drugs that may increase the risks of suicidal thoughts or tendencies in people who have been on the drug for a prolonged period. In individuals suffering from multiple seizure disorders, Klonopin may exacerbate symptoms.
A 2016 report by the Food and Drug Administration referred to a placebo-controlled study that observed an increase in suicidal thoughts as early as a week after using antiepileptic drugs, including Klonopin.
Mixing certain substances with Klonopin can be harmful. For example, medications, vitamins and herbs may not react well with the drug. When combined with clonazepam, these substances can prevent the drug from working efficiently or cause serious side effects.
Alcohol accentuates the sedative effects of Klonopin, leading to concentration problems, drowsiness and dizziness. Combining clonazepam and alcohol also can result in unusual behavior, seizures or thoughts of suicide.
Combining MAO inhibitors, such as Nardil, with Klonopin may increase sedation effects, lower blood pressure or cause respiratory depression. Similarly, protease inhibitors, such as Cordarone and Norvir, may lead to poisoning when they interact with clonazepam. Taking Klonopin with other benzodiazepines or sleeping pills can increase sedation and may even lead to death.
Antacids, alcohol addiction medications, antibiotics and oral contraceptives enhance the effects of Klonopin. Anticonvulsants, tricyclic antidepressants and respiratory medications dampen Klonopin’s effects.
Overdosing on benzodiazepines such as Klonopin is rarely life-threatening, but severe outcomes can occur. Klonopin overdoses share similar signs with other CNS depressant overdoses. These include confusion, drowsiness, coma and lowered reflexes.
Individuals who overdose on clonazepam may also experience:
If you suspect that someone has experienced an overdose, call 911 immediately. You may also call a local poison center and speak with experts who can explain how you can provide CPR and ensure the individual’s condition doesn’t worsen.
Klonopin and its primary metabolite, 7-aminoclonazepam, can be detected in the body for longer than most other benzodiazepines. While many benzodiazepines remain in the system one to four days after last use, 7-aminoclonazepam can linger in your system for several weeks.
A study published in the journal Analytical and Bioanalytical Chemistry examined the length of time Klonopin’s primary metabolite stays in the urine of 10 healthy volunteers who received a 3-milligram dose of clonazepam.
The results of the study showed that all participants produced a positive urine sample 14 days after last use. Eight volunteers had a positive sample 21 days after administration, and one person tested positive 28 days after ingestion.
In some cases, Klonopin can be eliminated from the system much sooner. A 2015 study published in the journal Therapeutic Drug Monitoring found that clonazepam and 7-aminoclonazepam were detectable in the oral fluid of detox patients with a history of heavy drug use for five to six days after administration.
Klonopin’s half-life — the amount of time it takes for the body to reduce the concentration of the drug in the blood by one half — ranges from 30 to 40 hours. This period is much a longer than the half-life of Xanax and some other benzodiazepines.
A long half-life means that clonazepam users are more likely to benefit from the effects of the medication for extended periods of time. Because the drug has a long half-life, withdrawal symptoms may not occur until several days after last use.
Mild withdrawal symptoms of Klonopin include rapid heart rate, increasing anxiety, sleeplessness and agitation.
When people abruptly quit clonazepam, they may experience other withdrawal symptoms, such as:
The serious withdrawal symptoms typically affect those who have been taking larger doses of Klonopin over a prolonged period. Acute withdrawal from benzodiazepines such as Klonopin can result in death. Withdrawal symptoms should be managed in a professional setting, such as a rehab facility, by a trained health care professional.
To treat Klonopin addiction, treatment specialists generally administer clonazepam one to three times per day, depending on the severity of the substance use disorder. Withdrawal symptoms are monitored during the first three days of treatment, and vital signs are observed every eight hours.
Low-risk clients can benefit from general treatment with a withdrawal program, while high-risk clients require constant monitoring at residential or outpatient treatment centers.
If the client is hospitalized, health care professionals should reduce the drug dosage by 10 percent each day. Outpatient clients should have their dose tapered by 10 percent every three to five days. Tapering may be slowed if the client develops insomnia or depression.
A 2015 report published in the journal Australian Prescriber found that gradually reducing benzodiazepine doses while receiving psychotherapy was more efficient than using dose reduction therapy alone.
However, the report referred to a Cochrane review that revealed only moderate evidence supporting the theory that joint cognitive behavioral therapy and drug tapering produced better results than those of tapering alone.
Some people need medication-assisted therapy to help them recover from clonazepam abuse. Doctors use a benzodiazepine substitution to prevent intoxication and withdrawal symptoms before tapering patients off the drug.
High-risk patients include:
While some people on medication-assisted therapy successfully manage to taper off the drug, others may need to be admitted to an inpatient treatment center that can address seizures and other serious medical problems associated with withdrawal.
Managing a clonazepam overdose requires emergency personnel. First responders can ensure that the patient’s airway is clear as they provide supportive treatment, including performing a stomach pump and administering intravenous fluids.
Similar to naloxone, a medication that reverses opioid overdose, flumazenil acts as a benzodiazepine overdose reverser. However, flumazenil should be used along with other forms of treatment when managing Klonopin overdose. After being treated with flumazenil, overdose victims should remain under medical watch for respiratory depression and residual effects from the overdose.
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