Klonopin (clonazepam) vs. Zoloft (sertraline)

• Klonopin (clonazepam and Zoloft (sertraline) are used to treat anxiety and panic disorders.
• Clonazepam is also used to prevent certain types of seizures and Lennox-Gastaut syndrome.
• Sertraline is also used to treat depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).
• A brand name for clonazepam is Klonopin.
• A brand name for sertraline is Zoloft.
• Clonazepam and Zoloft belong to different drug classes. Clonazepam is a benzodiazepine and sertraline is a selective serotonin reuptake inhibitor (SSRI).
• Side effects of clonazepam and sertraline that are similar include sedation/sleepiness, dizziness, headache, sleep problems (insomnia), changes in sexual desire, and skin rash.
• Side effects of clonazepam that are different from sertraline include depression, loss of orientation, weakness, unsteadiness, lack of inhibition, fatigue, amnesia, confusion, and irritability.
• Side effects of sertraline that are different from clonazepam include nervousness, nausea, tremor, constipation, upset stomach, loss of appetite, diarrhea, abnormal ejaculation, dry mouth, increased sweating, and weight loss.
• Suddenly stopping clonazepam after prolonged use can lead to withdrawal symptoms.

Clonazepam (Klonopin) is an anti-anxiety medication used to treat panic disorder and prevent certain types of seizures, and for short-term relief of anxiety symptoms. Clonazepam is a medication in the benzodiazepine class, which also includes diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and flurazepam (Dalmane). Clonazepam and other benzodiazepines enhance the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. Research shows that excessive activity in the brain may lead to anxiety or other psychiatric disorders.

Sertraline (Zoloft) belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs), which also includes fluoxetine (Prozac, Sarafem), paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva), citalopram (Celexa), and fluvoxamine (Luvox CR). Sertraline is used to treat depression, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD).

Clonazepam

The most common side effects associated with clonazepam are sedation, which is reported in approximately half of patients. Dizziness is reported in one-third of patients.

Other common side effects include:

• Depression
• Loss of orientation
• Headache
• Weakness
• Unsteadiness
• Sleep disturbance
• Lack of inhibition
• Fatigue
• Amnesia
• Confusion
• Changes in sexual desire
• Rash
• Irritability

Other serious side effects of clonazepam include:

• Respiratory depression
• Fainting
• Enlarged liver
• Withdrawal symptoms (if stopped suddenly)
• Increased heart rate
• Low blood pressure
• Blood disorders

Other serious adverse reactions:

• Antiepileptic medications have been associated with an increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need for the antiepileptic drug. Patients who begin antiepileptic therapy should be closely observed for clinical worsening, suicidal thoughts or unusual changes in behavior.

Sertraline

SERTRALINE (ZOLOFT) SIDE EFFECTS WARNING:

• As demonstrated in short-term studies, antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of sertraline (Zoloft) or any other antidepressant in a child or adolescent must balance this risk with the clinical need for the antidepressant. Patients who begin therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

The most common side effects of sertraline are:

• Sleepiness
• Nervousness
• Insomnia
• Dizziness
• Nausea
• Tremor
• Skin rash
• Constipation
• Upset stomach
• Loss of appetite
• Headache
• Diarrhea
• Abnormal ejaculation
• Decreased interest in sexual activity
• Dry mouth
• Increase in sweating, known as diaphoresis
• Weight loss

Possible serious side effects of sertraline include:

• Irregular heartbeats
• Serious allergic reactions
• Worsening of depression
• Serotonin syndrome
• Hyponatremia
• Abnormal bleeding
• Priapism (prolonged erection)
• Decreased liver function
• Suicidality
• Activation of mania in patients with bipolar disorder

Important side effects are irregular heartbeats, allergic reactions, and activation of mania in patients with bipolar disorder.

If sertraline is discontinued abruptly, some patients experience side effects such as:

• Abdominal cramps
• Fatigue
• Nausea
• Vomiting
• Diarrhea
• Headaches
• Lightheadedness
• Dizziness
• Diminished appetite
• Flu-like symptoms
• Sweating
• Chills
• Sleep disturbances
• Memory impairment

Reduce sertraline dosage gradually when discontinuing therapy.

Clonazepam

The dose of clonazepam is tailored to the patient's needs.

• For seizures in adults the initial dose is 1.5 mg daily in 3 divided doses.
• Dosage may be increased by 0.5 to 1 mg daily every 3 days until seizures are controlled or side effects preclude further increases in dose.
• The maximum dose is 20 mg daily. The initial dose for panic disorders is 0.25 mg twice daily.
• The dose may be increased to the target dose of 1 mg daily after 3 days.

Sertraline

• The recommended dose of sertraline is 25 to 200 mg once daily. Treatment of depression, OCD, panic disorder, PTSD, and social anxiety disorder is initiated at 25 to 50 mg once daily. Doses are increased at weekly intervals until the desired response is seen.
• The recommended dose for PMDD is 50 to 150 mg every day of the menstrual cycle or for 14 days before menstruation.
• Sertraline may be taken with or without food.

Clonazepam

Clonazepam, like all other benzodiazepines, accentuates the effects of other drugs that slow the brain's processes -- such as alcohol, barbiturates, and narcotics -- and leads to increased sedation.

Sertraline

All SSRIs, including sertraline, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example:

• isocarboxazid (Marplan)
• phenelzine (Nardil)
• tranylcypromine (Parnate)
• selegiline (Eldepryl, Emsam, Elazar)
• procarbazine (Matulane)

Other drugs that inhibit monoamine oxidase include:

• linezolid (Zyvox)
• intravenous methylene blue

Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. (A period of 14 days without treatment should lapse when switching between sertraline and MAOIs.) Similar reactions occur when sertraline is combined with other drugs -- for example, tryptophan, St. John's wort, meperidine (Demerol, Meperitab), tramadol (ConZip, Synapryn FusePaq, Ultram) -- that increase serotonin in the brain.

Cimetidine (Cimetidine Acid Reducer, Tagamet HB ) may increase the levels of sertraline in blood by reducing the liver's function to eliminate sertraline. Increased levels of sertraline may lead to more side effects.

Sertraline increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and sertraline.

Through unknown mechanisms, sertraline may increase the blood thinning action of warfarin (Coumadin, Jantoven). The effect of warfarin should be monitored when sertraline is started or stopped.

Clonazepam

• Clonazepam and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Clonazepam is best avoided in the first trimester and probably throughout pregnancy.
• Benzodiazepines are secreted in breast milk. Mothers who are breastfeeding should not take clonazepam.

Sertraline

• Use of sertraline during the third trimester of pregnancy may lead to adverse effects in the newborn.
• Use of sertraline by nursing mothers has not been adequately evaluated.