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Indications

Clonazepam is a long-acting and high-potency benzodiazepine. It behaves as a GABA-A receptor agonist. It also has serotonergic activity by increasing serotonin synthesis.[1] Clonazepam has anticonvulsant and anxiolytic effects; it is FDA-approved for treating seizure and panic disorders.[2][3] Clonazepam also has off-label use as monotherapy or adjunctive therapy to treat mania, restless leg syndrome, insomnia, tardive dyskinesia, and REM sleep behavior disorder.[4][5][6]

Seizure Disorders

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Clonazepam has a broad range of activities against different types of seizure disorders. The drug’s primary indications are acute management of epilepsy and acute treatment of non-convulsive status epilepticus (complex partial seizures or absence seizures), and it is also very effective in controlling the minor motor seizures of childhood, particularly petit mal absences, Lennox-Gastaut syndrome, and infantile spasms.[7] Clonazepam is also useful in treating psychomotor, myoclonic epilepsies, grand mal, and focal motor seizures. However, it is not used as first-line therapy for these conditions. The medication can be used in patients resistant to standard treatment.

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Panic Disorder

Clonazepam causes a significant improvement in patients who have panic disorders with or without agoraphobia. Clonazepam is efficacious in the short-term management of panic disorder due to the risk of developing withdrawal symptoms and abuse. However, this drug is also less likely to cause rebound anxiety upon cessation than other benzodiazepines because of its longer half-life. Clinicians also use it for the acute treatment of panic attacks.[8]

Acute Mania

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Clonazepam has anticonvulsant and serotonin agonist activity, both of which are associated with its antimanic effect. Therefore, it is sometimes helpful for the treatment of acute mania. The research found it to be significantly more effective than lithium in reducing manic symptoms; fewer patients required PRN administration of haloperidol, and the number of days on which haloperidol was needed was lower during clonazepam treatment. In this way, clonazepam reduces the need for antipsychotic drugs to treat acute mania and decreases the risk of side effects in these patients.[3] A combination of benzodiazepine and the antipsychotic haloperidol is considered the most effective treatment of acute agitation in the emergency department.[9]

Miscellaneous Uses

Clonazepam is also an option for treating akathisia, restless leg syndrome, and bruxism.[10][11][12] American Academy of Sleep Medicine (AASM) suggests using clonazepam for REM sleep behavior disorder (RBD).[13] Topical clonazepam is also being investigated for burning mouth syndrome.[14][15]

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