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Clonazepam, sold under the brand Klonopin among others, is a medication used to prevent and treat seizures, panic disorder, and the movement disorder known as akathisia.[9] It is a tranquilizer of the benzodiazepine class.[9] It is taken by mouth.[9] Effects begin within one hour and last between six and twelve hours.[7]

Common side effects include sleepiness, poor coordination, and agitation.[9] Long-term use may result in tolerance, dependence, and withdrawal symptoms if stopped abruptly.[9] Dependence occurs in one-third of people who take clonazepam for longer than four weeks.[8] There is an increased risk of suicide, particularly in people who are already depressed.[9][10] If used during pregnancy it may result in harm to the fetus.[9] Clonazepam binds to GABAA receptors, thus increasing the effect of the chief inhibitory neurotransmitter γ-aminobutyric acid (GABA).[8]

Clonazepam was patented in 1960 and went on sale in 1975 in the United States from Roche.[11][12] It is available as a generic medication.[9] In 2018, it was the 47th most commonly prescribed medication in the United States, with more than 17 million prescriptions.[13][14] In many areas of the world it is commonly used as a recreational drug.[15][16]

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Clonazepam, like other benzodiazepines, while being a first-line treatment for acute seizures, is not suitable for the long-term treatment of seizures due to the development of tolerance to the anticonvulsant effects.

Clonazepam has been found effective in treating epilepsy in children, and the inhibition of seizure activity seemed to be achieved at low plasma levels of clonazepam.[20] As a result, clonazepam is sometimes used for certain rare childhood epilepsies; however, it has been found to be ineffective in the control of infantile spasms.[21] Clonazepam is mainly prescribed for the acute management of epilepsies. Clonazepam has been found to be effective in the acute control of non-convulsive status epilepticus; however, the benefits tended to be transient in many people, and the addition of phenytoin for lasting control was required in these patients.[22]

It is also approved for treatment of typical and atypical absences (seizures), infantile myoclonic, myoclonic, and akinetic seizures.[23] A subgroup of people with treatment resistant epilepsy may benefit from long-term use of clonazepam; the benzodiazepine clorazepate may be an alternative due to its slow onset of tolerance.[8][24]

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