arbitrary and often vary between individuals. However,
plasma drug concentrations may be measured in children
with worsening seizures, status epilepticus, suspected
noncompliance, or suspected toxicity. Similarly,
haematological and biochemical monitoring should not be
undertaken unless clinically indicated.lPRESCRIBING AND DISPENSING INFORMATION
Switching between formulationsCare should be taken when
switching between oral formulations in the treatment of
epilepsy. The need for continued supply of a particular
manufacturer’s product should be based on clinical
judgement and consultation with the patient or their
carer, taking into account factors such as seizure
frequency and treatment history.
Patients being treated for epilepsy may need to be
maintained on a specific manufacturer’s branded or
generic clobazam product.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Clobazam for preventing
seizureswww.medicinesforchildren.org.uk/clobazam-
preventing-seizures- 0
lNATIONAL FUNDING/ACCESS DECISIONS
NHS restrictionsClobazam is not prescribable in NHS
primary care except for epilepsy and endorsed’SLS’.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: capsule, oral suspension
Oral suspension
CAUTIONARY AND ADVISORY LABELS2, 8, 19
▶Clobazam (Non-proprietary)
Clobazam 1 mg per 1 mlClobazam 5 mg/ 5 ml oral suspension sugar
free sugar-free| 150 mlP£ 90. 00 DT = £ 90. 00 dsugar-free
| 250 mlP£ 150. 00 d
Clobazam 2 mg per 1 mlClobazam 10 mg/ 5 ml oral suspension sugar
free sugar-free| 150 mlP£ 95. 00 DT = £ 95. 00 dsugar-free
| 250 mlP£ 158. 33 d
▶Perizam(Rosemont Pharmaceuticals Ltd)
Clobazam 1 mg per 1 mlPerizam 1 mg/ml oral suspension sugar-free
| 150 mlP£ 90. 00 DT = £ 90. 00 d
Clobazam 2 mg per 1 mlPerizam 2 mg/ml oral suspension sugar-free
| 150 mlP£ 95. 00 DT = £ 95. 00 d
▶Tapclob(Martindale Pharmaceuticals Ltd)
Clobazam 1 mg per 1 mlTapclob 5 mg/ 5 ml oral suspension sugar-
free| 150 mlP£ 90. 00 DT = £ 90. 00 dsugar-free|
250 mlP£ 150. 00 d
Clobazam 2 mg per 1 mlTapclob 10 mg/ 5 ml oral suspension sugar-
free| 150 mlP£ 95. 00 DT = £ 95. 00 dsugar-free|
250 mlP£ 158. 34 d
▶Zacco(Thame Laboratories Ltd)
Clobazam 1 mg per 1 mlZacco 5 mg/ 5 ml oral suspension sugar-free
| 150 mlP£ 82. 00 DT = £ 90. 00 d
Clobazam 2 mg per 1 mlZacco 10 mg/ 5 ml oral suspension sugar-free
| 150 mlP£ 87. 00 DT = £ 95. 00 d
Tablet
CAUTIONARY AND ADVISORY LABELS2, 8, 19
▶Clobazam (Non-proprietary)
Clobazam 10 mgClobazam 10 mg tablets| 30 tabletP£ 3. 65 DT
=£ 3. 58 d
▶Frisium(Sanofi)
Clobazam 10 mgFrisium 10 mg tablets| 30 tabletP£ 2. 51 DT =
£ 3. 58 d
eiiiiF 218Clonazepam 07-Feb-2018
lINDICATIONS AND DOSE
All forms of epilepsy
▶BY MOUTH
▶Child 1–11 months:Initially 250 micrograms once daily
for 4 nights, dose to be increased over 2 – 4 weeks, usual
dose 0. 5 – 1 mg daily, dose to be taken at night; may be
given in 3 divided doses if necessary▶Child 1–4 years:Initially 250 micrograms once daily for
4 nights, dose to be increased over 2 – 4 weeks, usual
dose 1 – 3 mg daily, dose to be taken at night; may be
given in^3 divided doses if necessary
▶Child 5–11 years:Initially 500 micrograms once daily for
4 nights, dose to be increased over 2 – 4 weeks, usual
dose 3 – 6 mg daily, dose to be taken at night; may be
given in 3 divided doses if necessary
▶Child 12–17 years:Initially 1 mg once daily for 4 nights,
dose to be increased over 2 – 4 weeks, usual dose
4 – 8 mg daily, dose usually taken at night; may be given
in 3 – 4 divided doses if necessarylUNLICENSED USEClonazepam doses in BNFC may differ
from those in product literature.IMPORTANT SAFETY INFORMATION
SAFE PRACTICE
Clonazepam has been confused with clobazam; care
must be taken to ensure the correct drug is prescribed
and dispensed.lCONTRA-INDICATIONSComa.current alcohol abuse.
current drug abuse.respiratory depression
lCAUTIONSAcute porphyrias p. 603 .airways obstruction.
brain damage.cerebellar ataxia.depression.spinal ataxia
.suicidal ideation
CAUTIONS, FURTHER INFORMATIONThe effectiveness of
clonazepam may decrease significantly after weeks or
months of continuous therapy.
lINTERACTIONS→Appendix 1 : clonazepam
lSIDE-EFFECTSAbnormal dreams.alopecia.bronchial
secretion increased.concentration impaired.
coordination abnormal.disorientation.drooling.hostility
.hypersalivation.incomplete precocious puberty.muscle
tone decreased.nervousness.nystagmus.psychotic
disorder.seizures.sexual dysfunction.skin reactions.
speech impairment.vision disorder
lBREAST FEEDINGPresent in milk, and should be avoided if
possible during breast-feeding.
MonitoringAll infants should be monitored for sedation,
feeding difficulties, adequate weight gain, and
developmental milestones.
lHEPATIC IMPAIRMENTCan precipitate coma. Avoid in
severe impairment.
Dose adjustmentsStart with smaller initial doses or reduce
dose.
lRENAL IMPAIRMENT
Dose adjustmentsStart with small doses in severe
impairment.
lMONITORING REQUIREMENTSRoutine measurement of
plasma concentrations of antiepileptic drugs is not usually
justified, because the target concentration ranges are
arbitrary and often vary between individuals. However,
plasma drug concentrations may be measured in children
with worsening seizures, status epilepticus, suspected
noncompliance, or suspected toxicity. Similarly,
haematological and biochemical monitoring should not be
undertaken unless clinically indicated.
lPRESCRIBING AND DISPENSING INFORMATION
The RCPCH and NPPG recommend that, when a liquid
special of clonazepam is required, the following strength is
used: 2 mg/ 5 mL.
Switching between formulationsCare should be taken when
switching between oral formulations in the treatment of
epilepsy. The need for continued supply of a particular
manufacturer’s product should be based on clinical
judgement and consultation with the patient or their
carer, taking into account factors such as seizure
frequency and treatment history.BNFC 2018 – 2019 Epilepsy and other seizure disorders 219
Nervous system4