Klonopin vs. Ativan
- Klonopin (clonazepam) and Ativan (lorazepam) are medications used to treat anxiety and panic attacks. Both drugs are also sometimes used for treating seizures.
- Both Klonopin and Ativan are in the benzodiazepine class of drugs, the same family that includes diazepam (Valium), alprazolam (Xanax), and flurazepam (Dalmane).
- Side effects of Klonopin and Ativan that are similar include drowsiness, dizziness, memory problems/amnesia, depression, weakness, unsteadiness, loss of orientation, headache, and sleep disturbances.
- Side effects of Klonopin that are different from Ativan include lack of inhibition, fatigue, confusion, changes in sexual desire, rash, and irritability.
- Both Klonopin and Ativan may interact with alcohol and other medications that can make you sleepy such as barbiturates, narcotic painkillers, and tranquilizers.
- Suddenly stopping Klonopin or Ativan after prolonged use can lead to symptoms of withdrawal such as insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, and fatigue.
What are Klonopin and Ativan?
Klonopin (clonazepam) is an anti-anxiety medication in the benzodiazepine family. Klonopin and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter (a chemical that nerve cells use to communicate with each other) that inhibits brain activity. It is believed that excessive activity in the brain may lead to anxiety or other psychiatric disorders. Klonopin is primarily used for treating panic disorder and preventing certain types of seizures.
Ativan (lorazepam) is a benzodiazepine used for the management of anxiety disorders, the short-term relief of symptoms of anxiety or anxiety associated with depression. Ativan is also effective for insomnia and panic attacks, and is used in combination with other medications to prevent nausea and vomiting resulting from chemotherapy. Ativan also is administered before anesthesia for sedation and used for prevention and treatment of alcohol withdrawal. It also is used for treating seizures (status epilepticus).
What are the side effects of Klonopin and Ativan?
The most common side effects associated with clonazepam are sedation, which is reported in approximately half of patients. Dizziness is reported in one-third of patients.
Other common side effects include:
- A feeling of depression,
- Loss of orientation,
- Unsteadiness, and
- Sleep disturbance
- Lack of inhibition
- Changes in sexual desire
Other serious side effects of clonazepam include:
- Respiratory depression
- Enlarged liver
- Withdrawal symptoms (if stopped suddenly)
- Increased heart rate
- Low blood pressure
- Blood disorders
Other serious adverse reactions:
- Antiepileptic medications have been associated with an increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need for the antiepileptic drug. Patients who begin antiepileptic therapy should be closely observed for clinical worsening, suicidal thoughts or unusual changes in behavior.
The most common side effects associated with Ativan are:
Other side effects include:
- A feeling of depression
- Loss of orientation
- Sleep disturbance
Possible serious side effects include:
- Extrapyramidal symptoms
- Respiratory depression
- Suicidal ideation/attempt
Like all benzodiazepines, Ativan can cause physical dependence. Suddenly stopping therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia. If Ativan is taken continuously for longer than a few months, stopping therapy suddenly may produce seizures, tremors, muscle cramping, vomiting, and sweating.
What is the dosage of Klonopin vs. Ativan?
The dose of clonazepam is tailored to the patient's needs.
- For seizures in adults the initial dose is 1.5 mg daily in 3 divided doses.
- Dosage may be increased by 0.5 to 1 mg daily every 3 days until seizures are controlled or side effects preclude further increases in dose.
- The maximum dose is 20 mg daily. The initial dose for panic disorders is 0.25 mg twice daily.
- The dose may be increased to the target dose of 1 mg daily after 3 days.
- The dose of Ativan is tailored to the patient's needs.
- The usual dose for treating anxiety is 2-6 mg orally every 8 to 12 hours as needed.
- Insomnia is treated with 2-4 mg given at bedtime.
What drugs interact with Klonopin and Ativan?
Clonazepam, like all other benzodiazepines, accentuates the effects of other drugs that slow the brain's processes, such as alcohol, barbiturates, and narcotics and leads to increased sedation.
Ativan and all benzodiazepines accentuate the effects of other drugs that slow the brain's processes such as alcohol, barbiturates, narcotics, and tranquilizers, and the combination of Ativan and these drugs may lead to excessive sedation. There have been cases of marked sedation when Ativan was given to patients taking the tranquilizer loxapine (Loxitane); it is unclear if there is a drug interaction, but caution should be used if Ativan and loxapine are used together.
Are Klonopin and Ativan safe to take while pregnant or breastfeeding?
- Clonazepam and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Clonazepam is best avoided in the first trimester and probably throughout pregnancy.
- Benzodiazepines are secreted in breast milk. Mothers who are breastfeeding should not take clonazepam.
- Ativan and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Ativan is best avoided if at all possible in the first trimester and probably throughout pregnancy.
- Ativan is excreted in human milk and should be avoided during pregnancy.