The Basics
What is Clonazepam?
Used to prevent and control seizures.
Brand names for Clonazepam
Klonopin
How Clonazepam is classified
Anticonvulsants, Benzodiazepines
Clonazepam During Pregnancy
Clonazepam pregnancy category
Category Not AssignedNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Clonazepam while pregnant
There are no adequate and well-controlled studies of Klonopin in pregnant women. Available human data on the risk of teratogenicity are inconclusive. There is insufficient evidence in humans to assess the effect of benzodiazepine exposure during pregnancy on neurodevelopment. Administration of benzodiazepines immediately prior to or during childbirth can result in a syndrome of hypothermia, hypotonia, respiratory depression, and difficulty feeding. In addition, infants born to mothers who have taken benzodiazepines during the later stages of pregnancy can develop dependence, and subsequently withdrawal, during the postnatal period. In three studies in which clonazepam was administered orally to pregnant rabbits at doses of 0.2, 1, 5, or 10 mg/kg/day during the period of organogenesis, a similar pattern of malformations (cleft palate, open eyelid, fused sternebrae and limb defects) was observed at all doses, in a low, non-dose-related incidence. The lowest dose tested is less than the maximum recommended human dose (MRHD) of 20 mg/day for seizure disorders and similar to the MRHD of 4 mg/day for panic disorder, on a mg/m2 basis. Reductions in maternal weight gain occurred at doses of 5 mg/kg/day or greater and reduction in embryofetal growth occurred in one study at a dose of 10 mg/kg/day. No adverse maternal or embryofetal effects were observed in mice or rats following oral administration of clonazepam during organogenesis of doses up to 15 or 40 mg/kg/day, respectively (4 and 20 times the MRHD of 20 mg/day for seizure disorders and 20 and 100 times the MRHD of 4 mg/day for panic disorder, respectively, on a mg/m2 basis). Data for other benzodiazepines suggest the possibility of adverse developmental effects (long-term effects on neurobehavioral and immunological function) in animals following prenatal exposure to benzodiazepines. To provide information regarding the effects of in utero exposure to Klonopin, physicians are advised to recommend that pregnant patients taking Klonopin enroll in the NAAED Pregnancy Registry. This can be done by calling the toll free number 1-888-233-2334, and must be done by patients themselves. Information on this registry can also be found at the website http://www.aedpregnancyregistry.org/.
Taking Clonazepam While Breastfeeding
What are recommendations for lactation if you're taking Clonazepam?
Maternal clonazepam occasionally causes sedation in their breastfed infants, especially when given with other central nervous system depressants. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. Monitoring of the infant’s serum concentration may be indicated if excessive sedation occurs. Because it has a long half-life, a safer, shorter-acting drug should be used as rather than clonazepam.[1][2] An expert consensus guideline indicates that low-dose clonazepam is an acceptable choice for refractory restless leg syndrome during lactation.[3]
Maternal / infant drug levels
Maternal clonazepam occasionally causes sedation in their breastfed infants, especially when given with other central nervous system depressants. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. Monitoring of the infant’s serum concentration may be indicated if excessive sedation occurs. Because it has a long half-life, a safer, shorter-acting drug should be used as rather than clonazepam.[1][2] An expert consensus guideline indicates that low-dose clonazepam is an acceptable choice for refractory restless leg syndrome during lactation.[3]
Possible effects of Clonazepam on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Clonazepam
(Sedative) Lorazepam, Oxazepam.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Davanzo R, Dal Bo S, Bua J et al. Antiepileptic drugs and breastfeeding. Ital J Pediatr. 2013;39:50. PMID: 23985170
2. Veiby G, Bjork M, Engelsen BA, Gilhus NE. Epilepsy and recommendations for breastfeeding. Seizure. 2015;28:57-65. PMID: 25837494
3. Picchietti DL, Hensley JG, Bainbridge JL et al. Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation. Sleep Med Rev. 2015;22:64-77. PMID: 25553600
4. Bossi L, Battino D, Caccamo ML et al. Pharmacokinetics and clinical effects of antiepileptic drugs in newborns of chronically treated epileptic mothers. In: Janz D et al, eds. Epilepsy, pregnancy and the child. New York: Raven Press, 1982:373-81.
5. Fisher JB, Edgren BE, Mammel MC et al. Neonatal apnea associated with maternal clonazepam therapy: a case report. Obstet Gynecol. 1985;66 (3 Suppl):34S-5S. PMID: 4022513
6. Soderman P, Matheson I. Clonazepam in breast milk. Eur J Pediatr. 1988;147:212-3. Letter. PMID: 3366144
7. Schaefer C, Peters P, Miller RK, eds. Drugs during pregnancy and lactation. Treatment options and risk assessment, 2nd ed. Amsterdam; Boston: Elsevier Academic Press. 2007:700-1.
8. Birnbaum CS, Cohen LS, Bailey JW et al. Serum concentrations of antidepressants and benzodiazepines in nursing infants: a case series. Pediatrics. 1999;104:e11. PMID: 10390297
9. Hartmann AM, Koch S, Jager-Roman E et al. [Breast feeding, weight gain and behaviour in newborns of epileptic women]. Monatsschr Kinderheilkd. 1994;142:505-12.
10. Kelly LE, Poon S, Madadi P, Koren G. Neonatal benzodiazepines exposure during breastfeeding. J Pediatr. 2012;161:448-51. PMID: 22504099
11. Soussan C, Gouraud A, Portolan G et al. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014;70:1361-6. PMID: 25183382
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
