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# Clobazam (Oral Formulation)
## Overview
Clobazam is a 1,5-benzodiazepine with anticonvulsant properties. It is a Schedule IV controlled substance.
## Primary Indications
* Adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
* Off-label uses may include other seizure types or anxiety disorders.
## Adult Dosing
* **LGS:** Start with 5 mg twice daily.
* Titrate dose every 3 days as needed, up to a maximum of 20 mg twice daily (40 mg/day).
## Pediatric Dosing
* **LGS (2 to less than 10 years of age):** Start with 5 mg once daily.
* Titrate dose every 3 days as needed, up to a maximum of 10 mg twice daily (20 mg/day).
* **LGS (10 years of age and older):** Dosing is the same as adults.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are provided, but lower doses may be warranted.
* **Renal Impairment:** Use with caution. No specific dose adjustments are provided.
## Contraindications
* Hypersensitivity to clobazam or other benzodiazepines.
## Adverse Effects
* **Common:** Somnolence, constipation, decreased appetite, irritability, aggression, cough, pyrexia, respiratory tract infections.
* **Serious:** Serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), withdrawal symptoms, suicidal behavior and ideation, respiratory depression (especially when used with other CNS depressants), dependence, abuse, misuse, paradoxical reactions.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other benzodiazepines, sedatives, hypnotics):** Additive CNS depression. Increased risk of respiratory depression, profound sedation, coma, and death.
* **CYP2C19 Inhibitors (e.g., fluconazole, omeprazole):** Increased clobazam concentrations.
* **CYP2C19 Inducers (e.g., rifampin):** Decreased clobazam concentrations.
* **Stimulants (e.g., methylphenidate):** May antagonize the anticonvulsant effects of clobazam.
## Monitoring
* Monitor for signs of suicidal behavior and ideation.
* Monitor for respiratory depression and excessive sedation, especially with concomitant use of other CNS depressants.
* Monitor for signs of withdrawal upon discontinuation.
* Monitor for serious skin reactions.
## Clinical Pearls
* Clobazam is a Schedule IV controlled substance.
* Dosing should be individualized.
* Withdrawal symptoms may occur upon abrupt discontinuation. Tapering is recommended.
* Patients and caregivers should be advised of the risk of suicidal behavior and ideation.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and clinical guidelines for complete and up-to-date details on drug therapy.
