Please check your internet connection and try again.
# Clobazam (Oral Formulation)
## Overview
Clobazam is a benzodiazepine derivative with anticonvulsant properties. It acts as an anxiolytic and has shown efficacy in certain seizure disorders.
## Primary Indications
* Adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
* Off-label: Management of anxiety disorders.
## Adult Dosing
* **LGS:** Initiate at 5 mg twice daily. Increase by 5-10 mg every week as needed and tolerated. Maximum daily dose: 20 mg twice daily (40 mg/day).
* **Anxiety (off-label):** Dosing varies widely. Common starting doses are 5-10 mg once or twice daily, titrated up to a maximum of 30 mg/day in divided doses.
## Pediatric Dosing
* **LGS (2 to <10 years or weighing <30 kg):** Initiate at 2.5 mg twice daily. Increase by 2.5-5 mg every week as needed and tolerated. Maximum daily dose: 10 mg twice daily (20 mg/day).
* **LGS (10 years or older or weighing ≥30 kg):** Initiate at 5 mg twice daily. Increase by 5-10 mg every week as needed and tolerated. Maximum daily dose: 10 mg twice daily (20 mg/day).
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Lower doses may be necessary.
* **Renal Impairment:** Use with caution. Lower doses may be necessary.
## Contraindications
* Hypersensitivity to clobazam or other benzodiazepines.
* Severe respiratory impairment.
* Severe hepatic insufficiency.
* Acute narrow-angle glaucoma.
## Adverse Effects
* **Common:** Somnolence, dizziness, fatigue, ataxia, drooling, constipation, nausea, vomiting, irritability, difficulty speaking, behavioral changes.
* **Serious:** Respiratory depression, dependence and withdrawal symptoms, suicidal ideation, serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), paradoxical reactions.
## Key Drug Interactions
* **CNS Depressants (alcohol, opioids, other sedatives):** Additive CNS depression; increased risk of sedation, respiratory depression.
* **CYP1A2 Inhibitors (e.g., fluvoxamine):** May increase clobazam levels.
* **CYP2C19 Inducers (e.g., rifampin):** May decrease clobazam levels.
* **CYP2C19 Substrates (e.g., proton pump inhibitors):** Clobazam may inhibit CYP2C19, potentially increasing levels of these drugs.
## Monitoring
* Monitor for sedation, dizziness, and cognitive impairment.
* Assess for respiratory depression, especially when co-administered with other CNS depressants.
* Observe for signs of withdrawal upon discontinuation.
* Monitor for changes in seizure frequency or severity.
* Monitor for behavioral changes and suicidal ideation.
## Clinical Pearls
* Clobazam has a longer half-life than many other benzodiazepines, potentially allowing for once or twice-daily dosing.
* Tapering of the dose is recommended upon discontinuation to avoid withdrawal symptoms.
* The risk of serious skin reactions is rare but can be life-threatening. Educate patients to discontinue immediately and seek medical attention if a rash develops.
* Clobazam is a Schedule IV controlled substance.
---
***Disclaimer:*** *This information is intended for healthcare professionals. Always consult the official prescribing information and relevant literature for complete details. Dosing and indications may vary based on local protocols and patient-specific factors.*
