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# Clobazam (oral formulation)
## Overview
Clobazam is a benzodiazepine derivative with anticonvulsant properties, primarily used as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older. It can also be used off-label for other seizure types.
## Primary Indications
* Adjunctive therapy for seizures in Lennox-Gastaut syndrome (LGS) in patients 2 years of age and older.
## Adult Dosing
* **Initial:** 5 mg twice daily.
* **Maintenance:** Gradually increase to a target dose of 10 mg twice daily.
* **Maximum:** 20 mg twice daily (40 mg total daily dose).
## Pediatric Dosing (2 to less than 10 years)
* **Initial:** 2.5 mg twice daily.
* **Maintenance:** Gradually increase to a target dose of 5 mg twice daily.
* **Duration of Titration:** Increase dose slowly over at least 1 week. Consider slower titration if side effects occur.
*Note: Dosing for pediatric patients (10 to less than 18 years) can follow adult dosing, with careful titration and monitoring.*
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are established, but a lower starting dose and slower titration may be warranted.
* **Renal Impairment:** Use with caution. No specific dose adjustments are established, but a lower starting dose and slower titration may be warranted.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
* Severe respiratory impairment.
* Severe hepatic impairment.
* Sleep apnea.
## Adverse Effects
Common: Somnolence, decreased appetite, constipation, irritability, aggression, increased upper airway secretions, pneumonia.
Serious: Suicidal behavior and ideation, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), respiratory depression, abuse and dependence.
## Key Drug Interactions
* **CNS Depressants (e.g., opioids, alcohol, other sedatives):** Increased risk of sedation, respiratory depression, and profound CNS depression.
* **CYP2C19 Inhibitors (e.g., fluconazole, omeprazole):** May increase clobazam concentrations.
* **CYP2C19 Inducers (e.g., rifampin):** May decrease clobazam concentrations.
* **Other Anticonvulsants:** Potential for additive CNS effects and altered pharmacokinetics.
## Monitoring
* Monitor for effectiveness (seizure frequency).
* Monitor for adverse effects, particularly somnolence, behavioral changes, and signs of respiratory depression.
* Monitor for signs of suicidal behavior or ideation.
* Monitor for signs of withdrawal if discontinuing, especially after long-term use.
## Clinical Pearls
* Clobazam is typically used as adjunctive therapy and should not be used as monotherapy for LGS.
* Titrate dose slowly to minimize adverse effects, especially somnolence and behavioral changes.
* Abrupt discontinuation can lead to withdrawal symptoms. Tapering is recommended.
* Due to potential for serious skin reactions, patients should be advised to seek immediate medical attention if a rash develops.
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*This information is intended for clinical use and is not a substitute for professional medical advice. Always verify current prescribing information with the official product monograph or other reliable sources before making clinical decisions.*
