Clonazepam Risks, Warnings, and Complications

LIFE-THREATENING BREATHING PROBLEMS: Clonazepam medication affects the central nervous system, and taking it can put you at risk of serious or life-threatening respiratory depression (breathing problems), sedation, or coma. This risk is especially high if clonazepam is used with certain other medications called sedative hypnotics (for example, cough formulations containing codeine or hydrocodone or pain medications such as morphine, codeine, fentanyl, meperidine, hydromorphone, methadone, oxycodone, and tramadol). 

Give your doctor a complete list of all your medications before starting clonazepam treatment. Seek immediate medical care if you develop signs and symptoms such as severe dizziness or lightheadedness, severe drowsiness, slowed or difficult breathing, or unresponsiveness. Your loved ones should know the signs to look out for so they can call your doctor or take you to the emergency room if breathing problems develop. 

IMPAIRED COGNITIVE PERFORMANCE: Clonazepam is a central nervous system (CNS) depressant and can cause drowsiness, dizziness, and slowed thinking. While on this medication, be careful during hazardous activities that require mental alertness, such as driving a motor vehicle or operating machinery. The risk of impaired cognitive performance is higher in people who drink alcohol or are on other CNS depressants. 

RISKS DURING PREGNANCY: The use of clonazepam during pregnancy can be harmful. Animal studies indicate this drug can cause congenital malformations such as cleft palate and limb defects. There are also concerns about the use of antiepileptic drugs in general by pregnant women. Medications used to treat epileptic seizures are linked to an increased incidence of birth defects in babies born to women who take these drugs while pregnant. While a direct cause and effect relationship has not been established and the majority of pregnant women who take anticonvulsant medication during pregnancy deliver normal infants, the possibility of birth defects exists. 

If you are pregnant, talk to your doctor about the benefits versus risks of taking clonazepam. Consult your healthcare provider before stopping your anticonvulsant drugs as doing so can lead to status epilepticus (prolonged seizure) with consequent hypoxia (decreased oxygen supply to the brain), which can be life-threatening. In addition, even mild seizures can cause harm to the fetus. Your doctor will carefully weigh the benefits versus risks of anticonvulsant therapy during pregnancy. You may be able to come off the medication if doing so does not pose a serious threat.

In addition to birth defects, there may also be non-teratogenic risks linked to benzodiazepine use during pregnancy. Babies born to mothers who took benzodiazepines while pregnant have been reported to have flaccidity (poor muscle tone), respiratory problems, feeding difficulties, and hypothermia (low body temperature). In addition, babies exposed to benzodiazepines during pregnancy can develop withdrawal effects after birth. 

Because of these risks associated with clonazepam use during pregnancy, it is rarely used for treating panic disorder in pregnant women who are in their first trimester. 

WITHDRAWAL SYMPTOMS: Stopping the use of benzodiazepines, including clonazepam, after taking high doses or taking them for a long time can result in withdrawal symptoms, such as sleep disturbances, irritability, increased anxiety, panic attacks, sweating, hand tremors, difficulty concentrating, nausea, weight loss, palpitations, headache, muscle pain, unusual movements or constant movement, ringing in the ears, convulsions, psychosis, and hallucinations. Your doctor will tell you how to reduce the dose gradually to prevent these benzodiazepine withdrawal symptoms.

CONTROLLED SUBSTANCE: Clonazepam is habit-forming and is a Schedule IV controlled substance. Misuse or abuse of this medication can lead to physical dependence as well as psychological dependence. Tell your doctor if you have a history of addiction (drug abuse or alcoholism). Your doctor will monitor you carefully while on clonazepam therapy. 

SUICIDAL THOUGHTS AND BEHAVIOR: Clonazepam has been linked to an increased risk of depression, suicidal thoughts, and behavior. Your family and friends should look out for any symptoms of new or worsening depression, changes in mood or behavior, or suicidal thinking.