Please check your internet connection and try again.
# Clobazam (Oral)
## Overview
Clobazam is a benzodiazepine derivative with anticonvulsant properties. It is primarily used as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS).
## Primary Indications
* Adjunctive treatment of seizures in patients with Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Initiation:** Start with 5 mg twice daily.
* **Titration:** Increase dose every week based on clinical response and tolerability, not to exceed 10 mg twice daily.
* **Maintenance:** Typical maintenance dose is 10 mg twice daily.
* **Maximum Dose:** 20 mg twice daily (40 mg/day).
## Pediatric Dosing
* **LGS (age 2 years and older):**
* **Initiation:** Start with 5 mg twice daily.
* **Titration:** Increase dose every week based on clinical response and tolerability.
* **Maintenance:**
* **2 to less than 10 years:** Up to 10 mg twice daily.
* **10 years and older (or weighing 30 kg or more):** Up to 20 mg twice daily.
* **Note:** For younger children or those weighing less than 30 kg, the dose should be carefully titrated to the lowest effective dose. Strict adherence to weight-based titrations is recommended.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are established, but a lower starting dose and slower titration may be necessary.
* **Renal Impairment:** No specific dose adjustments are established. Use with caution.
* **Elderly:** No specific dose adjustments are established. Consider a lower starting dose and slower titration due to potential increased sensitivity to benzodiazepines.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe hepatic impairment.
* Severe respiratory insufficiency.
## Adverse Effects
* **Common:** Somnolence, decreased appetite, aggression, irritability, constipation, vomiting, gait disturbances, fatigue, drooling.
* **Serious:** Suicidal ideation and behavior, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), respiratory depression, dependence and withdrawal symptoms, paradoxical reactions (increased seizure frequency or severity, agitation, aggression).
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other sedatives):** Additive CNS depression, potentially leading to excessive sedation, respiratory depression, and coma. Use concomitantly with extreme caution, consider dose reduction of one or both agents.
* **CYP1A2 and CYP2C19 Substrates:** Clobazam is a moderate inhibitor of CYP2C19 and can potentially increase the plasma concentrations of drugs metabolized by this enzyme (e.g., omeprazole, phenytoin, clopidogrel).
* **CYP3A4 Substrates:** Clobazam is a substrate of CYP3A4. Potent CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may increase clobazam levels. Potent CYP3A4 inducers (e.g., rifampin, carbamazepine) may decrease clobazam levels.
* **Other Anticonvulsants:** Clobazam may affect the pharmacokinetics of other anticonvulsants, leading to altered efficacy or toxicity. Monitor therapeutic drug levels and clinical response closely.
## Monitoring
* Monitor for signs of somnolence, sedation, and behavioral changes.
* Assess for worsening depression or suicidal ideation.
* Monitor for signs of paradoxical reactions or increased seizure frequency.
* Monitor for signs of withdrawal if the drug is discontinued abruptly.
* Evaluate for effectiveness in seizure control.
## Clinical Pearls
* Clobazam should be tapered slowly upon discontinuation to avoid withdrawal symptoms.
* Due to the risk of somnolence, patients should be cautioned about operating heavy machinery or driving until they know how the medication affects them.
* Clobazam can be taken with or without food.
* The active metabolite of clobazam, N-desmethylclobazam (norclobazam), has a long half-life and contributes significantly to the drug's effects.
---
**Disclaimer:** This information is intended for clinical use and does not replace the official prescribing information. Always consult the current drug monograph and local protocols for complete and up-to-date guidance.
