How Does Clonazepam Work? All About Its Mechanism of Action

Clonazepam (Klonopin) is a medication that treats panic disorder and certain types of seizures. It’s also used off-label for other conditions, such as anxiety and insomnia (trouble sleeping).

Here’s how clonazepam works and how it’s used for anxiety, seizures, and other conditions.

What is clonazepam?

Clonazepam is a benzodiazepine medication. Other benzodiazepines include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). 

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All benzodiazepines are considered controlled substances. These substances have an increased risk for dependence and misuse, so there are restrictions on how they’re prescribed and refilled.

Clonazepam is available as an oral tablet and an orally disintegrating tablet (a tablet that dissolves under your tongue). It’s FDA approved to treat panic disorder and certain types of seizures. 

Clonazepam also has several off-label uses:

• Anxiety disorders, including generalized anxiety disorder

• Sleep disorders, including insomnia and REM sleep behavior disorder

• Mental health conditions, including manic episodes related to bipolar disorder

What is clonazepam’s mechanism of action?

Clonazepam and other benzodiazepines work by attaching to gamma-aminobutyric acid (GABA) receptors. These are binding sites found in the brain and spinal cord. GABA is a naturally occurring chemical in the body that slows down nerve signals.

By attaching to these receptors, clonazepam enhances the activity of GABA. This can decrease anxiety and relax your muscles. It can also help prevent or treat seizures. However, it can also cause dizziness, trouble with coordination, and mood changes. Drowsiness is also a common side effect of clonazepam. But this may be helpful in some cases.

Does clonazepam start working immediately?

Clonazepam starts working quickly. You’ll likely feel its effects within an hour of taking it. But it may take up to 4 hours to feel its full effect.

EXPERT PICKS: WHAT TO READ NEXT

• What are the most commonly used panic disorder medications? Antidepressants are typically first-choice medications for daily management of panic disorder. But benzodiazepines like clonazepam may help treat active panic disorders.

• Does clonazepam have side effects? Clonazepam can cause drowsiness, dizziness, and mood changes. It also has more serious risks, such as injuries, misuse, and overdose.

• Can you drink alcohol with clonazepam? No, you shouldn’t drink alcohol while taking clonazepam. It’s one of several clonazepam interactions to avoid.

It can take some time to find the right clonazepam dose for you. And your health condition may not feel completely under control until you do. More on this below.

How do you know if clonazepam is working?

A clear sign that clonazepam is working is a reduction in your symptoms. 

For example, if you’re taking clonazepam for panic disorder, you may feel relaxed, less anxious, and drowsy soon after taking it. And you should start to have fewer panic attacks. However, this may take some time. 

Your prescriber will start you at a low dose then increase your dose slowly over time. It may take awhile to find an effective dose.

If you’re taking clonazepam for seizures, it can also take several days to find the right dose. So keep in touch with your prescriber when you start taking it and let them know if you’re still having seizures. They may want to adjust your dose if you are.

Are there alternatives to clonazepam?

Benzodiazepines aren’t typically a first-choice treatment option. This is because they have serious risks, including:

• Dependence and misuse, which may lead to substance use disorder

• Withdrawal symptoms (although not usually life-threatening, they can cause severe symptoms such as delirium, hallucinations, and seizures)

• Slowed breathing and overdose

• Injuries and accidents, including car accidents

You’ll usually have several other treatment options besides clonazepam. We’ll cover a few of these below.

Anxiety and panic disorder

Antidepressants are usually first-choice options for panic disorder and anxiety. These include:

• Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and escitalopram (Lexapro) 

• Serotonin norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor XR) and duloxetine (Cymbalta)

Clonazepam is typically a short-term treatment for anxiety disorders. For example, clonazepam may be:

• Taken while you wait for an antidepressant to start working (which can take several weeks)

• Prescribed to treat an active panic attack since it works faster than SSRIs or SNRIs

Other treatments — such as cognitive behavioral therapy — can also help with anxiety. So talk to a healthcare professional about the right methods for you. Combining medications and therapy may be the best option.

Seizures

The best seizure medication for you depends on the type of seizures you have and other factors. You may need to try several medications before finding what works best. 

Other seizure medications, such as levetiracetam (Keppra, Spritam) and lamotrigine (Lamictal), are often first-choice options.

Good to know: Taking clonazepam exactly as prescribed and avoiding other substances that have similar side effects can lower your risk of dependence, misuse, and overdose. For example, it’s best to avoid drinking alcohol or taking opioids if you’re prescribed clonazepam.

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Written by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

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