Clonazepam interactions
Full monograph for ClonazepamCheck it against another medicine
Medicines
676 documented
| Medicine | Severity | Mechanism | Effect | Sources |
|---|---|---|---|---|
| Fentanyl Citrate | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Morphine Sulfate | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Nalbuphine Hydrochloride | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Olanzapine | Major | Synergy | The safety and efficacy of intramuscular olanzapine administered in combination with benzodiazepines have not been established. CNS- and/or… | 22 sources — open the full entry |
| Oxymorphone Hydrochloride | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Paracetamol + Tramadol Hydrochloride | Major | Synergy · Unknown | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics…2 documented mechanisms | 1 sources — open the full entry |
| Pentazocine | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Pethidine Hydrochloride | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Remifentanil Hydrochloride | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Tapentadol Hydrochloride | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Tramadol Hydrochloride | Major | Synergy | Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics… | 1 sources — open the full entry |
| Abametapir | Moderate | Metabolism | Based on in vitro inhibition data, a single topical application of abametapir lotion may increase plasma concentrations of drugs that are substrates of CYP450… | 1 sources — open the full entry |
| Acetazolamide | Moderate | Antagonism | Benzodiazepines may counteract the beneficial effects of acetazolamide in preventing altitude sickness by inhibiting respiratory responses to hypoxia. | 8 sources — open the full entry |
| Adalimumab | Moderate | Metabolism | Plasma concentrations of drugs that are CYP450 substrates may decrease following the initiation of interleukin (IL) inhibitors, tumor necrosis factor (TNF)… | 19 sources — open the full entry |
| Alfuzosin Hydrochloride | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Amitriptyline Hydrochloride | Moderate | Synergy | Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking clonazepam and tricyclic… | 1 sources — open the full entry |
| Amitriptyline Hydrochloride + Chlordiazepoxide | Moderate | Synergy | Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking clonazepam and tricyclic…2 documented mechanisms | 45 sources — open the full entry |
| Amlodipine Besilate + Atenolol | Moderate | Synergy · Unknown | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
| Amlodipine Besilate + Benazepril Hydrochloride | Moderate | Synergy · Unknown | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
| Amlodipine Besilate + Olmesartan Medoxomil | Moderate | Synergy · Unknown | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
| Amlodipine Besilate + Telmisartan | Moderate | Synergy · Unknown | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
| Apalutamide | Moderate | Absorption · Metabolism | Coadministration with apalutamide may decrease the plasma concentrations and therapeutic effects of drugs that are substrates of CYP450 3A4, 2C9, 2C19, breast… | 5 sources — open the full entry |
| Aprepitant | Moderate | Metabolism | Coadministration with aprepitant or its prodrug, fosaprepitant, may increase the plasma concentrations of benzodiazepines that are metabolized by CYP450 3A4… | 4 sources — open the full entry |
| Aripiprazole | Moderate | Synergy | Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these… | 44 sources — open the full entry |
| Articaine Hydrochloride + Epinephrine Bitartrate | Moderate | Synergy · Unknown | The concomitant use of local anesthetics and benzodiazepines may have additive CNS-depressant effects. Both types of drugs are CNS depressants.3 documented mechanisms | 10 sources — open the full entry |
| Asciminib | Moderate | Metabolism | Coadministration with asciminib may increase the plasma concentrations of drugs that are primarily metabolized by the CYP450 3A4 isoenzyme. The mechanism is… | 1 sources — open the full entry |
| Asenapine Maleate | Moderate | Synergy | Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these… | 44 sources — open the full entry |
| Atenolol | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Atenolol + Chlorthalidone | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
| Atracurium Besilate | Moderate | Others | Benzodiazepines may have variable effects on nondepolarizing muscle relaxants. Potentiation, attenuation, and no effect have all been reported. | 9 sources — open the full entry |
| Azilsartan Medoxomil | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 18 sources — open the full entry |
| Azilsartan Medoxomil + Chlorthalidone | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…3 documented mechanisms | 18 sources — open the full entry |
| Baclofen | Moderate | Synergy | Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these… | 44 sources — open the full entry |
| Beclomethasone Dipropionate + Chloramphenicol + Clotrimazole + Lidocaine | Moderate | Synergy · Unknown | The concomitant use of local anesthetics and benzodiazepines may have additive CNS-depressant effects. Both types of drugs are CNS depressants.2 documented mechanisms | 7 sources — open the full entry |
| Benzocaine + Butamben + Tetracaine Hydrochloride | Moderate | Synergy | The concomitant use of local anesthetics and benzodiazepines may have additive CNS-depressant effects. Both types of drugs are CNS depressants. | 7 sources — open the full entry |
| Betamethasone + Phenylephrine + Lignocaine | Moderate | Synergy | The concomitant use of local anesthetics and benzodiazepines may have additive CNS-depressant effects. Both types of drugs are CNS depressants. | 7 sources — open the full entry |
| Betaxolol Hydrochloride | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Bimatoprost + Timolol | Moderate | Synergy · Unknown | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
| Bisoprolol Fumarate | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Bisoprolol Fumarate + Amlodipine Besilate | Moderate | Synergy · Unknown | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
| Bisoprolol Fumarate + Hydrochlorothiazide | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
| Bosentan Monohydrate | Moderate | Metabolism | Coadministration with bosentan may decrease the plasma concentrations of drugs that are substrates of the CYP450 2C9 and/or 3A4 isoenzymes. The mechanism is… | 5 sources — open the full entry |
| Brexpiprazole | Moderate | Synergy | Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these… | 44 sources — open the full entry |
| Brigatinib | Moderate | Metabolism | Coadministration with brigatinib may decrease the plasma concentrations of drugs that are substrates of the CYP450 3A4 isoenzyme. Brigatinib has been shown in… | 6 sources — open the full entry |
| Brimonidine Tartrate + Timolol Maleate | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Brinzolamide + Timolol | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Brivaracetam | Moderate | Synergy | Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these… | 44 sources — open the full entry |
| Bromocriptine Mesylate | Moderate | Synergy | Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these… | 44 sources — open the full entry |
| Bumetanide | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Bupivacaine Hydrochloride | Moderate | Synergy | The concomitant use of local anesthetics and benzodiazepines may have additive CNS-depressant effects. Both types of drugs are CNS depressants. | 7 sources — open the full entry |
Food & lifestyle
alcohol
ModerateMetabolism
Acute ethanol ingestion may potentiate the CNS effects of many benzodiazepines. Tolerance may develop with chronic ethanol use. The mechanism may be decreased clearance of the benzodiazepines because of CYP450 hepatic enzyme inhibition.
What to do: Patients should be advised to avoid alcohol during benzodiazepine therapy.
7 sources
- MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM "Diazepam actions and plasma concentrations following ethanol ingestion." Eur J Clin Pharmacol 11 (1977): 345-9
- Whiting B, Lawrence JR, Skellern GG, Meier J "Effect of acute alcohol intoxication on the metabolism and plasma kinetics of chlordiazepoxide." Br J Clin Pharmacol 7 (1979): 95-100
- Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
- Juhl RP, Van Thiel DH, Dittert LW, Smith RB "Alprazolam pharmacokinetics in alcoholic liver disease." J Clin Pharmacol 24 (1984): 113-9
- Ochs HR, Greenblatt DJ, Arendt RM, Hubbel W, Shader RI "Pharmacokinetic noninteraction of triazolam and ethanol." J Clin Psychopharmacol 4 (1984): 106-7
- Staak M, Raff G, Nusser W "Pharmacopsychological investigations concerning the combined effects of dipotassium clorazepate and ethanol." Int J Clin Pharmacol Biopharm 17 (1979): 205-12
- Nichols JM, Martin F, Kirkby KC "A comparison of the effect of lorazepam on memory in heavy and low social drinkers." Psychopharmacology (Berl) 112 (1993): 475-82
Conditions
Conditions in which Clonazepam needs care, as documented in this source.
Alcoholic Intoxication
MajorThe use of benzodiazepines with alcohol is not recommended. Patients with acute alcohol intoxication exhibit depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol, and severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.
14 sources
- "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
- "Product Information. Valium (diazepam)." Roche Laboratories (2002):
- "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
- "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
- "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
- "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
- "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
- "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
Show all 14 sourcesShow fewer sources
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
- "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
- "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
- "Product Information. Versed (midazolam)." Roche Laboratories (2001):
- "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
Glaucoma, Angle-Closure
MajorThe manufacturers consider the use of benzodiazepines to be contraindicated in patients with acute angle-closure glaucoma or untreated open-angle glaucoma. These agents do not possess anticholinergic activity but have very rarely been associated with increased intraocular pressure.
14 sources
- "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
- "Product Information. Valium (diazepam)." Roche Laboratories (2002):
- "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
- "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
- "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
- "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
- "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
- "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
Show all 14 sourcesShow fewer sources
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
- "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
- "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
- "Product Information. Versed (midazolam)." Roche Laboratories (2001):
- Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects" Boston, MA: Butterworth-Heinemann (2001):
Liver Diseases
MajorThe use of clonazepam is considered by the manufacturer to be contraindicated in patients with clinical or biochemical evidence of significant liver disease. Clonazepam is primarily metabolized by the liver, and the metabolites are eliminated by the kidney. Due to the possibility of excess accumulation of metabolites and the unknown effects of such accumulation, therapy with clonazepam should also be administered cautiously in patients with renal impairment.
1 source
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
Respiratory Insufficiency
MajorBenzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.
31 sources
- Iber FL, Livak A, Kruss DM "Apnea and cardiopulmonary arrest during and after endoscopy." J Clin Gastroenterol 14 (1992): 109-13
- Cohen S, Khan A "Respiratory distress with use of lorazepam in mania." J Clin Psychopharmacol 7 (1987): 199-200
- Donaldson D, Gibson G "System complications with intravenous diazepam." Oral Surg Oral Med Oral Patho 49 (1980): 126-30
- Eldridge PR, Punt JA "Risks associated with giving benzodiazepines to patients with acute neurological injuries." Br Med J 300 (1990): 1189-90
- Man GC, Hsu K, Sproule BJ "Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease." Chest 90 (1986): 832-6
- Mendelson WB, Weingartner H, Greenblatt DJ, Garnett D, Gillin JC "A clinical study of flurazepam." Sleep 5 (1982): 350-60
- "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
- "Product Information. Valium (diazepam)." Roche Laboratories (2002):
Show all 31 sourcesShow fewer sources
- "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
- "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
- "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
- Pierce MW, Shu VS, Groves LJ "Safety of estazolam. The United States clinical experience." Am J Med 88 (1990): s12-7
- Skatrud JB, Badr S, Begle RL, Juan D "Ventilatory response to single, high dose estazolam in healthy humans." J Clin Pharmacol 30 (1990): 543-8
- Sullivan RJ, Jr "Respiratory depression requiring ventilatory support following 0.5 mg of triazolam." J Am Geriatr Soc 37 (1989): 450-2
- "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
- "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
- Model DG, Berry DJ "Effects of chlordiazepoxide in respiratory failure due to chronic bronchitis." Lancet 2 (1974): 869-70
- Dixon D "Respiratory depression following midazolam." Anaesthesia 40 (1985): 922
- Yakel DL, Jr Whittaker SE, Elstad MR "Midazolam-induced angioedema and bronchoconstriction." Crit Care Med 20 (1992): 307-8
- Berggren L, Eriksson I, Mollenholt P, Sunzel M "Changes in respiratory pattern after repeated doses of diazepam and midazolam in healthy subjects." Acta Anaesthesiol Scand 31 (1987): 667-72
- Taylor JW, Simon KB "Possible intramuscular midazolam-associated cardiorespiratory arrest and death." DICP 24 (1990): 695-7
- Munoz HR, Dagnino JA, Rufs JA, Bugedo GJ "Benzodiazepine premedication causes hypoxemia during spinal anesthesia in geriatric patients." Reg Anesth 17 (1992): 139-42
- "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
- "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
- Murphy PJ, Erskine R, Langton JA "The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes." Anaesthesia 49 (1994): 105-10
- "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
- "Product Information. Versed (midazolam)." Roche Laboratories (2001):
- Berry RB, Kouchi K, Bower J, Prosise G, Light RW "Triazolam in patients with obstructive sleep apnea." Am J Respir Crit Care Med 151 (1995): 450-4
- "Product Information. Byfavo (remimazolam)." Acacia Pharma, Inc (2020):
Seizures
MajorThe use of benzodiazepines in patients with seizure disorders may increase the incidence or precipitate the onset of generalized tonic-clonic seizures (grand mal). Appropriate anticonvulsant medication might need to be initiated or the dosage increased. Abrupt cessation of benzodiazepine therapy may precipitate seizures and other withdrawal symptoms, particularly after prolonged use and/or excessive dosages. Status epilepticus may occur in patients with a history of seizures withdrawn rapidly from benzodiazepine therapy. Following chronic administration, cessation of benzodiazepine therapy should occur gradually with incrementally reduced dosages. Patients should be advised not to discontinue medication without first consulting with the physician.
35 sources
- Ananth J "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 592
- Wilbur R, Kulik AV "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 298-300
- Busto U, Sellers EM, Naranjo CA, et al. "Withdrawal reaction after long-term therapeutic use of benzodiazepines." N Engl J Med 315 (1986): 854-9
- Hersch EL, Billings RF "Acute confusional state with status petit mal as a withdrawal syndrome: and five year follow-up." Can J Psychiatry 33 (1988): 157-9
- Howe JG "Lorazepam withdrawal seizures." Br Med J 280 (1980): 1163-4
- Kales A, Bixler EO, Soldatos CR, Jacoby JA, Kales JD "Lorazepam: effects on sleep and withdrawal phenomena." Pharmacology 32 (1986): 121-30
- Robinson GM, Sellers EM "Diazepam withdrawal seizures." Can Med Assoc J 126 (1982): 944-5
- Browne JL, Hauge KJ "A review of alprazolam withdrawal." Drug Intell Clin Pharm 20 (1986): 837-41
Show all 35 sourcesShow fewer sources
- Ghadirian AM, Gauthier S, Wong T "Convulsions in patients abruptly withdrawn from clonazepam while receiving neuroleptic medication ." Am J Psychiatry 144 (1987): 686
- Hauser P, Devinsky O, De Bellis M, Theodore WH, Post RM "Benzodiazepine withdrawal delirium with catatonic features. Occurrence in patients with partial seizure disorders." Arch Neurol 46 (1989): 696-9
- Specht U, Boenigk HE, Wolf P "Discontinuation of clonazepam after long-term treatment." Epilepsia 30 (1989): 458-63
- Alvarez N, Hartford E, Doubt C "Epileptic seizures induced by clonazepam." Clin Electroencephalogr 12 (1981): 57-65
- Berlin RM, Conell LJ "Withdrawal symptoms after long-term treatment with therapeutic doses of flurazepam: a case report." Am J Psychiatry 140 (1983): 488-90
- Bond WS, Schwartz M "Withdrawal reactions after long-term treatment with flurazepam." Clin Pharm 3 (1984): 316-8
- "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
- "Product Information. Valium (diazepam)." Roche Laboratories (2002):
- "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
- "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
- "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
- Tien AY, Gujavarty KS "Seizure following withdrawal from triazolam." Am J Psychiatry 142 (1985): 1516-7
- Patterson WM "Triazolam withdrawal." J Clin Psychiatry 49 (1988): 369
- Schneider LS, Syapin PJ, Pawluczyk S "Seizures following triazolam withdrawal despite benzodiazepine treatment." J Clin Psychiatry 48 (1987): 418-9
- "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
- "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
- Ryan GP, Boisse NR "Experimental induction of benzodiazepine tolerance and physical dependence." J Pharmacol Exp Ther 226 (1983): 100-7
- Petursson H, Lader MH "Benzodiazepine dependence." Br J Addict 76 (1981): 133-45
- Finley PR, Nolan PE, Jr "Precipitation of benzodiazepine withdrawal following sudden discontinuation of midazolam." DICP 23 (1989): 151-2
- "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
- "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
- Roy-Byrne PP, Sullivan MD, Cowley DS, Ries RK "Adjunctive treatment of benzodiazepine discontinuation syndromes - a review." J Psychiatr Res 27 Suppl (1993): 143-53
- "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
- "Product Information. Versed (midazolam)." Roche Laboratories (2001):
- Frattola L, Garreau M, Piolti R, Bassi S, Albizzati MG, Borghi C, Morselli PL "Comparison of the efficacy, safety and withdrawal of alpidem and alprazolam in anxious patients." Br J Psychiatry 165 (1994): 94-100
Substance-Related Disorders
MajorBenzodiazepines have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use and/or excessive dosages. However, abrupt cessation following continual use of as few as 6 weeks at therapeutic levels has occasionally precipitated withdrawal symptoms. Addiction- prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance when treated with benzodiazepines. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of benzodiazepine therapy should be undertaken gradually using a dosage- tapering schedule. If withdrawal symptoms occur, temporary reinstitution of benzodiazepines may be necessary.
14 sources
- "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
- "Product Information. Valium (diazepam)." Roche Laboratories (2002):
- "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
- "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
- "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
- "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
- "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
- "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
Show all 14 sourcesShow fewer sources
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
- "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
- "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
- "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
- "Product Information. Byfavo (remimazolam)." Acacia Pharma, Inc (2020):
Depressive Disorder
ModerateAntiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.
16 sources
- "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals (2002):
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Dilantin (phenytoin)." Parke-Davis (2001):
- "Product Information. Cerebyx (fosphenytoin)." Parke-Davis (2001):
- "Product Information. Mysoline (primidone)." Elan Pharmaceuticals (2001):
- "Product Information. Lyrica (pregabalin)." Pfizer U.S. Pharmaceuticals Group (2005):
- "Product Information. Sabril (vigabatrin)." Lundbeck Inc (2009):
- "Product Information. Potiga (ezogabine)." GlaxoSmithKline (2011):
Show all 16 sourcesShow fewer sources
- "Product Information. Qsymia (phentermine-topiramate)." Vivus Inc (2012):
- "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
- "Product Information. Briviact (brivaracetam)." UCB Pharma Inc (2016):
- "Product Information. Diacomit (stiripentol)." Biocodex USA (2018):
- "Product Information. Epidiolex (cannabidiol)." Greenwich Biosciences LLC (2018):
- "Product Information. Xcopri (cenobamate)." SK Life Science, Inc. (2020):
- "Product Information. Fintepla (fenfluramine)." Zogenix, Inc (2020):
- "Product Information. Ztalmy (ganaxolone)." Marinus Pharmaceuticals, Inc (2022):
Depressive Disorder
ModerateBenzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.
13 sources
- "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
- "Product Information. Valium (diazepam)." Roche Laboratories (2002):
- "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
- "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
- "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
- "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
- "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
- "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
Show all 13 sourcesShow fewer sources
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
- "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
- "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
- "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
Obesity
ModerateThe plasma half-lives of benzodiazepines may be prolonged in obese patients, presumably due to increased distribution into fat. Marked increases in distribution (> 100%) have been reported for diazepam and midazolam, and moderate increases (25% to 100%) for alprazolam, lorazepam, and oxazepam. Therapy with benzodiazepines should be administered cautiously in obese patients, with careful monitoring of CNS status. Longer dosing intervals may be appropriate. When dosing by weight, loading doses should be based on actual body weight, while maintenance dose should be based on ideal body weight to avoid toxicity.
14 sources
- "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
- "Product Information. Valium (diazepam)." Roche Laboratories (2002):
- "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
- "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
- "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
- "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
- "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
- "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
Show all 14 sourcesShow fewer sources
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
- "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
- "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
- "Product Information. Versed (midazolam)." Roche Laboratories (2001):
- American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
Psychotic Disorders
ModerateParadoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.
35 sources
- French AP "Dangerously aggressive behavior as a side effect of alprazolam." Am J Psychiatry 146 (1989): 276
- Goodman WK, Charney DS "A case of alprazolam, but not lorazepam, inducing manic symptoms." J Clin Psychiatry 48 (1987): 117-8
- Edwards JG, Inman WH, Pearce GL, Rawson NS "Prescription-event monitoring of 10,895 patients treated with alprazolam." Br J Psychiatry 158 (1991): 387-92
- Wysowski DK, Barash D "Adverse behavioral reactions attributed to triazolam in the Food and Drug Administration's Spontaneous Reporting System." Arch Intern Med 151 (1991): 2003-8
- Bixler EO, Kales A, Brubaker BH, Kales JD "Adverse reactions to benzodiazepine hypnotics: spontaneous reporting system." Pharmacology 35 (1987): 286-300
- Cohen LS, Rosenbaum JF "Clonazepam: new uses and potential problems." J Clin Psychiatry 48 (1987): 50-6
- White MC, Silverman JJ, Harbison JW "Psychosis associated with clonazepam therapy for blepharospasm." J Nerv Ment Dis 170 (1982): 117-9
- Dorevitch A "Mania associated with clonazepam." DICP 25 (1991): 938-9
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- Marchevsky S, Isaacs G, Nitzan I "Behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 10 (1988): 447
- Binder RL "Three case reports of behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 9 (1987): 151-3
- Koczerginski D, Kennedy SH, Swinson RP "Clonazepam and lithium--a toxic combination in the treatment of mania?" Int Clin Psychopharmacol 4 (1989): 195-9
- Fava M, Borofsky GF "Sexual disinhibition during treatment with a benzodiazepine: a case report." Int J Psychiatry Med 21 (1991): 99-104
- Cunningham TA "Letter: Adverse reaction to flurazepam." Can Med Assoc J 112 (1975): 805
- Pollack MH "Clonazepam: a review of open clinical trials." J Clin Psychiatry 48 (1987): 12-5
- "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
- "Product Information. Valium (diazepam)." Roche Laboratories (2002):
- "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
- "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
- "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
- Karch FE "Rage reaction associated with clorazepate dipotassium." Ann Intern Med 91 (1979): 61-2
- Weilburg JB, Sachs G, Falk WE "Triazolam-induced brief episodes of secondary mania in a depressed patient." J Clin Psychiatry 48 (1987): 492-3
- Rothschild AJ "Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature." J Clin Psychiatry 53 (1992): 69-79
- Schogt B, Conn D "Paranoid symptoms associated with triazolam." Can J Psychiatry 30 (1985): 462-3
- "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
- "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
- Viscott DS "Chlordiazepoxide and hallucinations. Report of cases." Arch Gen Psychiatry 19 (1968): 370-6
- Fiset L, Milgrom P, Beirne OR, Roy-Byrne P "Disinhibition of behaviors with midazolam: report of a case." J Oral Maxillofac Surg 50 (1992): 645-9
- Lobo BL, Miwa LJ "Midazolam disinhibition reaction." Drug Intell Clin Pharm 22 (1988): 725
- "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
- "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
- "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
- "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
- Rush CR, Higgins ST, Hughes JR, Bickel WK "A comparison of the acute behavioral effects of triazolam and temazepam in normal volunteers." Psychopharmacology (Berl) 112 (1993): 407-14
- "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
- "Product Information. Versed (midazolam)." Roche Laboratories (2001):
Therapeutic duplication
Drug classes that overlap with Clonazepam, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.
benzodiazepines
The recommended maximum number of medicines in the 'benzodiazepines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'benzodiazepines' category.
Example product in the source data (US market): Librax
benzodiazepines
The recommended maximum number of medicines in the 'benzodiazepines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'benzodiazepines' category.
Example product in the source data (US market): Limbitrol ds
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Phrenilin with caffeine and codeine
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Phrenilin
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Butabarbital/hyoscyamine/phenazopyridine
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Aspirin/butalbital/caffeine/codeine
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Micrainin
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Nodolor
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Laniroif
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Phenohytro
tranquilizers
The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'tranquilizers' category.
Example product in the source data (US market): Nonbac