Rivotril contains clonazepam, a long-acting benzodiazepine, as 0.5 mg and 2 mg tablets and as drops. It is used mainly to control epilepsy and certain seizure types, and also for panic disorder and some movement disorders. It causes drowsiness and must never be stopped abruptly.
What is Rivotril?
Rivotril contains clonazepam, a benzodiazepine. In South Africa it is available as 0.5 mg and 2 mg tablets, as oral drops (2.5 mg/ml), and as an injection. It is a Schedule 5 medicine, also sold as Clonam.
Clonazepam enhances the effect of GABA, the brain’s main inhibitory signal. GABA quietens nerve activity, and clonazepam makes it work more strongly — which raises the threshold at which nerve cells fire abnormally.
What separates clonazepam from most benzodiazepines is that it is used primarily as an anticonvulsant rather than for anxiety. It is long-acting, staying in the system far longer than a short-acting benzodiazepine such as the alprazolam in Xanax, which makes it suited to steady round-the-clock seizure control rather than rapid relief.
Because it is often prescribed for epilepsy, one point matters more here than with other benzodiazepines: stopping it suddenly can trigger seizures, including in someone taking it for a reason other than epilepsy. Any change is made gradually, under medical supervision.
What is Rivotril commonly used for?
Clonazepam is prescribed for:
- Epilepsy, particularly myoclonic seizures, atonic seizures and absence seizures, and as add-on treatment where other anticonvulsants have not given full control.
- Lennox-Gastaut syndrome and other childhood epilepsy syndromes.
- Status epilepticus, in emergency settings, usually by injection.
- Panic disorder, where its long action gives steadier cover than a short-acting benzodiazepine.
- Restless legs syndrome, in some cases.
- REM sleep behaviour disorder, where it is a mainstay of treatment.
- Some movement disorders, including certain forms of myoclonus.
The epilepsy use is the one that shapes how the medicine should be handled. Seizure control depends on a steady level in the body, so consistency matters: take it at the same times every day, do not skip doses, and do not run out of supply. Missed doses are a recognised cause of breakthrough seizures.
For panic disorder, the same caveat applies as to every benzodiazepine. Clonazepam relieves symptoms; it does not treat the disorder. Cognitive behavioural therapy has strong evidence and lasting benefit, and an SSRI is the usual long-term medication. Clonazepam has a role — its longer action makes it somewhat less prone to between-dose rebound than alprazolam — but it is not the treatment.
How Rivotril fits into this medicine category
| Group | Examples | Role |
|---|---|---|
| Long-acting benzodiazepines | Clonazepam (Rivotril), diazepam (Betapam) | Seizures, spasm, sustained cover |
| Short-acting benzodiazepines | Alprazolam (Xanax) | Panic, acute anxiety |
| Other anticonvulsants | Lamotrigine, valproate, levetiracetam, pregabalin (Nurika) | First-line epilepsy treatment |
| SSRIs / SNRIs | Escitalopram, sertraline | Long-term anxiety and panic treatment |
| Tricyclics | Amitriptyline (Trepiline) | Depression; nerve pain at lower amounts |
Clonazepam is generally an add-on in epilepsy rather than a first choice, partly because tolerance to its anticonvulsant effect can develop over time. See the mental health and neurology medicines hub.
What to check before using Rivotril
Never stop it abruptly, and do not let your supply run out. Abrupt withdrawal can cause seizures — including in someone who does not have epilepsy — as well as severe anxiety, tremor and insomnia. Plan repeat prescriptions ahead of time.
Do not drink alcohol, which adds substantially to sedation and can suppress breathing.
Do not drive until you know how it affects you. Drowsiness is common and often persists into the day.
Tell your prescriber or pharmacist if:
- You take opioids — tramadol, codeine, morphine. Combining these with a benzodiazepine is a leading cause of fatal respiratory depression.
- You have breathing problems — sleep apnoea, COPD, severe asthma.
- You have liver or kidney disease.
- You have a history of dependence on alcohol, benzodiazepines or other substances.
- You are pregnant, planning pregnancy or breastfeeding. This needs a careful discussion — uncontrolled seizures also carry risk, so never simply stop it on discovering a pregnancy.
- You have depression, which benzodiazepines can deepen.
- You are older, where confusion and falls are markedly more common.
- The medicine is for a child, and check whether tablets or drops were prescribed — the two are not interchangeable by volume.
- You take other sedating medicines or other anticonvulsants.
Follow the dispensing label exactly. This page does not set doses.
Possible cautions and when to ask a pharmacist or doctor
Withdrawal is the central risk. Beyond seizures, stopping suddenly after prolonged use causes anxiety, insomnia, sweating, tremor and agitation. Coming off clonazepam is done slowly, over weeks or months, and is not something to attempt alone.
Tolerance to the anticonvulsant effect develops in some people over months or years — seizures that were controlled begin breaking through. That is a reason to see your prescriber, not to increase the dose yourself.
Drowsiness, unsteadiness and slowed thinking are the commonest effects. In children, behavioural changes and increased salivation or chest secretions are also recognised.
Watch for dependence. Needing more, or anxiety about running out, is worth raising — common, and treatable.
Confusion and falls in older adults are a serious concern.
Paradoxical reactions — agitation or aggression rather than calm — occur occasionally, more often in children and older adults.
Depression can worsen. Report low mood or thoughts of self-harm.
Seek urgent medical attention for slow, shallow or difficult breathing, extreme drowsiness or difficulty waking someone, a seizure that is longer or different from usual, repeated seizures, a fall with injury, confusion, or worsening depression. Contact your prescriber if seizures start breaking through, or if you are running low on supply.
Related medicine guides
Frequently asked questions
What is Rivotril used for? Mainly epilepsy — particularly myoclonic, atonic and absence seizures — and also panic disorder, restless legs and REM sleep behaviour disorder. It contains clonazepam.
Is it the same as Valium? No. Both are benzodiazepines, but Rivotril is clonazepam and Valium is diazepam. Clonazepam is used chiefly as an anticonvulsant.
Can I stop taking it if I feel fine? No. Stopping abruptly can cause seizures, even in someone without epilepsy. Any change must be gradual and medically supervised.
Is it addictive? It can cause dependence, like all benzodiazepines. That is managed by careful prescribing and supervised tapering, not by stopping suddenly.
What if I miss a dose? Ask your prescriber or pharmacist what to do — do not double up. In epilepsy, missed doses are a recognised cause of breakthrough seizures, so keep to a consistent routine.
Can I take it in pregnancy? This needs a specific discussion with your doctor. Uncontrolled seizures also carry risk, so do not stop it on your own if you discover you are pregnant.