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# Clobazam (Oral Formulation)
## Overview
Clobazam is a 1,5-benzodiazepine with anticonvulsant properties. It is generally considered less sedating than other benzodiazepines.
## Primary Indications
* Adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years and older.
## Adult Dosing
* **Lennox-Gastaut Syndrome:** Initial dose is typically 5 mg twice daily. Increase by 5 mg to 10 mg every week. Maximum daily dose is 20 mg twice daily. Dosing may be individualized based on clinical response and tolerability.
## Pediatric Dosing
* **Lennox-Gastaut Syndrome (2 to <10 years):** Initial dose is typically 5 mg once daily. Increase by 2.5 mg to 5 mg every week. Maximum daily dose is 10 mg twice daily.
* **Lennox-Gastaut Syndrome (10 to <18 years):** Initial dose is typically 10 mg once daily. Increase by 5 mg to 10 mg every week. Maximum daily dose is 20 mg twice daily.
* Dosing should be individualized based on clinical response and tolerability.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Specific dose adjustments are not well-defined but may be necessary due to decreased metabolism.
* **Renal Impairment:** Use with caution. Specific dose adjustments are not well-defined but may be necessary as clobazam and its active metabolite are excreted renally.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe respiratory insufficiency.
* Severe hepatic insufficiency.
* Myasthenia gravis.
* Severe sleep apnea.
## Adverse Effects
Common adverse effects include somnolence, saliva (increased), constipation, decreased appetite, fatigue, and aggression. Serious adverse effects include severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), suicidal behavior and ideation, and respiratory depression.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other sedatives):** Additive CNS depressant effects, increasing the risk of sedation, respiratory depression, and death.
* **CYP2C19 Inhibitors (e.g., fluconazole):** May increase clobazam concentrations.
* **CYP2C19 Inducers (e.g., rifampin, carbamazepine):** May decrease clobazam concentrations.
* **Other Anticonvulsants:** Monitor for additive CNS depression and potential changes in efficacy.
## Monitoring
* Monitor for signs of somnolence, behavioral changes, and suicidal ideation.
* Monitor respiratory status, especially in patients with pre-existing respiratory conditions.
* Monitor for signs of severe skin reactions.
* Monitor for drug interactions, especially with concomitant CNS depressants or drugs affecting CYP2C19.
## Clinical Pearls
* Clobazam is a Schedule IV controlled substance.
* Withdrawal symptoms can occur upon abrupt discontinuation. Taper slowly to minimize risks.
* The active metabolite, N-desmethylclobazam, contributes to the overall therapeutic effect and has a longer half-life than the parent drug.
* Due to potential for somnolence, patients should be advised to avoid driving or operating heavy machinery until they know how clobazam affects them.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details. This information is not a substitute for professional medical judgment.*
