Klonopin (clonazepam) for Lennox-Gastaut syndrome
Fact-checked by What is Klonopin for Lennox-Gastaut syndrome?
Klonopin (clonazepam) is an approved oral medication that’s used alone or as an add-on to control seizures in people with Lennox-Gastaut syndrome (LGS).
It works by putting the brakes on excessive nerve cell firing that causes seizures. Klonopin belongs to a class of medications called benzodiazepines, which boost inhibitory brain signaling.
The brand-name medication is sold by Roche and comes as oral tablets to be swallowed whole. Several generic versions are also available in the U.S. Some come as orally disintegrating tablets that dissolve on the tongue.
Klonopin is also used to treat certain other seizure disorders and panic disorder. It is sold under the brand name Rivotril in Europe, Canada, and elsewhere.
Therapy snapshot
| Brand name | Klonopin |
| Chemical name | Clonazepam |
| Usage | Used as a standalone or add-on treatment for LGS |
| Administration | Oral tablets; generics also available as orally disintegrating tablets |
Who with Lennox-Gastaut syndrome can take Klonopin?
Klonopin is approved in the U.S. for the treatment of LGS, when given alone or in combination with other medications.
It is contraindicated, or should not be used, by people with:
- a history of sensitivity to benzodiazepines
- clinical or laboratory signs of significant liver disease
- acute narrow angle glaucoma, a serious eye condition
Klonopin also comes with a boxed warning about serious risks of benzodiazepines, including:
- profound sedation, suppressed breathing, coma, or death when used with opioids
- abuse, misuse, and addiction, which can lead to overdose or death
- physical dependence, which could lead to withdrawal reactions upon discontinuation
For these reasons, the dose and duration of treatment should be limited to the minimum required, and use of the medication should be carefully considered in people at high risk of abuse.
How is Klonopin administered in Lennox-Gastaut syndrome?
Klonopin is available as oral tablets to be taken with water and swallowed whole. The recommended dose is individualized based on seizure control and side effects:
- Adults: Starting dose of no more than 1.5 mg/day, which can be gradually increased to a maximum of 20 mg/day.
- Children up to age 10 or 30 kg (66 pounds) of body weight: Klonopin is administered at a weight-based dose, and can be gradually increased to a maximum of 0.1 or 0.2 mg/kg body weight daily.
In general, the total daily dose of Klonopin should be split into three equal doses, taken throughout the day. If the dose cannot be equally divided, the largest dose should be taken before bed.
Dosing for orally disintegrating clonazepam tablets is similar. The tablets are placed on the tongue and easily disintegrate in saliva without the need for water.
Klonopin in Lennox-Gastaut syndrome clinical trials
Klonopin was approved for treating LGS in the 1970s, without any modern, large-scale placebo-controlled clinical trials.
Its use was mainly supported by several smaller studies showing that the medication reduced seizure frequency in people with LGS and other types of epilepsy. For example, one early study involving 13 children with LGS showed the medication helped control seizures in about half of the children.
Klonopin side effects
The most frequently reported side effects of Klonopin in people with seizure disorders include:
- drowsiness
- coordination problems
- behavioral changes
According to the boxed warning, Klonopin should not be combined with opioid medications unless there are no alternative treatment options because of the risk of life-threatening complications.
Abuse and misuse of Klonopin often involve the use of higher-than-recommended doses or simultaneous use of other medications, alcohol, or illicit substances, which further increases the risk of serious complications or death. Patients will be closely monitored for signs of medication misuse.
The risk of physical dependence and withdrawal increases with longer treatment and higher doses. Abrupt discontinuation of the medication after prolonged use can cause life-threatening withdrawal reactions, so the dose must be gradually tapered.
Klonopin also comes with warnings for other potentially serious side effects, including:
- disruptions in cognitive and motor function
- suicidal thoughts and behaviors
- worsening of certain seizure types
- psychiatric changes, such as irritability, aggression, anxiety, nightmares, or hallucinations
- increased salivation
- slow and shallow breathing
- worsening of porphyria, a group of rare disorders
Patients will be monitored for these side effects, and should undergo routine blood tests to monitor blood counts and liver function throughout treatment. They should also tell their doctor about any other medications they are taking, as there may be potential interactions. Alcohol should be avoided while taking Klonopin.
Some people who initially respond to Klonopin may notice a loss of efficacy, often within the first three months of treatment. In these cases, dose adjustments may be needed.
If used late in pregnancy, Klonopin can cause complications in the newborn, including sedation or withdrawal symptoms. Patients should inform their healthcare provider if they are pregnant.
Lennox-Gastaut Syndrome News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
