Home Drug Guide Clobazam

Drug Guide

Generic Name

Clobazam

Brand Names Onfi, Sympazan

Classification

Therapeutic: Anticonvulsant, Anxiolytic

Pharmacological: Benzodiazepine

FDA Approved Indications

  • Lennox-Gastaut syndrome (management of seizures)

Mechanism of Action

Clobazam enhances the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, anxiolytic, anticonvulsant, and muscle-relaxant properties.

Dosage and Administration

Adult: Initial dose typically 10-20 mg daily, divided into two doses; dose may be titrated based on response and tolerability.

Pediatric: Dosing varies based on age and weight; specific pediatric dosing guidance should be consulted. Use with caution in children.

Geriatric: Start at lower doses due to increased sensitivity and risk of sedation; monitor closely.

Renal Impairment: Adjust dosage based on severity of impairment.

Hepatic Impairment: Use with caution; start at lower doses, monitor liver function.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized in the liver primarily via CYP3A4 to norclobazam.

Excretion: Excreted mainly in urine as metabolites.

Half Life: Approximately 18 hours for clobazam; metabolite norclobazam has a longer half-life (~36-42 hours).

Contraindications

  • Hypersensitivity to benzodiazepines or any component of the formulation.

Precautions

  • Use with caution in patients with a history of substance abuse, respiratory impairment, hepatic impairment, or pregnancy. Risk of dependence, withdrawal, and respiratory depression. Not recommended during breastfeeding.

Adverse Reactions - Common

  • Somnolence (Common)
  • Sedation (Common)
  • Dizziness (Common)
  • Fatigue (Common)

Adverse Reactions - Serious

  • Respiratory depression (Serious)
  • Abnormal behaviors, including aggression and hallucinations (Serious)
  • Withdrawal symptoms upon discontinuation (Serious)
  • Seizures with abrupt withdrawal in some cases (Serious)

Drug-Drug Interactions

  • CNS depressants (e.g., opioids, other benzodiazepines), increasing sedation and respiratory depression risk.
  • CYP3A4 inhibitors (e.g., ketoconazole) may increase clobazam levels.
  • CYP3A4 inducers (e.g., rifampin) may decrease effectiveness.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for effectiveness in seizure control, sedation levels, and signs of over-sedation. Assess for history of substance abuse.

Diagnoses:

  • Risk for sedation or injury
  • Impaired respiratory function
  • Risk for dependence

Implementation: Administer as prescribed, preferably with food to decrease gastrointestinal upset. Monitor for adverse effects.

Evaluation: Evaluate seizure frequency and severity, sedation level, and patient adherence.

Patient/Family Teaching

  • Teach patient to avoid alcohol and other CNS depressants.
  • Warn about potential for drowsiness and impaired alertness.
  • Advise against abrupt discontinuation to prevent withdrawal.
  • Instruct patients to report any unusual mood changes or worsening seizures.

Special Considerations

Black Box Warnings:

  • Risk of respiratory depression and dependence

Genetic Factors: Monitor for variations in CYP2C19 enzyme activity which may affect metabolism.

Lab Test Interference: May interfere with certain liver function tests.

Overdose Management

Signs/Symptoms: Extreme sedation, confusion, diminished reflexes, respiratory depression, coma.

Treatment: Supportive care, airway management, possibly administration of flumazenil (a benzodiazepine antagonist); avoid if benzodiazepine dependence is present.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable for the duration of labeled shelf life.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.