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# Clobazam (Oral)
## Overview
Clobazam is a 1,5-benzodiazepine with anticonvulsant properties. It is used as 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 patients 2 years of age and older with Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Lennox-Gastaut Syndrome (LGS):** The recommended starting dose is 5 mg twice daily.
* **Titration:** Increase the dose every week as needed, based on response and tolerability, by 2.5 mg to 5 mg twice daily.
* **Maximum Dose:** The maximum recommended daily dose is 20 mg twice daily (40 mg/day).
## Pediatric Dosing
* **Lennox-Gastaut Syndrome (LGS):**
* **2 to 10 years:** The recommended starting dose is 5 mg once daily.
* **Titration:** Increase the dose every week as needed, based on response and tolerability, by 2.5 mg to 5 mg once daily.
* **Maximum Dose:** The maximum recommended daily dose is 10 mg twice daily (20 mg/day).
* **10 years and older:** Dosing is the same as for adults.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are provided, but lower doses may be warranted due to reduced clearance.
* **Renal Impairment:** Use with caution. No specific dose adjustments are provided.
## Contraindications
* Known hypersensitivity to clobazam or any of its ingredients.
## Adverse Effects
* **Common:** Somnolence, decreased appetite, constipation, aggression, irritability, fatigue, vomiting.
* **Serious:** Suicidal behavior and ideation, severe skin reactions (e.g., Stevens-Johnson syndrome), respiratory depression, dependence and withdrawal symptoms, cognitive impairment.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other benzodiazepines, sedating antihistamines):** Additive CNS depressant effects, increased risk of sedation, respiratory depression, and coma.
* **CYP2C19 Inhibitors (e.g., fluconazole):** May increase clobazam concentrations.
* **CYP2C19 Inducers (e.g., rifampin, carbamazepine):** May decrease clobazam concentrations.
* **Clobazam is a CYP2C19 inhibitor:** May increase concentrations of drugs metabolized by CYP2C19 (e.g., diazepam, phenytoin, proton pump inhibitors).
## Monitoring
* Monitor for somnolence and fatigue.
* Assess for signs and symptoms of suicidal behavior or ideation.
* Monitor for signs of respiratory depression, especially when used concomitantly with other CNS depressants.
* Monitor for signs of withdrawal if discontinuing the medication.
## Clinical Pearls
* Clobazam should be used as adjunctive therapy only.
* Taper the dose gradually when discontinuing to avoid withdrawal symptoms.
* Due to its long half-life, clobazam can accumulate, especially with multiple daily doses.
* Patients should be advised not to drive or operate heavy machinery until they know how clobazam affects them.
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**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the official prescribing information and current clinical guidelines for the most up-to-date and comprehensive information before making any treatment decisions.
