Please check your internet connection and try again.
# Clobazam (oral formulation)
## Overview
Clobazam is a 1,5-benzodiazepine with anticonvulsant properties. It is a Schedule IV controlled substance.
## Primary Indications
Adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
## Adult Dosing
* **LGS:** Initiate at 5 mg twice daily. After 1 week, increase to 10 mg twice daily. Further increases may be made in increments of 5-10 mg per day every 1 week based on clinical response and tolerability, not to exceed a maximum dose of 20 mg twice daily.
## Pediatric Dosing
* **LGS (2 to <10 years of age or <30 kg):** Initiate at 5 mg once daily. After 1 week, increase to 5 mg twice daily. Further increases may be made in increments of 2.5-5 mg per day every 1 week based on clinical response and tolerability, not to exceed a maximum dose of 10 mg twice daily.
* **LGS (10 years of age and older or ≥30 kg):** Initiate at 5 mg twice daily. After 1 week, increase to 10 mg twice daily. Further increases may be made in increments of 5-10 mg per day every 1 week based on clinical response and tolerability, not to exceed a maximum dose of 20 mg twice daily.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Initiate at the lower end of the dosing range and titrate slowly.
* **Concomitant CYP2C19 Inhibitors:** May require dose reduction.
## Contraindications
* Hypersensitivity to clobazam or other benzodiazepines.
## Adverse Effects
* **Serious:** Somnolence, Stevens-Johnson syndrome, toxic epidermal necrolysis, suicidal behavior and ideation, dependence and withdrawal symptoms, significant respiratory depression (especially when combined with other CNS depressants).
* **Common:** Somnolence, decreased appetite, constipation, aggression, irritability, insomnia, ataxia, vomiting.
## Key Drug Interactions
* **CYP2C19 Substrates:** Clobazam is a moderate inhibitor of CYP2C19. Avoid concurrent use or use with caution and consider dose reduction of CYP2C19 substrates (e.g., diazepam, phenytoin, certain proton pump inhibitors).
* **Central Nervous System (CNS) Depressants (e.g., alcohol, opioids, other benzodiazepines, barbiturates):** Concomitant use increases the risk of profound sedation, respiratory depression, coma, and death.
* **Antiepileptic Drugs (AEDs):** Clobazam may affect serum concentrations of other AEDs; monitor AED levels and adjust doses as needed.
## Monitoring
* Monitor for somnolence, behavioral changes, and signs of suicidal behavior or ideation.
* Assess for efficacy and tolerability.
* Monitor patients for signs of dependence and withdrawal upon discontinuation.
* Consider monitoring serum concentrations of concomitant AEDs if clinically indicated.
## Clinical Pearls
* Due to its long half-life, clobazam can be dosed once or twice daily.
* Gradual tapering is recommended upon discontinuation to minimize withdrawal symptoms.
* Clobazam may cause dose-related cognitive and motor impairments. Advise patients to avoid driving or operating heavy machinery until they know how clobazam affects them.
* The risk of serious skin reactions is rare but can be life-threatening. Advise patients to discontinue clobazam and seek immediate medical attention if a rash develops.
***
*Please verify current prescribing information for complete details.*
