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# Clobazam (Oral)
## Overview
Clobazam is a benzodiazepine with anticonvulsant properties used as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS).
## Primary Indications
Adjunctive treatment of seizures in patients 2 years of age and older with 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, not to exceed a maximum of 20 mg twice daily.
* **Maintenance:** 10 mg twice daily.
## Pediatric Dosing (2 to <10 years of age or <30 kg)
* **Initiation:** 2.5 mg twice daily.
* **Titration:** Increase dose by 2.5-5 mg every week based on clinical response and tolerability.
* If weight is <30 kg, do not exceed a total daily dose of 10 mg (5 mg twice daily).
* If weight is ≥30 kg, do not exceed a total daily dose of 20 mg (10 mg twice daily).
* **Maintenance:** Varies based on weight and response.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment provided, but consider lower doses and slower titration.
* **Renal Impairment:** Use with caution. No specific dose adjustment provided.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe hepatic impairment.
## Adverse Effects
* **Common:** Somnolence, decreased appetite, constipation, aggression, irritability, fatigue, vomiting.
* **Serious:** Suicidal ideation and behavior, respiratory depression, severe cutaneous adverse reactions (SCARs) including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), withdrawal symptoms, dependence.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other benzodiazepines, sedating antihistamines):** Additive CNS depression, increased risk of sedation, respiratory depression. Avoid concomitant use or use with extreme caution and close monitoring.
* **CYP2C19 Inhibitors (e.g., fluconazole, omeprazole):** May increase clobazam plasma concentrations, leading to increased adverse effects.
* **CYP2C19 Inducers (e.g., rifampin):** May decrease clobazam plasma concentrations.
* **Stimulants (e.g., methylphenidate, amphetamines):** May antagonize the sedative effects of clobazam, potentially leading to breakthrough seizures.
## Monitoring
* Monitor for signs and symptoms of suicidal ideation and behavior.
* Monitor for CNS depression, particularly sedation and respiratory depression.
* Monitor for signs of withdrawal upon discontinuation.
* Monitor for severe skin reactions.
* Therapeutic drug monitoring may be considered, especially in cases of poor response or toxicity, although specific target levels are not established.
## Clinical Pearls
* Clobazam is a Schedule IV controlled substance.
* Taper slowly when discontinuing to avoid withdrawal symptoms.
* Due to the risk of serious skin reactions, patients should be counseled to seek immediate medical attention if a rash develops.
* Patients with LGS may have comorbidities that require careful consideration when initiating clobazam.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and professional guidelines before making any clinical decisions.*
