cause or worsen depression. Occasional Dysphoria Induction of seizures or increased frequency of seizures Personality changes Behavioural disturbances Ataxia Rare Suicide through disinhibition Psychosis Incontinence Liver damage Paradoxical behavioural disinhibition (most frequently in children, the elderly, and in persons with developmental disabilities) Rage Excitement Impulsivity The long-term effects of clonazepam can include depression, disinhibition, and sexual dysfunction. Drowsiness Clonazepam, like other benzodiazepines, may impair a person's ability to drive or operate machinery. The central nervous system depressing effects of the drug can be intensified by alcohol consumption, and therefore alcohol should be avoided while taking this medication. Benzodiazepines have been shown to cause dependence. Patients dependent on clonazepam should be slowly titrated off under the supervision of a qualified healthcare professional to reduce the intensity of withdrawal or rebound symptoms. Withdrawal-related Anxiety Irritability Insomnia Tremors Headaches Stomach pain Hallucinations Suicidal thoughts or urges Depression Fatigue Dizziness Sweating Confusion Potential to exacerbate existing panic disorder upon discontinuation Seizures similar to delirium tremens (with long-term use of excessive doses) Benzodiazepines such as clonazepam can be very effective in controlling status epilepticus, but, when used for longer periods of time, some potentially serious side-effects may develop, such as interference with cognitive functions and behavior. Many individuals treated on a long-term basis develop a dependence. Physiological dependence was demonstrated by flumazenil-precipitated withdrawal. Use of alcohol or other CNS depressants while taking clonazepam greatly intensifies the effects (and side effects) of the drug. A recurrence of symptoms of the underlying disease should be separated from withdrawal symptoms. Tolerance and withdrawal Like all benzodiazepines, clonazepam is a GABA-positive allosteric modulator. One-third of individuals treated with benzodiazepines for longer than four weeks develop a dependence on the drug and experience a withdrawal syndrome upon dose reduction. High dosage and long-term use increase the risk and severity of dependence and withdrawal symptoms. Withdrawal seizures and psychosis can occur in severe cases of withdrawal, and anxiety and insomnia can occur in less severe cases of withdrawal. A gradual reduction in dosage reduces the severity of the benzodiazepine withdrawal syndrome. Due to the risks of tolerance and withdrawal seizures, clonazepam is generally not recommended for the long-term management of epilepsies. Increasing the dose can overcome the effects of tolerance, but tolerance to the higher dose may occur and adverse effects may intensify. The mechanism of tolerance includes receptor desensitization, down regulation, receptor decoupling, and alterations in subunit composition and in