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# Clobazam (Oral)
## Overview
Clobazam is a benzodiazepine derivative used as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
## Primary Indications
* Adjunctive treatment of seizures in Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Initial:** 5 mg twice daily.
* **Titration:** Increase dose every week by 5 mg to 10 mg per day, divided into two doses, as tolerated.
* **Maintenance:** Usual maintenance dose is 10 mg to 20 mg twice daily.
* **Maximum:** 20 mg twice daily (40 mg per day).
## Pediatric Dosing (2 years and older)
* **Initial:** 5 mg once daily.
* **Titration:** Increase dose every week by 2.5 mg to 5 mg per day, divided into two doses, as tolerated.
* **Maintenance:** Usual maintenance dose is 5 mg to 10 mg twice daily.
* **Maximum:** 10 mg twice daily (20 mg per day).
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower starting dose and slower titration.
* **Renal Impairment:** Use with caution. Consider a lower starting dose and slower titration.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe respiratory insufficiency.
* Severe hepatic insufficiency.
## Adverse Effects
* **Common:** Somnolence, agitation, aggression, irritability, mood changes, decreased appetite, constipation, abnormal gait, fatigue, respiratory depression.
* **Serious:** Suicidal behavior and ideation, severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis), withdrawal symptoms, dependence, paradoxical reactions (e.g., increased seizure frequency, aggression).
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other benzodiazepines, sedating antihistamines):** Additive CNS depression. Increased risk of sedation, respiratory depression, and coma.
* **CYP2C19 Inhibitors/Inducers:** Clobazam is a substrate of CYP2C19. Strong inhibitors (e.g., fluconazole) may increase clobazam levels, while strong inducers (e.g., rifampin) may decrease levels.
* **Stimulants:** May antagonize the therapeutic effect of stimulants used for ADHD.
## Monitoring
* Monitor for somnolence and fatigue.
* Assess for behavioral and mood changes, including suicidal ideation.
* Monitor for signs of withdrawal if discontinued abruptly.
* Evaluate seizure frequency and characteristics.
* Monitor for severe skin reactions.
## Clinical Pearls
* Clobazam should be tapered gradually upon discontinuation to avoid withdrawal symptoms.
* Due to the risk of somnolence, patients should be cautioned about operating machinery or driving until they know how clobazam affects them.
* Consider dose reduction in patients taking strong CYP2C19 inhibitors.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and local protocols for complete details.*
