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# Clobazam (Oral Formulation)
## Overview
Clobazam is a benzodiazepine medication used as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS). It acts as a central nervous system depressant.
## Primary Indications
Adjunctive treatment of seizures in patients 2 years of age and older with Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Initiation:** 5 mg twice daily.
* **Titration:** Increase dose by 5 mg to 10 mg every week based on clinical response and tolerability.
* **Maintenance:** Typical maintenance dose is 10 mg to 20 mg twice daily.
* **Maximum Dose:** 20 mg twice daily (40 mg/day).
## Pediatric Dosing (2 to <10 years of age OR <30 kg)
* **Initiation:** 5 mg once daily.
* **Titration:** Increase dose by 2.5 mg to 5 mg every week based on clinical response and tolerability.
* **Maintenance:** Typical maintenance dose is 0.5 mg/kg/day to 1 mg/kg/day divided into two doses.
* **Maximum Dose:** 10 mg twice daily (20 mg/day).
*Note: Dosing for children 10 years of age or older OR weighing 30 kg or more can follow adult dosing guidelines.*
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dosing adjustments are established, but dose reduction may be considered.
* **Renal Impairment:** Use with caution. No specific dosing adjustments are established, but dose reduction may be considered.
## Contraindications
* Hypersensitivity to clobazam or other benzodiazepines.
* Severe hepatic impairment.
## Adverse Effects
Common adverse effects include somnolence, drooling, constipation, decreased appetite, fatigue, aggression, and irritability. Serious adverse effects include respiratory depression, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), and withdrawal symptoms.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other benzodiazepines, barbiturates):** Increased risk of sedation, respiratory depression, and potentially fatal outcomes.
* **CYP2C19 Inhibitors (e.g., fluconazole, omeprazole):** May increase clobazam concentrations.
* **CYP2C19 Inducers (e.g., rifampin):** May decrease clobazam concentrations.
* **Other Antiepileptic Drugs (AEDs):** Monitor for potential additive CNS depression and efficacy changes.
## Monitoring
* Monitor for seizure frequency and severity.
* Assess for CNS depressant effects (e.g., somnolence, dizziness).
* Monitor for signs of abuse and dependence, especially with long-term use or higher doses.
* Observe for severe dermatologic reactions.
* Evaluate for withdrawal symptoms upon discontinuation.
## Clinical Pearls
* Clobazam should be used as adjunctive therapy and
