Clobazam

CLINICAL USE

Benzodiazepine:Anticonvulsant Anxiolytic

DOSE IN NORMAL RENAL FUNCTION

20–30 mg daily; maximum 60 mg daily (doses may be divided for anxiety and can go up to 80 mg)

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :300.7

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :85

%Excreted unchanged in urine &nbsp &nbsp : 87 (unchanged drug and metabolite)

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.87–1.83

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :11–77 (42 hours for metabolite)/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function. Start with low doses

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Unlikely to be dialysed. Dose as in GFR <10 mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsAntibacterials: metabolism possibly increased by rifampicinAntipsychotics: increased sedative effects Antivirals: concentration possibly increased by ritonavirDisulfiram: metabolism of clobazam inhibited; increased sedative effectsSodium oxybate: enhanced effects of sodium oxybate – avoid

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Syrup is available Metabolised to active N-desmethylclobazam which may accumulateCauses less sedation than clonazepam There is a case report of clobazam being used to treat phantom limb pain at a dose of 10 mg 3 times a day.

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