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# Clobazam (Oral Formulation)
## Overview
Clobazam is a benzodiazepine derivative with anticonvulsant properties. It is used as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in pediatric patients 2 years of age and older, and in adults.
## Primary Indications
* Adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Initiation:** Start at 5 mg twice daily.
* **Titration:** Increase dose gradually by 5-10 mg every week as tolerated.
* **Maintenance:** Usual maintenance dose is 10-20 mg twice daily.
* **Maximum:** Maximum recommended daily dose is 20 mg twice daily (40 mg/day).
## Pediatric Dosing (2 years and older)
* **Initiation:** Start at 5 mg once daily.
* **Titration:** Increase dose gradually by 5-10 mg every week as tolerated.
* **Maintenance:** Usual maintenance dose is 0.5-1 mg/kg/day divided into two doses.
* **Maximum:** Maximum recommended daily dose is 10 mg twice daily (20 mg/day).
* **Note:** Dosing should be individualized based on response and tolerance.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider lower starting doses and slower titration.
* **Renal Impairment:** Use with caution. Consider lower starting doses and slower titration.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe hepatic impairment.
## Adverse Effects
* **Common:** Somnolence, fatigue, decreased appetite, constipation, aggression, irritability, abnormal gait, dizziness, nausea, vomiting.
* **Serious:** Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), suicidal behavior or ideation, respiratory depression, dependence and withdrawal symptoms, paradoxical reactions (increased seizure frequency, aggression).
## Key Drug Interactions
* **CNS Depressants:** Increased risk of sedation and respiratory depression with alcohol, opioids, other benzodiazepines, sedating antihistamines, and antipsychotics.
* **CYP2C19 Substrates/Inhibitors:** Clobazam is a CYP2C19 substrate. Strong inhibitors (e.g., fluconazole) may increase clobazam levels, and strong inducers (e.g., rifampin) may decrease levels.
* **CNS Stimulants:** May decrease the effectiveness of stimulants.
* **Other Anticonvulsants:** Monitor for altered efficacy or increased adverse effects.
## Monitoring
* Monitor for seizure frequency and characteristics.
* Assess for signs of somnolence, sedation, and cognitive impairment.
* Evaluate for behavioral changes, including aggression and suicidal ideation.
* Monitor for signs of skin reactions.
* Assess for withdrawal symptoms upon discontinuation.
## Clinical Pearls
* Clobazam should be tapered slowly upon discontinuation to avoid withdrawal symptoms.
* Be aware of the potential for paradoxical worsening of seizures, especially in certain epilepsy syndromes.
* Due to potential for serious skin reactions, educate patients on early signs and symptoms and advise to seek immediate medical attention if they occur.
* Clobazam is a Schedule IV controlled substance.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical judgment. Always refer to the most current prescribing information and relevant guidelines before making clinical decisions.*
