Clonazepam

Not to be confused with clozapine, clonazolam, or clorazolam.

Clonazepam
Clinical data
Pronunciationkləˈnazɪpam, kloe-NAZ-e-pam
Trade namesKlonopin, Rivotril, Paxam,[1] others[2]
AHFS/Drugs.comMonograph
MedlinePlusa682279
License data
Pregnancy
category
Dependence
liability		Physical: Very High Psychological: Moderate
Addiction
liability		Moderate[4][5]
Routes of
administration		By mouth, intramuscular, intravenous, sublingual
Drug classBenzodiazepine
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability90%
Protein binding≈85%
MetabolismLiver (CYP3A)[11]
Metabolites7-aminoclonazepam
7-acetaminoclonazepam
3-hydroxy clonazepam[7][8]
Onset of actionWithin an hour[9]
Elimination half-life19–60 hours[10]
Duration of action8–12 hours[9][1]
ExcretionKidney
Identifiers
  • 5-(2-Chlorophenyl)-7-nitro-1,3-dihydro-1,4-benzodiazepin-2-one
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.015.088 Edit this at Wikidata
Chemical and physical data
FormulaC15H10ClN3O3
Molar mass315.71 g·mol−1
3D model (JSmol)
  • O=C1CN=C(c2ccccc2Cl)c2cc([N+](=O)[O-])ccc2N1
  • InChI=1S/C15H10ClN3O3/c16-12-4-2-1-3-10(12)15-11-7-9(19(21)22)5-6-13(11)18-14(20)8-17-15/h1-7H,8H2,(H,18,20) checkY
  • Key:DGBIGWXXNGSACT-UHFFFAOYSA-N checkY
  (verify)

Clonazepam, sold under the brand name Klonopin among others, is a benzodiazepine medication used to prevent and treat anxiety disorders, seizures, bipolar mania, agitation associated with psychosis, obsessive–compulsive disorder (OCD), and akathisia.[11] It is a long-acting[12] tranquilizer of the benzodiazepine class.[11] It possesses anxiolytic, anticonvulsant, sedative, hypnotic, and skeletal muscle relaxant properties. It is typically taken orally (swallowed by mouth) but is also used intravenously.[11][13] Effects begin within one hour and last between eight and twelve hours in adults.[9][1]

Common side effects may include sleepiness, weakness, poor coordination, difficulty concentrating, and agitation. Clonazepam may also decrease memory formation.[11] Long-term use may result in tolerance, dependence, and life-threatening withdrawal symptoms if stopped abruptly.[11][14] Dependence occurs in one-third of people who take benzodiazepines for longer than four weeks.[10] The risk of suicide increases, particularly in people who are already depressed.[11][15] Use during pregnancy may result in harm to the fetus.[11] Clonazepam binds to GABAA receptors, thus increasing the effect of the chief inhibitory neurotransmitter γ-aminobutyric acid (GABA).[10]

Clonazepam was patented in 1960 and went on sale in 1975 in the United States from Roche.[16][17] It is available as a generic medication.[11] In 2022, it was the 57th most commonly prescribed medication in the United States, with more than 11 million prescriptions.[18][19] In many areas of the world, it is commonly used as a recreational drug.[20][21]

  1. ^ a b c "Paxam Data Sheet" (PDF). medsafe.govt.nz. 18 October 2023. Archived (PDF) from the original on 9 December 2023. Retrieved 14 March 2024.
  2. ^ "Clonazepam International". Drugs.com. Archived from the original on 25 August 2017.
  3. ^ "Clonazepam Use During Pregnancy". Drugs.com. 4 May 2020. Archived from the original on 28 July 2020. Retrieved 17 May 2020.
  4. ^ Longo LP, Johnson B (April 2000). "Addiction: Part I. Benzodiazepines--side effects, abuse risk and alternatives". American Family Physician. 61 (7): 2121–2128. PMID 10779253. Archived from the original on 12 May 2008. Retrieved 11 December 2022.
  5. ^ Hupp JR, Tucker MR, Ellis E (2013). Contemporary Oral and Maxillofacial Surgery - E-Book. Elsevier Health Sciences. p. 679. ISBN 9780323226875.
  6. ^ "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 October 2023.
  7. ^ Ebel S, Schütz H (February 1977). "[Studies on the detection of clonazepam and its main metabolites considering in particular thin-layer chromatography discrimination of nitrazepam and its major metabolic products (author's transl)]". Arzneimittel-Forschung. 27 (2): 325–337. PMID 577149.
  8. ^ Steentoft A, Linnet K (January 2009). "Blood concentrations of clonazepam and 7-aminoclonazepam in forensic cases in Denmark for the period 2002-2007". Forensic Science International. 184 (1–3): 74–79. doi:10.1016/j.forsciint.2008.12.004. PMID 19150586.
  9. ^ a b c Cooper G, ed. (2007). Therapeutic uses of botulinum toxin. Totowa, N.J.: Humana Press. p. 214. ISBN 9781597452472. Archived from the original on 19 August 2016.
  10. ^ a b c Riss J, Cloyd J, Gates J, Collins S (August 2008). "Benzodiazepines in epilepsy: pharmacology and pharmacokinetics". Acta Neurologica Scandinavica. 118 (2): 69–86. doi:10.1111/j.1600-0404.2008.01004.x. PMID 18384456. S2CID 24453988.
  11. ^ a b c d e f g h i "Clonazepam". The American Society of Health-System Pharmacists. Archived from the original on 5 September 2015. Retrieved 15 August 2015.
  12. ^ Basit H, Kahwaji CI (2024). "Clonazepam". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32310470. Retrieved 15 March 2024.
  13. ^ Koubeissi M (2016). "Intravenous Clonazepam in Status Epilepticus". Epilepsy Currents. 16 (2): 89–90. doi:10.5698/1535-7511-16.2.89. PMC 4822737. PMID 27073337.
  14. ^ Edinoff AN, Nix CA, Hollier J, Sagrera CE, Delacroix BM, Abubakar T, et al. (November 2021). "Benzodiazepines: Uses, Dangers, and Clinical Considerations". Neurology International. 13 (4): 594–607. doi:10.3390/neurolint13040059. PMC 8629021. PMID 34842811.
  15. ^ Cite error: The named reference Dodd2017 was invoked but never defined (see the help page).
  16. ^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 535. ISBN 9783527607495. Archived from the original on 14 January 2023. Retrieved 28 July 2020.
  17. ^ Shorter E (2005). "B". A Historical Dictionary of Psychiatry. Oxford University Press. ISBN 9780190292010. Archived from the original on 2 October 2015.
  18. ^ "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
  19. ^ "Clonazepam Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Archived from the original on 29 April 2017. Retrieved 30 August 2024.
  20. ^ Martino D, Cavanna AE, eds. (2013). Advances in the neurochemistry and neuropharmacology of Tourette Syndrome. Burlington: Elsevier Science. p. 357. ISBN 9780124115613. Archived from the original on 2 October 2015. In several countries, prescription and use is now severely limited due to abusive recreational use of clonazepam.
  21. ^ Fisher GL (2009). Encyclopedia of substance abuse prevention, treatment, & recovery. Los Angeles: SAGE. p. 100. ISBN 9781412950848. Archived from the original on 12 August 2016. frequently abused