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# Clobazam (Oral) ## Overview Clobazam is a benzodiazepine derivative with anticonvulsant properties. It is used as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS). ## Primary Indications Adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older. ## Adult Dosing * **LGS:** The recommended starting dose is 5 mg twice daily. * **Titration:** Increase dose by 5 mg to 10 mg every week, as tolerated, to a maximum recommended dose of 20 mg twice daily. * **Usual maintenance dose:** 10 mg to 20 mg twice daily. ## Pediatric Dosing (2 years and older) * **LGS:** The recommended starting dose is 5 mg twice daily. * **Titration:** Increase dose by 2.5 mg to 5 mg every week, as tolerated, to a maximum recommended dose of 10 mg twice daily for patients weighing less than 30 kg, and 20 mg twice daily for patients weighing 30 kg or more. * **Usual maintenance dose:** 5 mg to 10 mg twice daily for patients weighing less than 30 kg, and 10 mg to 20 mg twice daily for patients weighing 30 kg or more. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. No specific dosing adjustments are recommended, but lower doses may be appropriate due to potential for increased exposure. * **Renal Impairment:** Use with caution. No specific dosing adjustments are recommended. ## Contraindications * Hypersensitivity to clobazam or other benzodiazepines. * Severe hepatic insufficiency. ## Adverse Effects Common adverse effects include somnolence, decreased appetite, constipation, aggression, irritability, and vomiting. Serious adverse effects include increased seizure frequency or severity, suicidal behavior or ideation, and withdrawal symptoms upon abrupt discontinuation. ## Key Drug Interactions * **CNS Depressants:** Additive CNS depression with alcohol, opioids, other benzodiazepines, sedating antihistamines, and antipsychotics. * **CYP2C19 Inhibitors/Inducers:** Clobazam is metabolized by CYP2C19. Strong inhibitors (e.g., fluconazole) may increase clobazam levels, while strong inducers (e.g., rifampin) may decrease levels. * **Other Anticonvulsants:** Monitor for potential additive CNS depression and altered efficacy of either agent. ## Monitoring * Monitor for increased seizure frequency or severity. * Monitor for signs of suicidal behavior or ideation. * Monitor for signs of withdrawal symptoms (e.g., anxiety, insomnia, tremors) if discontinuing. * Monitor for excessive sedation or behavioral changes. ## Clinical Pearls * Clobazam should be gradually tapered when discontinuing to avoid withdrawal symptoms. * The oral suspension may be preferred for patients with difficulty swallowing tablets. * Due to risks of somnolence and dizziness, patients should be advised to avoid driving or operating heavy machinery until they know how clobazam affects them. *** **Disclaimer:** This information is intended for clinical use and does not replace professional medical judgment. Always consult the most current prescribing information and relevant guidelines before making clinical decisions.