Klonopin (clonazepam) is a drug in the benzodiazepine class. It comes only as an oral medication. Benzodiazepine medications work by enhancing GABA activity in the brain. GABA (gamma-aminobutyric acid) is a neurotransmitter in the brain that works by inhibiting the excitation of neurons. Neurons are nervous system cells that carry messages to other cells. This causes the brain to undergo relaxation. When the brain is in a relaxed state, there are anti-anxiety effects.
Seizure Disorders
Benzodiazepines are a mainstay in the treatment of seizure disorders. Seizures are physical findings that occur due to abnormal electrical activity in the brain. Symptoms of seizures range from loss of awareness to shaking of the body. According to the article "Evaluation of a First Seizure," published by American Family Physician in 2007, there is no single symptom or test that differentiates a seizure from a non-seizure event. The activities that occur during a seizure are dependent upon what part of the brain is involved.
Clonazepam is thought to work to depress seizure activity by inhibiting the spike-and-wave discharge in a specific type of seizure known as an absence seizure. By suppressing nerve transmission in the motor cortex, the brain is not able to propagate a seizure by altering the flow of ions in and out of cells. The specific mechanism for reducing seizure activity is thought to be through clonazepam's activity to depress neurotransmission in the motor cortex by decreasing the flow of chloride. The area of brain that coordinates movements of the muscles of the body is the motor cortex.
When taken for seizure prophylaxis, clonazepam is taken daily.
Panic Disorder/Anxiety
A common indication for a benzodiazepine is for treatment of panic disorder and anxiety. Clonazepam works to relieve anxiety through its activity on GABA neurotransmission which creates a state of relaxation in the brain. The relaxation works to counter the flight-or-fight response of the panic attack where there is increased release of adrenaline. Taking a clonazepam pill may reduce anxiety quickly and help treat an acute panic attack. This benefit on anxiety occurs with as needed use in comparison to other anti-anxiolytics that require chronic use. The medication is taken either as needed or daily. However, due to it being a very addictive medication, many providers are reluctant to prescribe this medication more than on an as needed basis. There is also risk for withdrawal symptoms if abruptly stopped.
Burning Mouth Syndrome
Clonazepam is also approved for use in the treatment of burning mouth syndrome. Burning mouth syndrome is a condition where there is a burning sensation on the tongue or other sites in the mouth. There is generally no other clinical or lab findings. Treatment of burning mouth syndrome is aimed at treating the symptoms because the cause is unknown. Clonazepam works best at lower doses for burning mouth syndrome.
Other Indications
Some off-label or investigational uses for the medication include treatment of restless leg syndrome, neuralgia, multifocal tic disorder, parkinsonian dysarthria (slurred speech), bipolar disorder, and for schizophrenia along with standard anti-psychotic medications.
References
- Epocrates: Clonazepam
- "Current Medical Diagnosis and Treatment"; SJ McPhee, MA Papdakis, LM Tierney; 2007
- Psychiatry (Edgmont); Varying uses of anticonvulsant medications; E Cascade, AH Kalali, RH Weisler; June 2008
- American Family Physician; Evaluation of a first seizure; SM Adams, PD Knowles; May 2007
