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# Clobazam (Oral Formulation)
## Overview
Clobazam is a benzodiazepine derivative with anticonvulsant properties. It acts as an allosteric modulator of GABA-A receptors, increasing the frequency of chloride channel opening.
## Primary Indications
* Adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
## Adult Dosing
* **Initiation:** 5 mg twice daily.
* **Titration:** Increase dose every week by 5 mg to 10 mg per day, divided into two doses, as tolerated, up to a maximum of 20 mg twice daily.
* **Usual Maintenance:** 10 mg to 20 mg twice daily.
## Pediatric Dosing (2 to <10 years of age and <30 kg)
* **Initiation:** 2.5 mg twice daily.
* **Titration:** Increase dose every week by 2.5 mg to 5 mg per day, divided into two doses, as tolerated, up to a maximum of 10 mg twice daily.
* **Usual Maintenance:** 5 mg to 10 mg twice daily.
## Pediatric Dosing (≥10 years of age or ≥30 kg)
* **Initiation:** 5 mg twice daily.
* **Titration:** Increase dose every week by 5 mg to 10 mg per day, divided into two doses, as tolerated, up to a maximum of 20 mg twice daily.
* **Usual Maintenance:** 10 mg to 20 mg twice daily.
## Dose Adjustments
* **Hepatic Impairment:** Caution advised. Lower doses may be necessary.
* **Concomitant Medications:** Dose reduction of clobazam may be needed when used with strong CYP3A4 inhibitors. Conversely, dose increases may be needed with strong CYP3A4 inducers.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe hepatic impairment.
## Adverse Effects
* **Common:** Somnolence, decreased appetite, constipation, aggression, irritability, fatigue, gait disturbance.
* **Serious:** Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), suicidal behavior and ideation, dependence and withdrawal symptoms, respiratory depression.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other sedatives):** Additive CNS depression.
* **CYP3A4 Inhibitors (e.g., ketoconazole, itraconazole, ritonavir):** Increased clobazam levels.
* **CYP3A4 Inducers (e.g., rifampin, carbamazepine, phenytoin):** Decreased clobazam levels.
* **CNS Stimulants:** May antagonize the sedative effects of clobazam.
## Monitoring
* Monitor for somnolence, fatigue, and gait disturbances, particularly during dose titration.
* Monitor for signs of withdrawal symptoms upon discontinuation.
* Monitor for suicidal behavior and ideation.
* Assess for any skin reactions.
## Clinical Pearls
* Clobazam is generally considered to have a lower risk of tolerance and dependence compared to other benzodiazepines, but this risk still exists.
* Abrupt discontinuation can lead to withdrawal symptoms. Tapering is recommended.
* Clobazam is a Schedule IV controlled substance.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and your institution's protocols for complete and up-to-date guidance.*
