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# Clobazam (Oral)
## Overview
Clobazam is a benzodiazepine derivative used as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years and older.
## Primary Indications
* Adjunctive therapy for seizures in Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Initiation:** 5 mg twice daily.
* **Titration:** Increase dose by 5-10 mg every week based on clinical response and tolerability.
* **Maintenance:** Usual dose is 10-20 mg twice daily.
* **Maximum:** 20 mg twice daily.
## Pediatric Dosing (2 to less than 10 years of age, or weighing less than 30 kg)
* **Initiation:** 2.5 mg twice daily.
* **Titration:** Increase dose by 2.5-5 mg every week based on clinical response and tolerability.
* **Maintenance:** Usual dose is 5-10 mg twice daily.
* **Maximum:** 10 mg twice daily.
*Note: Dosing for pediatric patients 10 years and older, or weighing 30 kg or more, should follow adult dosing guidelines.*
## 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
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe respiratory impairment.
* Severe hepatic impairment.
* Acute narrow-angle glaucoma.
## Adverse Effects
* **Common:** Somnolence, decreased appetite, constipation, fatigue, aggression, irritability, vomiting.
* **Serious:** Suicidal behavior and ideation, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), respiratory depression, physical and psychological dependence, withdrawal symptoms.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other sedatives):** Additive CNS depression. Avoid concomitant use or use with extreme caution and dose reduction.
* **CYP2C19 Inhibitors (e.g., omeprazole):** May increase clobazam concentrations.
* **CYP2C19 Inducers (e.g., rifampin):** May decrease clobazam concentrations.
* **Antiepileptic Drugs (AEDs):** Clobazam may increase or decrease levels of other AEDs; monitor for efficacy and toxicity.
## Monitoring
* Monitor for therapeutic efficacy (reduction in seizure frequency).
* Monitor for signs of somnolence, dizziness, and fatigue.
* Monitor for suicidal behavior and ideation.
* Monitor for signs of respiratory depression, especially with concomitant CNS depressants.
* Monitor for withdrawal symptoms upon discontinuation.
* Monitor for severe skin reactions.
## Clinical Pearls
* Clobazam is a Schedule IV controlled substance.
* Withdrawal symptoms can occur upon abrupt discontinuation. Tapering is recommended.
* Risk of serious skin reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), is increased in patients with the **HLAB*15:02** allele. Genetic testing may be considered prior to initiating therapy in populations where this allele is prevalent.
* Paradoxical reactions (e.g., increased seizure frequency, agitation) may occur.
***Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details and to guide patient-specific management.*
