Medication Profile - Clonazepam (Klonopin) Off-Label Use for Migraine

Nancy Harris Bonk Health Guide
  • Clonazepam (Klonopin) is classified in a group of medications called benzodiazepines. It controls the chemicals in the brain that may become disturbed and set off anxiety. It's also used to treat seizure disorders, panic disorders and other conditions as determined by your doctor. It is also prescribed off-label as a Migraine and headache preventive.
     

     

    Precautions:

    • Do not use this medication if you suffer from severe liver problems.
    • If you are allergic to clonazepam or other benzodiazepines including Xanax, Librium, Tranxene, Valium, Ativan and Serax, do not use this medication.
    • For patients over 60 years of age, the sedation effects may last longer. Care needs to be used when taking clonazepam to prevent falling or unintended injury because these are common in older patients who take this medication.
    • Use this medication as it is prescribed by your doctor. Your doctor may make changes in your dose to get the desired results. Follow the directions on the label of the prescription bottle, being sure to take no more or less than prescribed.
    • Clonazepam can become habit forming and should only be taken for a short time. Do not share clonazepam with anyone, especially people who have or have had a problem with drug abuse and/or addiction. 
    • Because alcohol can intensify certain effects of clonazepam, do not drink alcohol while taking this medication.
    • While taking clonazepam, you will need to see your doctor on a regular basis. The doctor may do blood work to check if there are any harmful effects while taking this medication and to ensure your liver is functioning properly.
    • Clonazepam can reduce your reaction time and reasoning. Use extra care and caution when operating machinery, driving or doing anything that needs you to be alert.
    • Do not stop taking clonazepam suddenly.

    Pregnancy and Breastfeeding:

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    • FDA Pregnancy Category D. Clonazepam may affect a fetus negatively and newborns may have breathing and/or feeding problems after birth. Seizure activity during pregnancy can be harmful to both the baby and mother, so it is imperative to have a conversation with your doctor if you become pregnant or plan on becoming pregnant. It is advised not to start or stop this medication while pregnant without medical attention.
    • There is a pregnancy registry and if you take this medication and are pregnant, your name may go on it.  This is for tracking the pregnancy and see what effects this medication has on babies.
    • Mothers should not breast-feed while taking clonazepam because this medication may pass in breast milk.

    Other medical conditions:


    Be sure to let your doctor know of other medical problems you may have, including:

    • addiction to drugs and/or alcohol; hypersensitivity to drugs
    • any breathing issues
    • asthma
    • bronchitis
    • COPD (chronic obstructive pulmonary disorder)
    • depression
    • disabled or elderly
    • glaucoma
    • history of seizure
    • kidney disease
    • liver disease
    • porphyria
    • sleep apnea
    • thoughts of suicide

    Other medications:


    Make sure your doctor knows about ALL the medications you take. The following medications are contraindicated (should not be taken) when taking clonazepam:

    • sodium oxybate

    The following medications should be avoided when taking clonazepam:

    • boceprevir
    • chloramphenicol
    • cimetidine
    • clarithromycins
    • conivaptan
    • cyclosporine
    • delavirdine
    • HIV protease inhibitors
    • imatinib
    • itraconazole
    • ketoconazole
    • nefazodone
    • posaconazole
    • telaprevir
    • telithromycin
    • valproic acid derivatives
    • voriconazole

    Medications that need to be monitored closely while taking clonazepam include:

    • aripiprazole
    • dexmedetomidine
    • propofol

    Please use caution when taking clonazepam and the following medications:

    • acetaminophen combinations
    • aldesleukin
    • amiodarone
    • antihistamine/ decongestant combinations
    • antihistamines, sedating
    • apomorphine
    • aprepitant
    • artemether/ lumefantrine
    • asenapine
    • aspirin combinations
    • azelastine nasal
    • barbiturates
    • benzodiazepines, all
    • bexarotene
    • bosentan
    • brompheniramine/ dextromethorphan/ phenylephrine
    • brompheniramine/ dextromethorphan/ pseudoephedrine
    • butalbital/ acetaminophen
    • calcium channel blockers, others
    • calendula
    • cannabinoids
    • capsicum
    • carbamazepine
    • carisoprodol/ aspirin
    • central alpha 2 agonists
    • cetirizine
    • cetirizine/pseudoephedrine
    • chamomile, German
    • chlorpheniramine/ dextromethorphan
    • chlorpheniramine/ dextromethorphan/ pseudoephedrine
    • chlorpheniramine/ hydrocodone
    • clozapine
    • CNS depressant/ aspirin/ caffeine combinations
    • danazol
    • dantrolene
    • dexamethasone
    • doxylamine/ dextromethorphan
    • dronedarone
    • droperidol
    • efavirenz
    • efavirenz/ emtricitabine/ tenofovir disoproxil
    • erythromycins
    • ethanol
    • ethosuximide
    • etomidate
    • ezogabine
    • fluconazole
    • fluvoxamine
    • gabapentin
    • ginseng, Siberian
    • goldenseal
    • gotu kola
    • grapefruit
    • green tea
    • guarana
    • haloperidol
    • hawthorn
    • hydrocodone/ chlorpheniramine/ pseudoephedrine
    • hydrocodone/ ibuprofen
    • hydrocodone/ pseudoephedrine
    • iloperidone
    • inhaled anesthetics
    • kava
    • ketamine
    • lemon balm
    • levocetirizine
    • loxapine
    • lurasidone
    • maprotiline
    • meprobamate
    • methadone
    • metoclopramide
    • mirtazapine
    • mitotane
    • morphine liposomal
    • muscle relaxants
    • nevirapine
    • NSAID/ chlorpheniramine/ pseudoephedrine combinations
    • NSAID/ diphenhydramine combinations
    • olanzapine
    • olanzapine/ fluoxetine
    • olopatadine nasal
    • opiate agonist/ antagonists
    • opiate/ acetaminophen combinations
    • opiate/ aspirin combinations
    • opiates
    • oxcarbazepine
    • oxycodone/ ibuprofen
    • paliperidone
    • passionflower
    • pheniramine/ dextromethorphan/ phenylephrine
    • phenobarbital/ hyoscyamine/ atropine/ scopolamine
    • phenothiazines
    • phenytoins
    • pimozide
    • pramipexole
    • pregabalin
    • promethazine/ codeine
    • propoxyphene
    • propoxyphene/ acetaminophen
    • quetiapine
    • rifabutin
    • rifampin
    • rifampin/ isoniazid
    • rifampin/ isoniazid/ pyrazinamide
    • rifapentine
    • risperidone
    • ropinirole
    • rotigotine transdermal
    • rufinamide
    • sedative/ hypnotics
    • St. John’s wort
    • tamoxifen
    • tapentadol
    • tetrabenazine
    • thalidomide
    • thiothixene
    • tiagabine
    • topiramate
    • tramadol
    • tramadol/ acetaminophen
    • trazodone
    • tricyclic antidepressants
    • valerian
    • vigabatrin
    • ziconotide intrathecal
    • ziprasidone
    • zonisamide

    Potential side effects:

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    Please seek immediate medical attention if you experience any of the following which may be an allergic reaction to clonazapem:

    • hives
    • hoarseness
    • rash
    • trouble breathing
    • swelling of face, lips, tongue and/or throat

    Please speak with your doctor right away if you experience any new-found or more severe symptoms. These may include:

    • feeling agitated
    • anxiety
    • behavior and mood changes
    • blood dyscrasias
    • depression
    • fainting
    • hostile, angry and/or aggressive
    • either mentally or physically hyperactive
    • low blood pressure
    • swelling of the liver
    • tachycardia
    • thoughts of hurting yourself or suicide

    Talk to your doctor right away if you experience the following serious side effects:

    • any confusion, unusual behavior and/or hallucinations
    • easy to bruise, and/or pale skin or bleeding
    • fluttering in the chest or pounding heartbeat
    • involuntary movement of the eye or unusual eye movement
    • new and/or worsening seizures
    • problematic or painful urination
    • shallow or weak breathing
    • unusual behavior such as risk taking and no fear of danger

    Less serious side effects can include but are not limited to:

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    • amnesia
    • balance and/or issues with coordination
    • blurred vision
    • changes in weight and/or loss of appetite
    • changes in sex drive
    • diplopia
    • diarrhea and/or constipation
    • dizziness
    • drooling and/or dry mouth
    • drowsiness
    • dysarthria
    • dystonia
    • feeling tired or muscle weakness
    • gums that are sore
    • headache
    • insomnia or sleeping issues
    • incontinence
    • nasal discharge, or runny nose
    • rash
    • stomach problems - diarrhea and/or constipation
    • urinary retention

    Additional information:

     

    Please tell you doctor if you use other medications such as cold and allergy, sleeping pills, muscle relaxers, narcotic pain relievers and those for anxiety and depression on a regular basis. These medications, in addition to benzodiazepines (and other seizure drugs) may contribute to the drowsiness caused by clonazepam. You should also tell your doctor if you take any of these drugs:

    • antibiotics that include clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), or telithromycin (Ketek)
    • antidepressants that include amitriptyline (Elavil, Vanatrip, Limbitrol), doxepin (Sinequan), nefazodone, nortriptyline (Pamelor), and others
    • antifungals that include fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend)
    • barbiturates including butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton)
    • MAO inhibitors  (Monoamine oxidase inhibitor) including furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate)
    • drugs that treat psychiatric disorders including chlorpromazine (Thorazine), droperidol (Inapsine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), thioridazine (Mellaril), or thiothixene (Navane).

    Clonazepam comes in tablet form and disintegrating wafer.

    • Tablet form - swallow the entire pill with a full glass of water. Do not crush or break up this medication.
    • Disintegrating wafer - keep the medication in the blister pack until use and when you are ready to use it, do not push the tablet through the packaging as it my destroy it. With dry hands put the wafer in your mouth and let it dissolve, do not swallow whole or chew this. Continue to swallow and let the wafer dissolve. You can drink water to help this medication dissolve.

    Brand Names:

    • Klonopin
    • Klonopin wafer

    Related Information:

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    Resources:

     

    Wolters Kluwer. Clonazepam. Drugs.com. Last revised September 20, 2012.

     

    Cerner Multum, Inc. Clonazepam. Epocrates.com. Last revised  March 3, 2011.

     

    Material on this page is for informational purposes only, and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications.

     

    NancySig

     

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    © The HealthCentral Network, 2012
    Last Updated October 2, 2012.

Published On: October 02, 2012