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Onfi
clobazam
Black Box Warnings .
Risks from Concomitant Opioid Use
concomitant benzodiazepine use w/ opioids may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation
Addiction, Abuse, and Misuse
benzodiazepines expose users to risk of abuse, misuse, and addiction, can lead to overdose or death; commonly involves concomitant use w/ other meds, alcohol, and/or illicit substances, which is assoc. w/ incr. frequency of serious adverse outcomes; assess risk for abuse, misuse, and addiction before prescribing and throughout tx
Dependence and Withdrawal Reactions
cont. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. w/ longer tx duration and higher daily dose; use gradual taper to D/C after cont. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening
Adult Dosing .
Dosage forms: TAB: 10 mg, 20 mg; SUSP: 2.5 mg per mL
seizures, Lennox-Gastaut syndrome
- [adjunct tx, <30 kg]
- Dose: 10 mg PO bid; Start: 5 mg PO qd x1wk, then 5 mg PO bid x1wk, then 10 mg PO bid; Max: 20 mg/day; Info: in elderly pts or CYP2C19 poor metabolizers, start 5 mg PO qd x2wk, then 5 mg PO bid x1wk, then may incr. to 10 mg PO bid; taper dose by no more than 5-10 mg/day qwk to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
- [adjunct tx, >30 kg]
- Dose: 20 mg PO bid; Start: 5 mg PO bid x1wk, then 10 mg PO bid x1wk, then 20 mg PO bid; Max: 40 mg/day; Info: in elderly pts or CYP2C19 poor metabolizers, start 5 mg PO qd x1wk, then 5 mg PO bid x1wk, then 10 mg PO bid x1wk, then may incr. to 20 mg PO bid; taper dose by no more than 5-10 mg/day qwk to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [see below]
- CrCl >30: no adjustment; CrCl <30 or ESRD: not defined
- HD/PD: not defined
hepatic dosing
- [<30 kg]
- Child-Pugh Class A or B: start 5 mg qd x2wk, then 5 mg bid x1wk, then may incr. to 10 mg bid; Child-Pugh Class C: not defined
- [>30 kg]
- Child-Pugh Class A or B: start 5 mg qd x1wk, then 5 mg bid x1wk, then 10 mg bid x1wk, then may incr. to 20 mg bid; Child-Pugh Class C: not defined
Peds Dosing .
- Dosage forms: TAB: 10 mg, 20 mg; SUSP: 2.5 mg per mL
seizures, Lennox-Gastaut syndrome
- [adjunct tx, 2 yo and older, <30 kg]
- Dose: 10 mg PO bid; Start: 5 mg PO qd x1wk, then 5 mg PO bid x1wk, then 10 mg PO bid; Max: 20 mg/day; Info: in CYP2C19 poor metabolizers, start 5 mg PO qd x2wk, then 5 mg PO bid x1wk, then may incr. to 10 mg PO bid; taper dose by no more than 5-10 mg/day qwk to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
- [adjunct tx, 2 yo and older, >30 kg]
- Dose: 20 mg PO bid; Start: 5 mg PO bid x1wk, then 10 mg PO bid x1wk, then 20 mg PO bid; Max: 40 mg/day; Info: in CYP2C19 poor metabolizers, start 5 mg PO qd x1wk, then 5 mg PO bid x1wk, then 10 mg PO bid x1wk, then may incr. to 20 mg PO bid; taper dose by no more than 5-10 mg/day qwk to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [see below]
- CrCl >30: no adjustment; CrCl <30 or ESRD: not defined
- HD/PD: not defined
hepatic dosing
- [<30 kg]
- Child-Pugh Class A or B: start 5 mg qd x2wk, then 5 mg bid x1wk, then may incr. to 10 mg bid; Child-Pugh Class C: not defined
- [>30 kg]
- Child-Pugh Class A or B: start 5 mg qd x1wk, then 5 mg bid x1wk, then 10 mg bid x1wk, then may incr. to 20 mg bid; Child-Pugh Class C: not defined