Clonazepam alternatives: What can I take instead of clonazepam?

Clonazepam doesn't work for everyone. Alprazolam, diazepam, fluoxetine, paroxetine, and venlafaxine ER are some clonazepam alternatives. Get the full list here

By Chad Shaffer, MD | Sep. 13, 2022

Clonazepam (brand name Klonopin) is a common medication used to help treat panic attacks and 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 excitability of neurons. These medications decrease the excitability of neurons which reduces their communication leading to a calming effect on many of the functions of the brain. As a treatment for certain types of seizure disorders, clonazepam is often used in Lennox-Gastaut syndrome, myoclonic, and atonic seizures. Clonazepam is also used off-label (no FDA approval) to treat other conditions such as anxiety, restless leg syndrome, sleep terrors, sleep walking, and Tourette syndrome. Clonazepam is available as an oral tablet and an oral disintegrating tablet which can be useful for people who have difficulty swallowing traditional oral tablets or capsules. For treating panic attacks and seizure disorders, clonazepam is typically dosed two to three times daily.

While an effective treatment for some people, clonazepam may not be the best and safest option for all people managing panic attacks or seizure disorders. 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, use of benzodiazepines and opioids together should be avoided or carefully monitored. 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 use of other medications, alcohol, and/or illicit substances. Abuse and misuse is 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).

What can I take in place of clonazepam?

There are other options available to treat conditions such as panic attacks and seizure disorders 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 history of placement in treatment programs. Depending on the reason clonazepam is being prescribed, there are several classes of medications that could be used as alternatives including other benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and anticonvulsants. These treatment options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

Compare clonazepam alternatives
Drug name	Uses	Dosage	Coupons
Klonopin (clonazepam)	-Panic disorder -Seizure disorder	Take 0.5 to 5 mg by mouth two to three times daily	Klonopin coupons
Xanax (alprazolam)	-Generalized anxiety disorder -Panic disorder	Take 0.25 to 3 mg by mouth three times daily	Xanax coupons
Epidiolex (cannabidiol)	-Seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex	Take 5 mg/kg/dose by mouth twice daily	Epidiolex coupons
Onfi (clobazam)	-Lennox Gastaut syndrome	Take 10 to 20 mg by mouth twice daily	Onfi coupons
Valium (diazepam)	-Alcohol withdrawal -Anxiety disorder -Muscle spasm -Procedural sedation -Seizure disorder	Take 2 to 10 mg by mouth two to four times daily	Valium coupons
Prozac (fluoxetine)	-Bulimia nervosa -Major depressive disorder -Obsessive compulsive disorder -Panic disorder	Take 20 to 80 mg by mouth once daily	Prozac coupons
Ativan (lorazepam)	-Anxiety disorder -Insomnia -Status epilepticus	Take 2 to 6 mg by mouth daily in divided doses	Ativan coupons
Paxil (paroxetine)	-Generalized anxiety disorder -Major depressive disorder -Obsessive compulsive disorder -Panic disorder -Social anxiety disorder	Take 20 to 50 mg by mouth once daily	Paxil coupons
Banzel (rufinamide)	-Lennox Gastaut syndrome	Take 1,600 mg by mouth twice daily	Banzel coupons
Zoloft (sertraline)	-Major depressive disorder -Obsessive compulsive disorder -Panic disorder -Post traumatic stress disorder -Premenstrual dysphoric disorder -Social anxiety disorder	Take 50 to 200 mg by mouth once daily	Zoloft coupons
Effexor XR (venlafaxine extended release)	-Generalized anxiety disorder -Major depressive disorder -Panic disorder -Social anxiety disorder	Take 75 to 225 mg by mouth once daily	Effexor XR coupons

Other alternatives to clonazepam

Depending on the reason clonazepam is being prescribed, there are several classes of medications that could be used as alternatives.

Anticonvulsants

Felbatol (felbamate)
Keppra (levetiracetam)
Topamax T (topiramate)
Zonegran (zonisamide)

Benzodiazepines

Librium (chlordiazepoxide)
Tranxene (clorazepate dipotassium)
Serax (oxazepam)

Selective serotonin reuptake inhibitors (SSRIs)

Celexa (citalopram)
Lexapro (escitalopram)
Luvox (fluvoxamine)

Tricyclic antidepressants (TCAs)

Anafranil (clomipramine)
Imipramine

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. Similar to common side effects of clonazepam, alprazolam can cause sedation, drowsiness, fatigue, psychomotor impairment, and reduced 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.

2. Valium (diazepam)

Diazepam is a benzodiazepine that is used to manage alcohol withdrawal, anxiety disorder, muscle spasm, procedural sedation, and seizure disorder. Similar to clonazepam, common side effects of alprazolam include sedation, drowsiness, fatigue, psychomotor impairment, and reduced 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).

3. Prozac (fluoxetine)

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that is used to manage bulimia nervosa, major depressive disorder, obsessive compulsive disorder, and panic disorder. SSRIs like fluoxetine may be favored for those treating both panic disorder and depression. 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 dysfunction. It’s important for new users of SSRIs to know it typically takes 4 to 6 weeks for the medication to become effective versus the faster response seen with benzodiazepines. Fluoxetine is available in three dosage strengths as tablets, capsules, delayed release capsules, and oral solution.

4. Paxil (paroxetine)

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) that is used to manage generalized anxiety disorder, major depressive disorder, obsessive compulsive disorder, panic disorder, and social anxiety disorder. SSRIs like paroxetine may be favored for those treating panic disorder and another mood disorder. Unlike benzodiazepines, SSRIs are not associated with tolerance or physical dependence. Side effects of paroxetine include nausea, weakness, headache, depression, insomnia, dizziness, sleepiness/tiredness, and diarrhea. It’s important for new users of SSRIs to know it typically takes 4 to 6 weeks for the medication to become effective versus the faster response seen with benzodiazepines. Clinical trials have found paroxetine to be safe, efficacious, and well tolerated in the short-term treatment of panic disorder. Paroxetine is available as capsules, tablets, extended release tablets, and oral solution.

5. Effexor XR (venlafaxine extended release)

Venlafaxine extended release is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is used to manage generalized anxiety disorder, major depressive disorder, panic disorder, and social anxiety disorder. Venlafaxine may be best suited for those managing panic attacks and other mental health conditions like depression. Unlike benzodiazepines, SNRIs are not associated with tolerance or physical dependence. Side effects of venlafaxine extended release include nausea, sleepiness/tiredness, dry mouth, sweating, abnormal ejaculation, anorexia, constipation, sexual dysfunction, and decreased libido. Venlafaxine extended release has been found to be effective and well tolerated in both the short-term and long-term treatment of panic disorder. Venlafaxine extended release is available as capsules.

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 (neurotrophic or growth factors) which cause nerve cells to grow and make new connections.

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 to manage overwhelming emotions and 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 which involves the symptoms of either panic attacks or anxiety due to consumption of caffeine. Avoiding or limiting alcohol and caffeine consumption may lessen symptoms of anxiety.

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 the prescribing doctor has reviewed all health conditions. SSRIs and SNRIs such as fluoxetine, paroxetine, and venlafaxine may cause sexual dysfunction and/or insomnia. TCAs such as clomipramine and imipramine have cardiovascular precautions including blood pressure changes and effects on heart rate. 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 (2–3 weeks recommended after 2 months of treatment). 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 for clonazepam may have serious drug interactions when used with other prescription drugs and over-the-counter meds or supplements. Benzodiazepines like alprazolam, diazepam, and lorazepam have serious risks if taken with opioids. Using benzodiazepines with opioids can cause extreme sedation, respiratory depression, coma, and death.

4. Start and continue to monitor panic attack symptoms or seizure disorder 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.

For people with seizure disorders, it’s important to establish care with a healthcare team. A plan may include tracking seizures, determining and managing seizure triggers, and educating on management of seizure emergencies.