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## Clobazam (Oral) ### Overview Clobazam is a 1,5-benzodiazepine with anticonvulsant properties. It is used as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in pediatric and adult patients. ### Primary Indications Adjunctive therapy for seizures in Lennox-Gastaut syndrome (LGS). ### Adult Dosing * **Initial:** 5 mg twice daily. * **Titration:** Increase dose every week as tolerated, up to a maximum of 10 mg twice daily (total daily dose 20 mg). * **Maintenance:** Dose should be individualized based on response and tolerability. ### Pediatric Dosing * **Patients 2 to less than 10 years:** * **Initial:** 5 mg once daily. * **Titration:** Increase dose every week as tolerated, up to a maximum of 10 mg twice daily (total daily dose 20 mg). * **Patients 10 years and older:** Dosing is the same as for adults. * **Note:** For children under 2 years, dosing is not established. ### Dose Adjustments * **Hepatic Impairment:** Use with caution. Data is limited, but a reduced dose may be necessary. * **Renal Impairment:** Use with caution. Data is limited, but a reduced dose may be necessary. * **Concomitant Medications:** Consider potential drug interactions, particularly with other CNS depressants and CYP2C19 inhibitors/inducers. ### Contraindications * Hypersensitivity to clobazam or other benzodiazepines. ### Adverse Effects * **Common:** Somnolence, decreased appetite, constipation, aggression, irritability, fatigue, vomiting, drooling, ataxia, difficulty with gait, sleep disturbances. * **Serious:** Suicidal behavior or ideation, severe somnolence, withdrawal symptoms (including seizures if abruptly discontinued), respiratory depression, potential for dependence and abuse. ### Key Drug Interactions * **CYP2C19 Inhibitors (e.g., fluconazole):** May increase clobazam concentrations. Consider dose reduction. * **CYP2C19 Inducers (e.g., rifampin):** May decrease clobazam concentrations. Consider dose increase. * **Other CNS Depressants (e.g., opioids, alcohol, other benzodiazepines):** Additive sedative effects. Monitor closely for respiratory depression and excessive sedation. * **Stimulants (e.g., methylphenidate, amphetamines):** Clobazam may reduce the efficacy of stimulants. ### Monitoring * Monitor for somnolence, behavioral changes, and signs of withdrawal. * Assess for suicidal ideation and behavior regularly. * Monitor for effectiveness in seizure control. ### Clinical Pearls * Clobazam is a Schedule IV controlled substance. * Do not abruptly discontinue clobazam; taper gradually to avoid withdrawal symptoms. * Clobazam can be taken with or without food. * Oral suspension should be administered using the provided dosing device. *** **Disclaimer:** This information is intended for clinical use and does not replace the official prescribing information or institutional protocols. Always verify current prescribing information with the manufacturer's product monograph or other reliable resources.