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# Clobazam (Oral Formulation)
## 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 patients 2 years of age and older. It may also be used for other seizure types as per local protocol.
## Primary Indications
* Adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Initiation:** Start with 5 mg twice daily.
* **Titration:** Increase dose by 5-10 mg every week based on clinical response and tolerability.
* **Maintenance:** Usual maintenance dose is 10 mg to 20 mg twice daily.
* **Maximum Daily Dose:** 20 mg twice daily (40 mg/day) for LGS. Higher doses may be used in other seizure types as per local protocol, but caution is advised.
## Pediatric Dosing (2 years and older)
* **Initiation:** Start with 2.5 mg twice daily.
* **Titration:** Increase dose by 2.5-5 mg every week based on clinical response and tolerability.
* **Maintenance:** Usual maintenance dose is 5 mg to 10 mg twice daily.
* **Maximum Daily Dose:** 10 mg twice daily (20 mg/day) for LGS.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. A lower starting dose and slower titration may be warranted.
* **Renal Impairment:** Use with caution. A lower starting dose and slower titration may be warranted.
* **Concomitant Medications:** Consider potential interactions (see Key Drug Interactions).
## Contraindications
* Hypersensitivity to clobazam or other benzodiazepines.
* Severe respiratory insufficiency.
* Severe hepatic insufficiency.
* Myasthenia gravis.
* Severe sleep apnea.
## Adverse Effects
Common adverse effects include somnolence, decreased appetite, constipation, aggression, irritability, and difficulty with coordination. Serious adverse effects include severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), suicidal behavior or ideation, and withdrawal symptoms.
## Key Drug Interactions
* **CYP3A4 Inhibitors/Inducers:** Clobazam is a substrate of CYP3A4. Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole) may increase clobazam levels. Concomitant use with strong CYP3A4 inducers (e.g., rifampin, carbamazepine) may decrease clobazam levels.
* **CYP2C19 Substrates:** Clobazam can inhibit CYP2C19, potentially increasing levels of substrates like citalopram and clopidogrel.
* **CNS Depressants:** Additive CNS depression with other sedating medications (e.g., opioids, alcohol, other benzodiazepines, antihistamines).
* **Phenytoin:** Clobazam can increase phenytoin levels.
## Monitoring
* Monitor for efficacy (seizure frequency).
* Monitor for adverse effects, especially somnolence, dizziness, and behavioral changes.
* Monitor for signs of suicidal behavior or ideation.
* Monitor for signs of withdrawal if discontinuing therapy.
* Consider drug levels if interactions are suspected or efficacy is suboptimal.
## Clinical Pearls
* Clobazam has a longer half-life than many other benzodiazepines, which may allow for less frequent dosing, though it is typically dosed twice daily.
* Abrupt discontinuation can lead to withdrawal symptoms, including seizures. Taper gradually under medical supervision.
* Clobazam oral suspension contains sorbitol and may have a laxative effect.
**Disclaimer:** This information is intended for healthcare professionals and does not substitute for current prescribing information. Always consult the official drug monograph and local protocols for the most up-to-date and comprehensive guidance.
