Clobazam

Adults: General dosage guidance: The dose and length of treatment should be tailored to the condition being treated, how severe it is, and how the individual patient responds. Because clobazam can affect alertness and reaction time, the guiding rule is to use the lowest dose that works. For treating anxiety in adults and adolescents over 15 years: the usual starting dose is 20 mg of clobazam a day. This can be increased if needed, but the total daily dose should generally not go above 30 mg. For elderly patients: older adults may respond more strongly to the medicine and are more prone to side effects, so treatment should start with a low dose and be increased gradually while the patient is monitored closely. A maintenance dose of 10 to 15 mg a day is often enough. For children aged 3 to 15 years: children, too, may respond more strongly and are more prone to side effects, so treatment should begin with a low dose and be increased gradually under close observation. A daily dose of 5 to 10 mg is often enough. Benzodiazepines should only be given to children after the need for them has been carefully assessed. Secondary dosage adjustment: once symptoms improve, the dose may be lowered. Timing of doses: when the daily dose is split into more than one portion, the larger portion should be taken in the evening. Duration of treatment: treatment should be kept as short as possible. The patient should be reviewed within 4 weeks of starting and at regular intervals afterward to check whether treatment is still needed, particularly once symptoms have resolved. In general, the total treatment period, including the time taken to taper off the dose, should not exceed 8 to 12 weeks. In some cases treatment may need to continue beyond this, but only after the patient's condition has been reassessed by someone with the appropriate expertise. Long, uninterrupted courses of treatment are best avoided, since they can lead to dependence. Discontinuation of treatment: after extended use, clobazam should not be stopped abruptly. The dose should instead be lowered gradually under medical supervision, since stopping suddenly can bring on withdrawal symptoms. For treating epilepsy alongside one or more other anticonvulsant medicines, in adults and adolescents over 15 years: treatment is usually started at a low dose of 5 to 15 mg a day, and if needed this can be increased step by step up to a maximum of about 80 mg a day. For children aged 3 to 15 years: treatment normally begins at 5 mg a day. A maintenance dose of 0.3 to 1.0 mg per kilogram of body weight per day is usually sufficient. Children may be more prone to side effects, so the dose should be increased gradually under close observation, and benzodiazepines should only be used in children after careful assessment of the need for them. For elderly patients: because older adults may be more prone to side effects, treatment should start with a low dose and be increased gradually under close observation. Timing of doses: when the daily dose is divided across the day, the larger portion should be taken in the evening. Doses of up to 30 mg can also be given as a single dose in the evening. Duration of treatment: the patient should be reviewed within 4 weeks of starting and at regular intervals afterward to assess whether treatment should continue. Discontinuation of treatment: at the end of treatment, including in cases where it has not worked well, clobazam should not be stopped abruptly. The dose should be reduced gradually, since sudden withdrawal can increase the risk of seizures as well as other withdrawal symptoms.