Please check your internet connection and try again.
# 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.
## Adult Dosing
* **Lennox-Gastaut Syndrome:** The recommended starting dose is 5 mg twice daily. Increase by 2.5 mg to 5 mg every week to a target maintenance dose of 10 mg twice daily.
* **Maximum Dose:** 20 mg twice daily.
## Pediatric Dosing
* **Lennox-Gastaut Syndrome (2 to less than 10 years of age):** The recommended starting dose is 2.5 mg twice daily. Increase by 2.5 mg every week to a target maintenance dose of 5 mg twice daily.
* **Lennox-Gastaut Syndrome (10 years of age and older):** Dosing is the same as adults: 5 mg twice daily, increasing to a target maintenance dose of 10 mg twice daily.
* **Maximum Dose:** 10 mg twice daily for patients 2 to less than 10 years of age; 20 mg twice daily for patients 10 years of age and older.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are available, but consider lower starting doses and slower titration.
* **Renal Impairment:** Use with caution. No specific dose adjustments are available.
* **Concomitant Medications:** Gradual dose reduction of clobazam may be necessary if co-administered with strong CYP3A4 or CYP2C19 inhibitors.
## Contraindications
* Hypersensitivity to clobazam or other benzodiazepines.
## Adverse Effects
* **Common:** Somnolence, decreased appetite, constipation, aggression, irritability, upper respiratory tract infection, pneumonia, ataxia, drooling, vomiting, fatigue.
* **Serious:** Suicidal behavior and ideation, severe somnolence, withdrawal symptoms (including seizures), serious skin reactions (e.g., Stevens-Johnson syndrome), respiratory depression.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other benzodiazepines, sedating antihistamines):** Increased risk of sedation, respiratory depression, and coma.
* **CYP3A4 Inhibitors (e.g., ketoconazole, itraconazole):** May increase clobazam concentrations.
* **CYP2C19 Inhibitors (e.g., fluconazole, omeprazole):** May increase clobazam concentrations.
* **CYP3A4/CYP2C19 Inducers (e.g., carbamazepine, phenytoin, rifampin):** May decrease clobazam concentrations.
* **Stimulants (e.g., amphetamine, methylphenidate):** May reduce the efficacy of clobazam.
## Monitoring
* Monitor for worsening depression, suicidal thoughts or behaviors, and unusual changes in behavior.
* Monitor for excessive sedation and cognitive impairment.
* Monitor for signs and symptoms of withdrawal upon discontinuation.
* Monitor seizure frequency.
## Clinical Pearls
* Clobazam is indicated as adjunctive therapy for LGS. Its efficacy in other seizure types is not established.
* Due to its potential for somnolence and cognitive impairment, patients should be cautioned about operating machinery or driving.
* Abrupt discontinuation can lead to withdrawal symptoms, including seizures. Tapering is recommended.
* Be aware of the potential for drug interactions, especially with other CNS depressants and CYP enzyme modulators.
***
**Disclaimer:** This information is intended for healthcare professionals and does not replace professional judgment. Always consult the most current prescribing information and relevant guidelines before making clinical decisions.
