Clobazam
Clobazam is a benzodiazepine that, when combined with other medications, helps manage seizures in adults and children aged 2 years and older who have Dravet, Lennox-Gastaut syndrome and other types of epilepsy.What are the uses of Clobazam (Indications)?
- Seizures associated with Lennox-Gastaut syndrome (LGS) in patients aged 2 years or older (adjunctive)
- Dravet Syndrome
- Febrile Seizures
- Seizures treatment refractory (adjunctive, off-label)
- Catamenial epilepsy (adjunctive, off-label)
How is Clobazam available?
- Tablets – Typically in doses of 5 mg and 10 mg.
- Oral Suspension – Usually available in a concentration of 5 mg/5 mL and also 2.5mg/ 1ml. Before giving any medicine to your child, please double-check the doctor’s prescription and make sure the medicine and its strength match what was prescribed.
- Orally Disintegrating Tablets – For easier administration in certain patients, especially those with difficulty swallowing.
How does Clobazam work in the body? /How does Clobazam control seizures?
Clobazam is a benzodiazepine that helps to regulate excessive brain activity by increasing the effects of GABA, a neurotransmitter that slows down nerve signals, thereby preventing seizures and reducing anxiety.How much time does it take for Clobazam to show results?
Clobazam usually begins to take effect within 30 minutes to 2 hours after being taken orally. The highest concentration in the blood is typically reached within 1 to 4 hours. However, the timing and duration of its effects can vary depending on factors such as dosage, metabolism, and whether it is taken with food. For long-term effects, it may take a few days to achieve a steady level in the body, particularly with regular use.Why is Clobazam a key part of your/your child’s treatment plan?
Clobazam is an important part of epilepsy treatment plan because it helps reduce the frequency of seizures, providing better control over daily activities and improving overall quality of life. By enhancing the calming effects in the brain, it helps stabilize brain activity, making seizures less likely to occur. It works quickly and is generally well-tolerated, making it a valuable option for managing seizures and improving overall well-being.
What is the best time to take Clobazam for maximum effectiveness?
Clobazam is ideally taken at bedtime if prescribed once daily, as it can cause drowsiness, helping to minimize daytime sedation. If taken twice daily, doses are usually split between morning and night to maintain steady blood levels and seizure control.
What is the right way to give the medicine?
Tablets: Swallow the tablets intact with some water. Don’t crush, chew, or break the tablet unless your doctor advises you to do so.Liquid or suspension: It comes with an adapter and oral dosing syringes. Use syringe to measure your dose and keep the second one as a backup. Be sure to shake the liquid thoroughly before each use to ensure the medication is evenly mixed.
Orally Disintegrating/ Dispersible Tablets: Place the dispersible tablet under the tongue or between the cheek and teeth. Let it dissolve completely, then take a sip of water.
What steps should I take if I forget or miss a dose?
If you forget a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed one and continue with your regular dosing schedule.
DO NOT DOUBLE THE DOSE OF CLOBAZAM.
What should I do if my child vomits after taking a dose of Clobazam?
If your child vomits within 30 minutes of taking the dose, you can give the dose again. However, if they vomit after 30 minutes, simply skip the missed dose and do not repeat it.
Are there any potential side effects of Clobazam for my child?
Every medication has both beneficial and potential negative effects. Fortunately, not everyone experiences adverse effects, but it is important to be aware of them. Knowing the possible side effects helps us react swiftly and appropriately if they occur, ensuring we can address any concerns promptly while continuing to experience the benefits of the medication.
Although rare, some individuals may experience serious side effects when taking a drug. If you notice any of the following signs or symptoms, which may indicate a severe side effect, consult your doctor or seek medical assistance immediately.
Side effects of Clobazam (Adverse drug reactions):
- Nervous System: Drowsiness, trouble sleeping, coordination issues, aggression, irritability, tiredness, slurred speech.
- Respiratory: Cough, breathing problems, upper respiratory infections, pneumonia.
- Digestive: Nausea, vomiting, constipation, changes in appetite, stomach bloating.
- Urinary: Drooling, urinary problems, urinary tract infections.
- Muscles: Muscle spasms.
- Blood: Low red blood cells, white blood cells, or platelets.
- Skin: Rash, serious skin reactions (SJS, TEN), hives.
- Eyes: Blurred or double vision.
- Liver: Increased liver enzymes.
- Other: Low body temperature.
Serious allergic reaction involving multiple organs (Drug reaction with eosinophilia and systemic symptoms (DRESS)/Multiorgan hypersensitivity)
Does taking Clobazam affect body weight?
Clobazam is not commonly associated with significant weight gain, but it can affect appetite and metabolism in some children and adults. Some individuals may experience increased appetite, which could lead to gradual weight gain, while others might have a reduced appetite and lose weight.
Is it safe to take other medicines while using Clobazam?
Yes, many common medicines can be taken with Clobazam, but it is important to be careful. While it can be taken with other medications, there are several important interactions to consider.
For example:
- CNS Depressants (e.g., opioids, alcohol, antihistamines, sedatives, muscle relaxants)– Can increase drowsiness and respiratory depression.
- Antiepileptic Drugs (e.g., phenytoin, carbamazepine, valproate, lamotrigine) – May either enhance or reduce clobazam’s effects.
- Antidepressants (e.g., SSRIs, TCAs, MAOIs) – Can increase sedation or serotonin-related side effects.
- Antifungals (e.g., ketoconazole, fluconazole) – May slow down the metabolism of clobazam, increasing its effects.
- Macrolide Antibiotics (e.g., erythromycin, clarithromycin) – Can also affect clobazam metabolism.
However, it is highly recommended to talk to your doctor before taking any new medications. They can assess your health needs, help avoid any potential drug interactions, and ensure that the medication is right for you.
Are there any foods that should be avoided while taking Clobazam?
There aren’t any specific foods you need to avoid while taking Clobazam. However, it is always a good idea to follow general health guidelines to support the effectiveness of the medication. Here are a few things to consider:- Grapefruit and Grapefruit Juice: Grapefruit can interfere with enzymes in the liver that break down clobazam. This can lead to higher levels of the medication in your bloodstream, increasing the risk of side effects like drowsiness and sedation.
- Alcohol: Drinking alcohol while taking clobazam can increase the sedative effects of the drug, leading to severe drowsiness, dizziness, difficulty concentrating, or impaired judgment. It is best to avoid alcohol or consult your doctor before consuming it.
- High-fat meals: Large, high-fat meals can slow the absorption of clobazam, which may affect how well the medication works. It is generally good to avoid excessive amounts of high-fat foods when taking clobazam.
- Caffeine (in excess): While caffeine itself does not directly interact with clobazam, it can counteract the sedative effects of the medication. If you find that clobazam makes you drowsy, consuming too much caffeine could affect how you feel.
What should I know about taking Clobazam during pregnancy or lactation?
Clobazam should be used in pregnancy only if the benefits outweigh the risks. If necessary, the lowest effective dose should be used. Gradual tapering before delivery may be considered to reduce neonatal withdrawal effects. Folic acid supplementation is recommended, as with other antiepileptic drugsBreastfeeding while on clobazam is generally not recommended, especially at high doses. If continued, close monitoring of the infant for excessive sedation or feeding difficulties is required. Alternative medications with a better safety profile may be considered
What are the risks of becoming pregnant while on Clobazam?
There are potential risks if you conceive while taking Clobazam. It is important to consult your doctor before trying to conceive or if you are pregnant while on Clobazam. Your doctor can help assess risks and suggest safer alternatives.What happens if I stop taking Clobazam abruptly?
Drug should not be discontinued abruptly because of the possibility of increasing seizures, anxiety, panic attacks, insomnia, tremors, and, in severe cases, hallucinations or confusion. Abruptly stopping clobazam can be dangerous, especially for individuals with epilepsy, as it may trigger seizures.
What is the proper way to store Clobazam?
Tablets: Store at controlled room temperature 20-25°C (68-77°F)Oral disintegrating tablets: Store at a controlled room temperature 20-25°C (68-77°F)
Oral suspension: Store at controlled room temperature 20-25°C (68-77°F) and in the original bottle in an upright position. Use within 90 days of first opening the bottle; discard remaining suspension after 90 days
What can I do to manage Clobazam’s side effects?
Sleepiness & Tiredness:- Take it at night if it makes you too sleepy (ask your doctor).
- Avoid driving until you know how it affects you.
- Stick to a regular sleep routine.
- Stand up slowly.
- Drink enough water.
- Avoid alcohol.
- Use reminders or notes.
- Do brain-boosting activities like puzzles.
- Talk to your doctor if it affects daily life.
- Notice any mood changes and tell your doctor.
- Try calming activities (deep breathing, light exercise).
- Seek help if feeling very low.
- Take with food.
- Eat more fiber and drink water.
- Stay active. Ask your doctor if constipation continues.
- Remove tripping hazards at home.
- Use support like handrails if needed.
- Don’t get up too quickly.
- Avoid mixing with other sleep medicines.
- Get medical help if breathing becomes slow or shallow.
- Don’t stop suddenly. Reduce slowly as advised by your doctor.
- Tell your doctor if you feel unwell while reducing the dose.
When to Contact the Doctor:
- Severe allergic reactions – Rash, itching, swelling (especially of the face, tongue, or throat), difficulty breathing, or severe dizziness.
- Signs of Stevens-Johnson Syndrome (SJS) – Painful skin rash, blisters, peeling skin, fever, and flu-like symptoms.
- Respiratory problems – Slow, shallow, or difficult breathing, especially if using opioids or other sedatives.
- Severe drowsiness or confusion – Extreme sedation, trouble staying awake, or difficulty responding.
- Worsening seizures – If seizures become more frequent or severe after starting or adjusting the medication.
- Unusual mood or behaviour changes – Increased aggression, agitation, suicidal thoughts, or severe depression.
Summary
Clobazam is a valuable medication used to help control seizures in conditions like Dravet and Lennox-Gastaut syndromes. When used correctly and under medical guidance, it can greatly improve quality of life. Like any medicine, it may cause side effects, but most can be managed with simple steps and regular monitoring. Always follow your doctor’s instructions, avoid stopping it suddenly, and reach out if you notice any unusual symptoms. Being informed and alert helps you and your child get the most benefit from the treatment, safely and confidently.
Let us know if you find this useful!
Author:
1. Dr. Ramya. R, Pharm D, Clinical pharmacologist, Aster Hospitals, Bengaluru
2. Dr Praveen Kumar, B. Pharm, Pharm D(PB), Head Clinical Pharmacologist, Aster Hospitals, Bengaluru
3. Dr C P Ravi Kumar, Consultant Paediatric Neurologist, Aster CMI Hospital.