Clonazepam is a benzodiazepine that is principally used to prevent seizures and to treat panic attacks and other anxiety disorders. It is marketed by the Swiss pharmaceutical company Roche under a number of brand names, and best known as Klonopin in the United States. It was first approved by the Food and Drug Administration in 1975 for the treatment of epileptic and other seizures (Browne, 1976), and later for panic disorder. Clonazepam and similar benzodiazepines are popular and frequently prescribed because of their rapid onset, effectiveness, few harmful interactions with other medications, and low toxicity, reducing the chance of harmful overdose (Riss, Cloyd, Gate, & Collins, 2008). Nonetheless, benzodiazepines can have serious side effects and cause dependency, and Klonopin is one of the most dangerous and frequently prescribed medications in this category in America (Byron, 2011).
Like other benzodiazepines, clonazepam acts by stimulating a natural brain chemical, the neurotransmitter GABA (gamma-aminobutyric acid) (Ashton, 2002). GABA has an inhibitory effect in the brain, telling neurons to slow down or stop functioning entirely, with the result being an overall quieting influence on the brain. This sedating action is heightened by benzodiazepines, exerting an extra inhibitory effect on the brain (Ashton, 2012). As Riss, Cloyd, Gate, & Collins (2008) stress, “Benzodiazepines do not substitute for GABA, but instead enhance the inhibitory effects of GABA” by interacting with GABA receptors in the brain (p. 70). Because of GABA’s inhibitory effect on neurons, the brain’s production of other, excitatory neurotransmitters, such as norepinephrine, serotonin, and dopamine, is reduced. As these neurotransmitters are responsible for many stimulating functions, such as alertness, coordination, and emotional response, these are all impaired by benzodiazepines. This impairment results in the common adverse effects of clonazepam and other benzodiazepines.
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Common side effects include drowsiness, confusion, and loss of motor skills, and, for this reason, it is advised that a person taking clonazepam not drive, operate machinery, or engage in other dangerous activities until the full effects of the drug on that individual are known (Genentech, 2013). Clonazepam can cause suicidal ideation in rare cases and, in pregnant women, be harmful to an unborn or developing baby (U.S. Food and Drug Administration, 2009). The medication may also, in rare cases, have paradoxical effects, worsening conditions that it is intended to treat, such as anxiety and depression. When a person develops a tolerance and becomes dependent on the medication – which can occur in as little as four weeks (Riss, Cloyd, Gate, & Collins, 2008) – serious withdrawal effects may manifest, including seizures, hallucinations, stomach cramps, nausea, sleep disturbances, and anxiety attacks (Ashton, 1991). These are often collectively referred to as “benzodiazepine withdrawal syndrome.”
Because benzodiazepines can be habit-forming and have some potential for abuse, they are a Schedule IV controlled substance under the U.S. Controlled Substances Act. While schedule IV substances have an accepted use in medical treatment and thus can be legally prescribed without severe restrictions, some types of medical insurance do not cover clonazepam, either in the form of Klonopin or its generic equivalent. In 2006 Medicare and Medicaid ceased coverage for benzodiazepines, including clonazepam, but this coverage was reinstated in 2013 (Settlement Solutions, 2012).
Medicare Part D, or the Medicare prescription drug benefit, is a federal program which subsidizes the costs of prescription drugs and prescription drugs for beneficiaries of Medicare and Medicaid. Because “Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary)” and “Many Medicare drug plans place drugs into different ‘tiers’ on their formularies,” it is possible that some Medicare-sponsored prescription drug plans will not cover clonazepam, or will assign it a higher cost to the recipient (Centers for Medicare & Medicaid Services, n.d.). Most private health insurance will cover clonazepam and other benzodiazepines through a default or supplemental drug plan.
- Ashton, C. H. (1991) Protracted withdrawal syndromes from benzodiazepines. Journal of Substance Abuse Treatment, 8,19-28.
- —. (2002). Benzodiazepines: How they work and how to withdraw. Benzo.org. Retrieved from http://www.benzo.org.uk/manual/index.htm
- Browne, T. R. (1976). Clonazepam: A review of a new anticonvulsant drug. Archives of Neurology, 33(5), 326-332. doi:10.1001/archneur.1976.00500050012003
- Byron, C. (2011). America’s most dangerous pill? Alternet. Retrieved from http://www.alternet.org/story/151166/america%27s_most_dangerous_pill
- Centers for Medicare & Medicaid Services. (n.d.). What drug plans cover. Medicare.gov. Retrieved from http://www.medicare.gov/part-d/coverage/part-d-coverage.html
- Genentech. (2013). Medication guide: Klonopin. San Francisco, CA: Genentech. Retrieved from http://www.gene.com
- Riss, J., Cloyd, J., Gate S. J., & Collins, S. (2008). Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics. Acta Neurologica Scandinavica, 118, 69 –86. doi:10.1 111/j.1600-0404.20 08.01004.x
- Settlement Solutions. (2012, Aug. 27). Medicare to expand Part D coverage for barbiturates and benzodiazepines. MedicareInsights.com. Retrieved from http://medicareinsights.com/2012/08/27/medicare-to-expand-part-d-coverage-for-barbiturates-and-benzodiazepines/
- U.S. Food and Drug Administration. (2009). Klonopin (clonazepam) tablets and Klonopin (clonazepam) orally disintegrating. Retrieved from http://www.fda.gov/Safety/MedWatch/SafetyInformation/Safety-RelatedDrugLabelingChanges/ucm154476.htm
