Please check your internet connection and try again.
# Clobazam (oral)
## Overview
Clobazam is a 1,5-benzodiazepine with anticonvulsant properties. It is used as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS).
## 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:** Doses typically range from 10 mg to 20 mg twice daily.
* **Maximum Recommended Dose:** 20 mg twice daily (40 mg daily).
## Pediatric Dosing
* **Age 2 to <10 years OR weight <30 kg:**
* **Initiation:** 2.5 mg twice daily.
* **Titration:** Increase dose by 2.5 mg to 5 mg every week.
* **Maintenance:** Doses typically range from 5 mg to 10 mg twice daily.
* **Maximum Recommended Dose:** 10 mg twice daily (20 mg daily).
* **Age 10 years and older OR weight >=30 kg:** Dosing is the same as adults.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dosing recommendations, but may require lower doses and slower titration.
* **Renal Impairment:** Use with caution. No specific dosing recommendations.
## Contraindications
* Known hypersensitivity to clobazam or any other benzodiazepine.
* Severe hepatic impairment.
## Adverse Effects
The most common adverse effects include somnolence, decreased appetite, constipation, aggression, irritability, ataxia, and vomiting. Serious adverse effects can include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), respiratory depression, and withdrawal symptoms.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, other benzodiazepines):** Increased risk of sedation, respiratory depression.
* **CYP3A4 Inhibitors (e.g., ketoconazole, ritonavir):** May increase clobazam concentrations.
* **CYP3A4 Inducers (e.g., rifampin, carbamazepine):** May decrease clobazam concentrations.
* **Valproic Acid:** Increased risk of valproate-induced hyperammonemia. Monitor ammonia levels.
* **Stimulants (e.g., methylphenidate, amphetamines):** There is a potential for paradoxical increase in seizure frequency or worsening of behavioral symptoms.
## Monitoring
* Monitor for seizure frequency, efficacy, and adverse effects.
* Monitor for signs and symptoms of SJS/TEN (rash, fever, blistering, mucosal lesions).
* Monitor for signs of withdrawal if the drug is discontinued abruptly.
* Monitor ammonia levels when used concomitantly with valproic acid.
## Clinical Pearls
* Clobazam should be initiated at a low dose and gradually titrated to minimize adverse effects.
* Consider dividing the total daily dose into two or three administrations for better tolerability.
* Abrupt discontinuation can lead to withdrawal symptoms, including a rebound or worsening of seizures. Taper the dose slowly when discontinuing.
*
