Please check your internet connection and try again.
# Clobazam (Oral Formulation)
## Overview
Clobazam is a benzodiazepine derivative with anticonvulsant properties, primarily used as adjunctive therapy for seizures. It has a longer half-life and a different pharmacokinetic profile compared to other benzodiazepines.
## Primary Indications
* Adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
## Adult Dosing
* **Lennox-Gastaut Syndrome (LGS):**
* **Initiation:** 5 mg twice daily.
* **Maintenance:** Increase dose every week as needed based on clinical response and tolerability, not to exceed a total daily dose of 10 mg twice daily (20 mg/day).
## Pediatric Dosing
* **Lennox-Gastaut Syndrome (LGS):**
* **Ages 2 to less than 10 years OR weighing less than 30 kg:**
* **Initiation:** 2.5 mg once daily.
* **Maintenance:** Increase dose every week as needed based on clinical response and tolerability, not to exceed a total daily dose of 5 mg twice daily (10 mg/day).
* **Ages 10 years and older OR weighing 30 kg or more:**
* **Initiation:** 5 mg twice daily.
* **Maintenance:** Increase dose every week as needed based on clinical response and tolerability, not to exceed a total daily dose of 10 mg twice daily (20 mg/day).
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment guidelines are established, but reduced doses may be necessary due to impaired metabolism.
* **Renal Impairment:** Use with caution. No specific dose adjustment guidelines are established.
## Contraindications
* Known 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 vomiting. Serious adverse effects include severe skin reactions (e.g., Stevens-Johnson syndrome), withdrawal symptoms, and paradoxical reactions (e.g., increased seizures, agitation).
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other sedatives):** Increased risk of profound sedation, respiratory depression, coma, and death.
* **CYP2C19 Inhibitors (e.g., fluconazole, omeprazole):** May increase clobazam concentrations.
* **CYP2C19 Inducers (e.g., rifampin):** May decrease clobazam concentrations.
* **CNS Stimulants:** May antagonize the sedative effects of clobazam.
## Monitoring
* Monitor for seizure frequency and severity.
* Assess for adverse effects, particularly somnolence, behavioral changes, and signs of skin reactions.
* Monitor for signs of withdrawal upon discontinuation.
## Clinical Pearls
* Clobazam should be tapered gradually upon discontinuation to avoid withdrawal symptoms.
* Due to the risk of severe skin reactions, patients should be educated to discontinue clobazam and seek immediate medical attention if a rash develops.
* Dosing should be individualized based on clinical response and tolerability.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details. Dosing and recommendations may vary based on individual patient factors and local protocols.*
