Please check your internet connection and try again.
# Clobazam (Oral Formulation)
## Overview
Clobazam is a 1,5-benzodiazepine with anticonvulsant properties, used as adjunctive therapy in certain seizure disorders. It is a schedule IV controlled substance.
## Primary Indications
Adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
## Adult Dosing
* **Lennox-Gastaut Syndrome:**
* Initiate at 5 mg twice daily.
* After 1 week, increase to 10 mg twice daily.
* Further increases of 5-10 mg per day may be made at intervals of 1 week or more, not to exceed a maximum daily dose of 20 mg twice daily (40 mg/day).
* Doses should be titrated based on clinical response and tolerability.
## Pediatric Dosing (2 years and older)
* **Lennox-Gastaut Syndrome:**
* Initiate at 2.5 mg twice daily.
* After 1 week, increase to 5 mg twice daily.
* Further increases of 2.5-5 mg per day may be made at intervals of 1 week or more, not to exceed a maximum daily dose of 10 mg twice daily (20 mg/day).
* Doses should be titrated based on clinical response and tolerability.
## Dose Adjustments
* **Hepatic Impairment:** Caution is advised. Lower doses may be required.
* **Renal Impairment:** Caution is advised. Lower doses may be required.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe hepatic impairment.
## Adverse Effects
Common: Somnolence, decreased appetite, constipation, aggression, irritability, fatigue, rash.
Serious: Serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), suicidal ideation and behavior, withdrawal symptoms (seizures, rebound insomnia, anxiety), respiratory depression (especially when combined with other CNS depressants).
## Key Drug Interactions
* **CNS Depressants (e.g., opioids, alcohol, other benzodiazepines):** Additive CNS depression, potentially leading to profound sedation, respiratory depression, coma, and death. Use with extreme caution or avoid.
* **CYP3A4 Inducers (e.g., rifampin, carbamazepine):** May increase clobazam metabolism and decrease efficacy.
* **CYP3A4 Inhibitors (e.g., ketoconazole, fluconazole):** May increase clobazam levels and toxicity.
* **Valproic Acid:** Concomitant use may increase valproic acid levels.
## Monitoring
* Monitor for efficacy (seizure frequency).
* Monitor for adverse effects, especially somnolence, behavioral changes, and signs of serious skin reactions.
* Monitor for signs of withdrawal upon discontinuation.
* Consider monitoring valproic acid levels if co-administered.
## Clinical Pearls
* Clobazam should be used as adjunctive therapy and not as monotherapy for LGS.
* Taper slowly upon discontinuation to avoid withdrawal symptoms.
* Patients and caregivers should be advised about the risks of suicidal behavior and serious skin reactions.
* Clobazam's long half-life can lead to accumulation, particularly in the elderly or those with hepatic/renal impairment.
This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details.
