Please check your internet connection and try again.
# Clobazam (Oral)
## Overview
Clobazam is a 1,5-benzodiazepine with anticonvulsant properties. It is used as an adjunct therapy for seizures associated with Lennox-Gastaut syndrome (LGS) and other seizure types.
## 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. The dose may be increased every 7 days based on clinical response and tolerability.
* **Maximum Dose:** 20 mg twice daily (40 mg/day) for patients weighing 30 kg or more. For patients weighing less than 30 kg, the maximum dose is 10 mg twice daily (20 mg/day).
## Pediatric Dosing
* **Lennox-Gastaut Syndrome (LGS):**
* **2 to less than 10 years of age OR weighing less than 30 kg:**
* Starting Dose: 0.5 mg/kg/day divided into two doses.
* Maximum Dose: 10 mg twice daily (20 mg/day).
* **10 years of age and older OR weighing 30 kg or more:**
* Starting Dose: 5 mg twice daily.
* Maximum Dose: 20 mg twice daily (40 mg/day).
* Dose increases should be made cautiously, no more than every 7 days, based on clinical response and tolerability.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dosage adjustments are provided, but liver impairment may affect metabolism.
* **Renal Impairment:** Use with caution. No specific dosage adjustments are provided.
* **Concomitant Use with CYP2C19 Inhibitors or Inducers:** May require dose adjustment of clobazam. Monitor for efficacy and toxicity.
* **Concomitant Use with Valproic Acid:** Monitor for elevated valproic acid levels and signs of valproic acid toxicity (e.g., hyperammonemia, encephalopathy). Dose reduction of clobazam may be necessary.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
## Adverse Effects
* **Common:** Somnolence, decreased appetite, constipation, aggression, irritability, cough, fatigue, vomiting, upper respiratory tract infection, ataxia, drooling.
* **Serious:** Serious skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis), suicidal behavior and ideation, withdrawal symptoms (including rebound seizures, status epilepticus), respiratory depression, dependence and abuse potential.
## Key Drug Interactions
* **Central Nervous System (CNS) Depressants:** Additive CNS depression (e.g., alcohol, opioids, other benzodiazepines, sedatives, hypnotics, certain antihistamines). Use with caution and consider dose reduction.
* **CYP2C19 Substrates/Inhibitors/Inducers:** Clobazam is metabolized by CYP2C19. Fluconazole (inhibitor) can increase clobazam levels. Rifampin (inducer) can decrease clobazam levels. Monitor for altered efficacy or toxicity.
* **Valproic Acid:** May lead to elevated valproic acid levels. Close monitoring of valproic acid levels and clinical signs of toxicity is recommended.
* **Opioids:** Co-administration with opioids can increase the risk of respiratory depression, sedation, coma, and death. Use the lowest effective doses and limit treatment duration. Monitor for signs and symptoms of respiratory depression and sedation.
## Monitoring
* **Seizure Frequency and Severity:** Monitor for efficacy.
* **CNS Depression:** Assess for somnolence, sedation, and coordination.
* **Behavioral Changes:** Monitor for aggression, irritability, and suicidal ideation.
* **Skin Reactions:** Educate patients and caregivers to report any rash promptly.
* **Withdrawal Symptoms:** Taper dose gradually when discontinuing to minimize withdrawal.
* **Valproic Acid Levels:** If used concurrently.
## Clinical Pearls
* Clobazam can be initiated rapidly and titrated relatively quickly compared to some other antiepileptic drugs.
* Somnolence is a common adverse effect and may necessitate dose reduction or slower titration.
* Long-term use can lead to dependence and withdrawal symptoms upon abrupt discontinuation. Tapering is essential.
* Clobazam has a Black Box Warning regarding serious skin reactions and suicidal behavior/ideation.
***
*Please verify the current prescribing information for complete details.*
