86 Clonazepam
administered together as a successful treatment for cluster headaches. Clona-
zepam has eased burning mouth syndrome, a self-descriptive sensation that
can persist for years. The drug has been used experimentally with limited
success to treat ringing in the ears.
Drawbacks.Clonazepam is not recommended for persons suffering from
narrow-angle glaucoma. The compound may worsen respiratory disease. The
substance increases saliva production. It often makes people tired, interferes
with muscular coordination, and can impede decision making; such effects
hinder ability to operate dangerous machinery. Dozens of less common ad-
verse effects are described, ranging from skin rash to painful gums. One case
report concludes that clonazepam may promote porphyria, a body chemistry
disorder that can make a person violent and supersensitive to light, but such
a result is virtually unheard of. A review of medical records of men being
treated for posttraumatic stress disorder suggested that the drug may com-
monly inhibit sexual performance in such a population. Some persons suffer
from a disquieting affliction called apnea in which they temporarily stop
breathing; case reports say clonazepam can cause apnea attacks. An experi-
ment noted a rebound effect when people stop taking the drug for insomnia,
meaning the condition is not cured but instead returns worse than ever, at
least for awhile.
Contrary to normal expectations, the drug has occasionally been reported
to bring on mania and even aggression. One case report noted that if panic
attacks act as a warning against certain behavior, clonazepam’s ability to re-
duce or eliminate panic attacks can also remove a person’s inhibitions against
the behavior. A small study suggests that clonazepam may reduce inhibitions
in children, and case reports exist about the same effect in children, teenagers,
and adults. Researchers curious about whether clonazepam especially reduces
inhibitions examined medical records of 323 persons institutionalized for psy-
chiatric disturbance, a population in which such a clonazepam effect might be
particularly evident; although the study was not designed to demonstrate
cause and effect, the records were consistent with a low risk of reduced in-
hibition from clonazepam and other benzodiazepine class drugs.
Abuse factors.Clonazepam has a withdrawal syndrome similar toalcohol’s:
cramps and tremors, convulsions, hallucinations, and general mental distress.
The syndrome can be avoided if a person reduces dosage gradually. Suddenly
halting the drug after taking it for an extended period of time can cause ep-
ileptic seizures.
Drug interactions.Clonazepam’s actions can be boosted by alcohol, barbi-
turates, opiates, tricyclic antidepressants, and monoamine oxidase inhibitors
(MAOIs). A case report suggests that effects may also be boosted by the heart
medicine amiodarone. Another case report indicates that clonazepam reduces
blood levels of the epilepsy medicine phenytoin. Taking clonazepam with the
antidepressant paroxetine is suspected of causing a dangerous reaction called
serotonin syndrome, a serious condition which can involve confusion, tremors,
and high body temperature. Combining clonazepam with the antimania med-
icine lithium is suspected of causing muscular discoordination, including
muscles used for speech. A case report noted delirium brought on by simul-
taneously taking clonazepam and the schizophrenia medicine clozapine.