Clonazepam

Relative contraindication in patients with COPD, obstructive sleep apnea, or any condition limiting respiratory reserve. Risk increases substantially with concurrent CNS depressants.

Paradoxical absence status epilepticus has been reported when clonazepam and valproate are co-administered in patients with absence seizures. Monitor carefully if combination is clinically necessary.

Significant dependence liability requires careful risk stratification in patients with history of any substance use disorder.

Contraindicated in severe liver disease due to risk of drug accumulation and excessive sedation.

Former FDA Category D. Particularly risky in first trimester (teratogenicity) and third trimester (floppy infant syndrome, neonatal withdrawal). Benefits must outweigh risks for continued use.

Clonazepam is excreted into breast milk at generally low levels, but impaired neonatal metabolism creates risk of drug accumulation. Breastfeeding is best avoided during clonazepam use.

AGS Beers Criteria lists clonazepam as a Potentially Inappropriate Medication in older adults. Increased risk of falls, fractures, delirium, and cognitive decline.

Contraindicated in patients with known hypersensitivity to clonazepam or any benzodiazepine.

Clonazepam is contraindicated in patients with narrow-angle glaucoma per FDA labeling.

FDA Black Box Warning. Concurrent benzodiazepine-opioid use carries substantially elevated mortality risk. Requires careful benefit-risk assessment before co-prescribing.