5 clonazepam alternatives and how to switch your Rx

In this article:

• Potential drawbacks of clonazepam
• What can I take in place of clonazepam?
• Top 5 clonazepam alternatives
• Compare clonazepam alternatives
• Natural alternatives to clonazepam
• How to switch to a clonazepam alternative

In this article

• Potential drawbacks of clonazepam
• What can I take in place of clonazepam?
• Top 5 clonazepam alternatives
• Compare clonazepam alternatives
• Natural alternatives to clonazepam
• How to switch to a clonazepam alternative

Clonazepam (brand name Klonopin) is a common medication used to help treat panic attacks and certain types of seizure disorders. Clonazepam belongs to the class of medications called benzodiazepines. Benzodiazepines work by increasing the effectiveness of the neurotransmitter gamma-aminobutyric acid (GABA), a chemical messenger in the brain, which controls the excitability of neurons. These medications decrease the excitability of neurons, leading to a calming effect on the central nervous system. Clonazepam is also used off-label (for a non-FDA-approved use) to treat other conditions such as anxiety, restless legs syndrome, and insomnia. Clonazepam is available as an oral tablet and an oral disintegrating tablet, which can be useful for people who have difficulty swallowing pills. 

Potential drawbacks of clonazepam

While an effective treatment for some people, clonazepam may not be the best and safest option for everyone. Benzodiazepines, like clonazepam, have serious risks if used with opioids, which may lead to extreme sedation, respiratory depression, coma, and death. Because of these risks, the use of benzodiazepines and opioids together should be avoided—or carefully monitored, if they must be used together. Additionally, benzodiazepines can be habit-forming and carry risks of abuse, misuse, and addiction. Abuse and misuse of benzodiazepines (sometimes referred to as benzos) can often involve the use of doses greater than the maximum recommended dosage and commonly involve the use of other medications, alcohol, or illicit substances. Abuse and misuse are associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death. As a result, benzodiazepines are classified as controlled medications, specifically as Schedule IV by the DEA (Drug Enforcement Administration).

RELATED: Preventing teen prescription misuse

What can I take in place of clonazepam?

There are other options available to treat panic attacks and related anxiety conditions that do not improve with clonazepam. When considering alternative prescription medication, it’s important to consider the specific condition being treated and the potential for abuse, which may include a history of drug misuse or abuse, alcohol dependence, or a history of placement in treatment programs. For panic disorder or other related anxiety conditions, there are several classes of medications that could be used as alternatives, including other benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), or serotonin-norepinephrine reuptake inhibitors (SNRIs). These treatment options may be more suitable for certain individuals.

RELATED: Clonazepam side effects and how to avoid them

Top 5 clonazepam alternatives

The following are some of the most common alternatives to clonazepam.

1. Xanax (alprazolam) 

Alprazolam is a benzodiazepine that is used to manage generalized anxiety disorder and panic disorder in adults. Similar to clonazepam, alprazolam can cause sedation, drowsiness, fatigue, psychomotor impairment, and problems with memory and concentration. As similar medications, the prescribing preference between the two drugs may be determined by provider experience and the individual’s response to treatment with one over the other. Alprazolam is available in a variety of dosage forms, including tablets, extended-release tablets, orally disintegrating tablets, and oral solution (liquid). Alprazolam works quickly and wears off faster than other benzodiazepines, which is helpful for symptom relief—but also makes it more likely to be misused or abused.

RELATED: Klonopin vs. Xanax: Differences, similarities, and which is better for you

2. Valium (diazepam)

Diazepam is a benzodiazepine that is used to manage anxiety disorders, muscle spasms, procedural sedation, and seizure disorders, among other uses. Similar to clonazepam and alprazolam, diazepam may cause sedation, drowsiness, fatigue, psychomotor impairment, and problems with memory and concentration. As similar medications, the prescribing preference between the two drugs may be determined by provider experience and the individual’s response to treatment with one over the other. Diazepam is available in a variety of dosage forms, including tablets, oral solution, intramuscular injection, and rectal gel (used for seizures). Diazepam is one of the longer-acting benzodiazepines—its effects can last up to 12 hours.

RELATED: Klonopin vs. Valium: Differences, similarities, and which is better for you

3. Prozac (fluoxetine) 

Antidepressants are often a first-choice treatment not only for depression, but also for anxiety. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that is used to manage major depressive disorder (depression), obsessive-compulsive disorder (OCD), panic disorder, and bulimia nervosa. Unlike benzodiazepines, SSRIs are not associated with tolerance or physical dependence. Side effects of fluoxetine include anxiety, agitation, insomnia, tremors, nausea, anorexia, headache, and sexual problems. It’s important for new users of SSRIs to know it may take up to six weeks for the medication to reach its full effects, versus the faster response seen with benzodiazepines. Fluoxetine is available in several dosage strengths as tablets, capsules, delayed-release capsules, and liquid.

4. Paxil (paroxetine) 

Paroxetine is an SSRI that is used to manage conditions such as generalized anxiety disorder, depression, OCD, panic disorder, and social anxiety disorder. Unlike benzodiazepines, SSRIs are not associated with tolerance or physical dependence. Common side effects of paroxetine include nausea, weakness, insomnia, dizziness, sleepiness, diarrhea or constipation, dry mouth, and yawning. As with Prozac, it may take several weeks for paroxetine to reach its full effects. Paroxetine is available as capsules, tablets, extended-release tablets, and liquid.

5. Effexor XR (venlafaxine extended-release) 

Venlafaxine extended-release (ER) is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is used to manage generalized anxiety disorder, depression, panic disorder, and social anxiety disorder. Unlike benzodiazepines, SNRIs are not associated with tolerance or physical dependence. Common side effects of venlafaxine ER include nausea, sleepiness, dry mouth, sweating, sexual problems, appetite loss, and constipation. As an antidepressant, it may take several weeks to reach its full effects. Venlafaxine ER is available in capsule form and is typically taken once daily.

Compare clonazepam alternatives
Drug name	Drug class	Uses	Coupons
Klonopin (clonazepam)	Benzodiazepine	–Panic disorder -Seizure disorder	Klonopin coupons
Xanax (alprazolam)	Benzodiazepine	-Generalized anxiety disorder –Panic disorder	Xanax coupons
Valium (diazepam)	Benzodiazepine	-Alcohol withdrawal –Anxiety disorder -Muscle spasm -Procedural sedation -Seizure disorder	Valium coupons
Prozac (fluoxetine)	SSRI	-Major depressive disorder -Obsessive-compulsive disorder  –Panic disorder -Bulimia nervosa	Prozac coupons
Ativan (lorazepam)	Benzodiazepine	–Anxiety disorder -Insomnia -Status epilepticus	Ativan coupons
Paxil (paroxetine)	SSRI	-Generalized anxiety disorder -Major depressive disorder -Obsessive-compulsive disorder –Panic disorder -Social anxiety disorder	Paxil coupons
Zoloft (sertraline)	SSRI	-Major depressive disorder -Obsessive-compulsive disorder –Panic disorder -Post-traumatic stress disorder -Premenstrual dysphoric disorder -Social anxiety disorder	Zoloft coupons
Effexor XR (venlafaxine extended release)	SNRI	-Generalized anxiety disorder -Major depressive disorder –Panic disorder -Social anxiety disorder	Effexor XR coupons
Buspirone	Anxiolytic	-Generalized anxiety disorder	Buspirone coupons

Some of the medications listed may also be used for seizures, but this article focuses on their use for anxiety and panic disorder.

Natural alternatives to clonazepam

Alternative remedies for clonazepam include therapy, lifestyle changes, and diet modifications to help improve mood and overall well-being. Some of these remedies include regular exercise, cognitive behavioral therapy, and avoiding triggers.

Both high-intensity exercise and consistent low-intensity exercise can have a positive impact on brain function, improving how people feel. High-intensity exercise releases the body’s feel-good chemicals called endorphins, while low-intensity exercise promotes the release of proteins that cause nerve cells to grow and make new connections.

RELATED: 7 health conditions that exercise prevents

Often, panic attacks and anxiety are associated with sudden symptoms, and the 3-3-3 rule may be beneficial. This tactic involves looking around and naming three things one sees, naming three sounds one hears, and moving three body parts, such as an ankle, finger, or arm. Cognitive behavioral therapy can be used in mental health conditions like depression, anxiety, substance use, and phobias. This form of therapy can help identify the thinking patterns that cause distress, manage overwhelming emotions, and reduce unhelpful behaviors.

Diet modifications can be made to help prevent future panic attacks. According to the American Addiction Centers, alcohol use can cause new-onset anxiety and worsen pre-existing anxiety symptoms. Many individuals will use alcohol as an unhealthy coping tool to reduce symptoms of anxiety. Additionally, caffeine use may be associated with increased anxiety. The American Psychiatric Association recognizes Caffeine-Induced Anxiety Disorder as a condition that involves the symptoms of either panic attacks or anxiety due to the consumption of caffeine. Avoiding or limiting alcohol and caffeine consumption may lessen symptoms of anxiety.

RELATED: Can caffeine cause anxiety? | 5 ways to boost your mental health

How to switch to a clonazepam alternative

1. Discuss all health conditions with a healthcare provider

Before switching from clonazepam to an alternative, it’s important to let your prescribing healthcare provider know about all of your health conditions. SSRIs and SNRIs such as fluoxetine, paroxetine, and venlafaxine may cause side effects such as sexual problems or insomnia. With a full review of an individual’s health history, prescribers can make the most appropriate medication recommendations, so it is best to seek medical advice prior to changing medication therapy.

2. Do not suddenly stop taking clonazepam

Withdrawal syndrome can appear after short-term and long-term use of clonazepam, and the severity can depend on the dose, duration of the treatment, and the length of the taper period. Withdrawal symptoms may include sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, nausea, some weight loss, palpitations, headache, and muscular pain and stiffness. Abruptly stopping clonazepam may cause status epilepticus (a seizure requiring immediate medical attention).

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Alternatives to clonazepam may have serious drug interactions when used with other prescription drugs and over-the-counter medications or supplements. Benzodiazepines like alprazolam, diazepam, and lorazepam have serious risks if taken with opioid pain medicines. Using benzodiazepines with opioids can cause extreme sedation, respiratory depression, coma, and death.

4. Start and continue to monitor panic attack symptoms

For people with panic attacks, it’s important to find a mental health provider for managing symptoms and establishing a treatment plan. Treatment plans may include anti-anxiety medication and alternative remedies, including therapy. When looking for a place to start, there is an online resource provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) that can help locate mental health treatment facilities and programs. 

If clonazepam was originally prescribed for a seizure condition, consult your healthcare provider about other treatment options.