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# Clobazam (oral formulation)
## Overview
Clobazam is a benzodiazepine derivative used as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS).
## Primary Indications
Adjunctive treatment of seizures in patients with Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Initial:** 5 mg twice daily.
* **Maintenance:** Titrate dose every week as needed and tolerated.
* Typical maintenance dose: 10 mg to 20 mg twice daily.
* Maximum recommended dose: 40 mg twice daily (80 mg total per day).
## Pediatric Dosing
* **Patients 2 years and older:**
* **Initial:** 5 mg twice daily.
* **Maintenance:** Titrate dose every week as needed and tolerated.
* Typical maintenance dose: 0.5 mg/kg/day to 1 mg/kg/day, divided into two doses.
* Maximum recommended dose: 20 mg twice daily (40 mg total per day).
* **Note:** Dosing for children younger than 2 years has not been established.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are established, but consider starting at the lower end of the dosing range.
* **Renal Impairment:** Use with caution. No specific dose adjustments are established.
* **Concomitant CYP2C19 Inhibitors:** Dose may need to be reduced due to increased exposure.
## Contraindications
* Hypersensitivity to clobazam or other benzodiazepines.
* Severe hepatic insufficiency.
## Adverse Effects
* **Common:** Somnolence, decreased appetite, constipation, aggression, irritability, ataxia, vomiting, lethargy, pneumonia.
* **Serious:** Suicidal ideation and behavior, respiratory depression, severe skin reactions (e.g., Stevens-Johnson syndrome), dependence and withdrawal.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other sedatives):** Additive CNS depression, increased risk of sedation and respiratory depression.
* **CYP2C19 Inhibitors (e.g., fluconazole):** Increased clobazam levels and potential for increased adverse effects.
* **CYP2C19 Inducers (e.g., rifampin):** Decreased clobazam levels.
* **Antiepileptic Drugs (AEDs):** Monitor for potential additive sedative effects or changes in AED efficacy.
## Monitoring
* Monitor for increased seizure frequency or severity.
* Monitor for signs and symptoms of suicidal ideation or behavior.
* Monitor for excessive sedation, ataxia, and cognitive impairment.
* Monitor for signs of drug dependence and withdrawal symptoms upon discontinuation.
## Clinical Pearls
* Clobazam is typically used as adjunctive therapy and should not be used as monotherapy for LGS.
* Due to the risk of serious skin reactions, patients should be advised to seek immediate medical attention if a rash develops.
* Abrupt discontinuation can lead to withdrawal symptoms. Tapering is recommended.
* Consider the potential for drug interactions, especially with CYP2C19 substrates and inhibitors.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information for complete details and to ensure patient-specific safety.*
