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# Clobazam (Oral)
## Overview
Clobazam is a benzodiazepine with anticonvulsant properties. It is primarily used as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS).
## Primary Indications
* Adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
## Adult Dosing
* **Lennox-Gastaut Syndrome (LGS):** Initial dose: 5 mg twice daily.
* **Titration:** Increase dose every 3 days as needed, based on clinical response and tolerability, to a target dose of 0.5-1 mg/kg/day divided into two doses.
* **Maximum Dose:** 20 mg twice daily.
## Pediatric Dosing (2 years and older)
* **Lennox-Gastaut Syndrome (LGS):** Initial dose: 5 mg twice daily.
* **Titration:** Increase dose every 3 days as needed, based on clinical response and tolerability, to a target dose of 0.5-1 mg/kg/day divided into two doses.
* **Maximum Dose:** 10 mg twice daily for patients weighing less than 30 kg; 20 mg twice daily for patients weighing 30 kg or more.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dosage adjustments are recommended, but caution is advised due to potential for increased exposure.
* **Renal Impairment:** Use with caution. No specific dosage adjustments are recommended, but caution is advised.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe hepatic impairment.
## Adverse Effects
* **Common:** Somnolence, drooling, constipation, decreased appetite, aggression, irritability, fatigue, vomiting, ataxia, upper respiratory tract infection.
* **Serious:** Suicidal ideation and behavior, serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), respiratory depression, dependence and withdrawal symptoms, cognitive impairment, paradoxical reactions.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other sedatives):** Additive CNS depressant effects, increasing risk of sedation, respiratory depression, and coma.
* **CYP2C19 Inhibitors (e.g., fluconazole):** May increase clobazam concentrations.
* **CYP2C19 Inducers (e.g., rifampin):** May decrease clobazam concentrations.
* **Valproic Acid:** Increased valproic acid levels have been reported. Monitor for signs of valproic acid toxicity.
## Monitoring
* Monitor for efficacy (reduction in seizure frequency).
* Monitor for adverse effects, especially somnolence, behavioral changes, and signs of dependence.
* Monitor for signs and symptoms of serious skin reactions.
* Monitor for suicidal ideation and behavior.
* If co-administered with valproic acid, monitor valproic acid levels.
## Clinical Pearls
* Clobazam is a Schedule IV controlled substance.
* Withdrawal symptoms can occur upon abrupt discontinuation. Taper gradually.
* Long-term use may lead to tolerance.
* Use caution when driving or operating machinery.
* Patients should be advised to avoid alcohol.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for any medical decisions.*
