II. Indications

  1. Seizure Disorder (Lennox-Gastaut Syndrome)
    1. Adjunctive anticonvulsant

III. Mechanism

  1. Benzodiazepine and partial Gamma-Aminobutyric Acid (GABA) receptor Agonist
  2. Anticonvulsant, Sedative and Anxiolytic properties
  3. Binds CNS at the Benzodiazepine-GABA-A-chloride ionophore receptor complex
    1. GABA affinity becomes increased at receptor site resulting in increased Neuron chloride channel opening
    2. Hyperpolarizes the Neuron, inhibiting the Action Potential and a decreasing Neuron excitability

IV. Precautions

  1. Exercise caution in elderly
  2. Avoid in combination with Opioids and other Sedatives (e.g. other Benzodiazepines)
    1. May result in respiratory depression or coma

V. Dosing: Seizure Disorder (Lennox-Gastaut Syndrome)

  1. Available as tablets, oral suspension (2.5 mg/ml) and oral films (Sympazan)
    1. Film (Sympazan) should be applied to Tongue and allowed to dissolve (do not take with liquids)
  2. Weight >30 kg (and age >=2 years)
    1. Start 5 mg orally twice daily
    2. Increase to 10 mg orally twice daily after 1 week
    3. Increase to 20 mg orally twice daily after 2 weeks
  3. Weight <30 kg (and age >=2 years)
    1. Start 5 mg orally daily
    2. Increase to 5 mg orally twice daily after 1 week
    3. Increase to 10 mg orally twice daily after 2 weeks

VI. Metabolism

  1. CYP2C19 metabolism
    1. Lower dose and titrate slowly in slow CYP2C19 metabolizers

VII. Safety

  1. Avoid in Pregnancy
    1. Use in second and third trimester associated with fetal adverse effects
    2. Effects include decreased fetal movement, Floppy Infant syndrome and medication dependence and withdrawal
  2. Unknown Safety in Lactation

IX. References

  1. (2022) Presc Lett, Resource #361206, Antiseizure Medications
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

clobazam (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CLOBAZAM 10 MG TABLET Generic $0.37 each
CLOBAZAM 2.5 MG/ML SUSPENSION Generic $0.32 per ml
CLOBAZAM 20 MG TABLET Generic $0.49 each
onfi (on 1/2/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
ONFI 10 MG TABLET Generic $0.37 each
ONFI 2.5 MG/ML SUSPENSION Generic $0.32 per ml
ONFI 20 MG TABLET Generic $0.49 each

Ontology: clobazam (C0055891)

Definition (NCI) A 1,5-benzodiazepine and partial gamma-aminobutyric acid (GABA) receptor agonist, with anxiolytic, sedative, and anticonvulsant activities. Clobazam binds to a specific site, distinct from the inhibitory neurotransmitter GABA binding site, on the benzodiazepine-GABA-A-chloride ionophore receptor complex located in the central nervous system (CNS). This binding causes an allosteric modification of the receptor and enhances the affinity of GABA to the receptor leading to an increase in the opening of chloride-channels. This leads to an increase in chloride ion conductance, neuronal hyperpolarization, inhibition of the action potential and a decrease in neuronal excitability.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C012255
SnomedCT 322974006, 387572002, 96236000
LNC LP16080-1, MTHU003360
English 1-phenyl-5-methyl-8-chloro-1,2,4,5- tetrahydro-2,4-diketo-3H-1,5-benzodiazepine, clobazam, Clobazam [epilepsy only], clobazam (medication), clobazam [Chemical/Ingredient], CLOBAZAM, Clobazam [epilepsy only] (product), Clobazam, Clobazam (product), Clobazam (substance), Clobazam [epilepsy only] (substance)
Spanish clobazam [antiepiléptico solamente] (producto), clobazam [antiepiléptico solamente], clobazam (producto), clobazam (sustancia), clobazam