- Clobazam is a benzodiazepine.
- Clobazam is usually used as an adjunctive therapy in patients with focal and Lennox-Gastaut Epilepsies.
- It has also been used in generalised seizures not controlled by first line drugs.
Common side effects
- Sedation, tiredness or drowsiness.
Other notable side effects
- Less commonly, headache and dry mouth
- Be aware of paradoxical reactions which can lead to restlessness, difficulty in falling asleep and agitation, hyperactivity and aggressive outbursts.
- All anticonvulsants are potentially teratogenic and this is often dose related (see section: AED Prescribing - Pregnancy)
- For a complete list of adverse effects, appropriate formularies should be consulted.
- The initiation and escalation dose depends upon age, weight, syndrome, seizure frequency and severity, and side effect profile.
- Unfortunately, a one-dose regime does not fit all.
- A Paediatric Neurologist should be consulted if there is uncertainty.
Commonly used regime
- Initially 0.1 to 0.2mg/kg/day in 1 to 2 doses. Slowly increase initially at weekly intervals up to a total of 0.8mg/kg/day (beyond weight of 30-40kg this guideline does not apply). The dose of 0.8mg/kg/day is a high dose. Dosages of this level should be done in conjunction with a neurologist. Efficacy and side-effect profile must be monitored and slow escalation is emphasised.
- In children > 12 years a reasonable starting dose is 5 mg. However smaller doses are used in young children. It is often helpful to start with a nocte dose.
- In children with a difficult epilepsy, increasing at weekly increments of 5 mgs to a total daily dose of 10 -20mg if tolerated is reasonable. Rarely there may be a need to increase to higher doses.
- If the patient is unable to swallow the tablets whole, the tablet may be crushed and mixed with a small amount of food such as apple sauce, yoghurt, ice cream.
- When discontinuing, withdraw very slowly. Sudden cessation of benzodiazepines can cause seizures. The withdrawal plan is dependent on total daily dosage and duration of treatment but should be done very gradually.
- Dosages per kilogram can only be used in children of weight approximately up to 30-40kgs.
- Consult appropriate formularies for children with higher weights and in the adult range.
- These dosages are only a guide and appropriate formularies should be consulted as needed and tailored to the patient by the primary physician.
- Tablets: 10mg. scored
- Syrup: Can be compounded by a pharmacy.
Interactions | Precautions
- Clobazam may cause drowsiness or sedation.
- Clobazam should be used with extreme caution in patients with severe respiratory insufficiency or sleep apnoea. Caution should be taken if used in conjunction with other potentially sedating drugs.
- You need to adjust the dose in patients who are known to slowly metabolize medications through the liver (known CYP2C19 metabolizers) and individuals with liver disease.