Clobazam

About Clobazam

Clobazam, a benzodiazepine, is thought to work by strengthening the calming effect of GABA in the brain. Its label covers only the seizures of Lennox-Gastaut syndrome, as an add-on treatment from age 2. The dose depends on body weight: up to 30 kg it starts at 5 mg a day and rises to 10 mg on day 7 and 20 mg on day 14; above 30 kg it starts at 10 mg and rises to 20 mg and then 40 mg on the same days. Daily doses above 5 mg are split into two doses. Older adults, people with mild to moderate liver impairment and known CYP2C19 poor metabolizers, who build up higher levels of its active breakdown product, start at 5 mg a day and are raised to half those doses at first, with a further step to the full dose possible from day 21.

The boxed warning has three parts. Taken with opioids it can cause profound sedation, slowed breathing, coma and death, so the two are prescribed together only when other options are inadequate. It exposes users to abuse, misuse and addiction, which can lead to overdose or death. And continued use causes physical dependence: stopping suddenly or cutting the dose quickly can bring on acute withdrawal reactions, which can be life-threatening, so it is tapered gradually. Constipation, sleepiness or sedation, fever, lethargy and drooling are the most common side effects, and aggression, irritability and unsteadiness also occur. The label also warns of serious skin reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis), a multi-organ allergic reaction (DRESS) and suicidal thoughts, and alcohol and other sedatives deepen its effects.

As a Schedule IV drug, a prescription can carry up to five refills within six months of the date written, and refill information can be transferred between pharmacies only once unless they share a real-time online database. Clobazam can make hormonal contraceptives less effective, so a nonhormonal method is added. Use late in pregnancy can cause sedation and withdrawal symptoms in the newborn. Sympazan is a film placed on top of the tongue to dissolve; tablets can be broken in half along the score or crushed into applesauce.

Taking Clobazam

How to take it

Once or twice a day as prescribed, with or without food. Tablets can be swallowed whole, broken in half along the score, or crushed, mixed into a spoonful of applesauce and taken right away. Shake the suspension before each dose and measure it with the syringe and adapter supplied. Place the film on top of the tongue and let it dissolve, without liquid and without chewing, spitting or talking.

If you miss a dose

Take it as soon as you remember unless the next dose is almost due; then skip the missed dose. Do not take a double dose, and do not stop it suddenly.

Storage

At room temperature, away from moisture and heat, somewhere no one can use it improperly. Throw away any suspension left 90 days after the bottle is first opened.

Interactions to know about

Opioids, alcohol and other sedatives deepen sedation and can slow breathing dangerously; alcohol also raises its levels. Fluconazole, fluvoxamine, ticlopidine and omeprazole, which block CYP2C19, can raise its active breakdown product, and it can raise levels of medicines cleared by CYP2D6, so doses may need adjusting. It can make hormonal contraceptives less effective.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Clobazam differs from pharmacy to pharmacy

Generic tablets and suspension have many makers, so quotes for them differ mostly by fee and markup, while a prescription that names Onfi without allowing substitution is filled at the brand price. Sympazan has no generic, so it is priced as a brand, and a pharmacy may need to order it.

The quantity quoted depends on the weight-based dose, which can mean half tablets or two tablets a day, and the suspension is sold by the bottle. Stock of this Schedule IV drug varies between pharmacies.

Ways to pay less for Clobazam without insurance

• Ask for generic tablets or suspension, and make sure the prescription allows substitution.
• If the film was chosen only for ease of swallowing, ask the prescriber whether tablets crushed into applesauce or the generic suspension would suit; the decision is theirs.
• Choose the pharmacy before the first fill, since Schedule IV refill information can be transferred only once.
• For Sympazan, ask the maker whether a savings or patient assistance program applies to someone paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Clobazam

1. 1.Does my dose need changing if I am a CYP2C19 poor metabolizer or take fluconazole or omeprazole?
2. 2.How would it be tapered if it is ever stopped?
3. 3.Does it make my birth control less effective?
4. 4.Which rash, fever or swelling symptoms mean I should call at once?

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