Clobazam (Onfi) visual mnemonics

Excerpt from Cafer's Mood Stabilizers and Antiepileptics

 Clobazam (Onfi)
“Clobber On wi-fi”
Pronunciation: KLOE ba zam / ON fee
Clobazam (Onfi) visual mnemonic by Jason Cafer MD (CaferMed)
❖ 1,5 benzodiazepine
❖ Rapid onset
❖ Long duration
❖ DEA Schedule IV
 FDA approved for:
 ❖ Seizures of Lennox-Gastaut syndrome (LGS)
Clobazam, long available in other countries, was finally FDA approved in the US in 2011 for adjunctive treatment of seizures associated with Lennox-Gastaut Syndrome (ages 2 years or older). Outside of the US it was marketed as an anxiolytic since 1975 and an anticonvulsant since 1984.

 Lennox-Gastaut syndrome (LGS), pronounced gas-TOE, is a type of childhood-onset epilepsy characterized by a triad of symptoms including multiple seizure types, intellectual impairment, and characteristic EEG findings. 
Clobazam is a Schedule IV controlled substance like all of the other benzos.  Alcohol ingestion increases the blood concentration of clobazam by about 50%. 

 
So, what is so special about clobazam? Probably not much. It does have a unique structure. Clobazam is the only available 1,5 BZD. Unlike the 1,4 BZDs, clobazam is thought to be advantageous due to a rapid onset of action, broad spectrum of activity, and long half-life. However, the other benzos were not directly compared to clobazam for treatment of LGS.

 
The clinical advantage of clobazam is it appears to be less sedating than other benzos. 

 
While most benzos are 3A4 substrates, clobazam is a 2C19 substrate.

Dosing: For those >30 kg start 5 mg BID x 1 week, then 10 mg BID x 1 week, then to target dose of 20 mg BID. Maximum is 40 mg/day. Use a half-strength dose for 2C19 poor metabolizers. Also, as with any antiepileptic, taper to discontinue. 
  
Dynamic interactions: 
 ❖ Sedation 
 ❖ Respiratory depression 
 ❖ Do not combine with alcohol or opioids		Kinetic interactions: 
❖ While most benzos are 3A4 substrates, clobazam is a 2C19 substrate (major) 
❖ Cannabidiol (CBD), also approved for Lennox–Gastaut syndrome, is a 2C19 inHibitor that increases exposure to clobazam 3-fold.
Onfi is a CYP2C19 substrate, mnemonic by Jason Cafer MD

Compare pharmacy prices for
Xcopri Titration pack of 12.5mg/25mg package (1 qty)
Costco97.18
Medicine Shoppe100.31
Rite Aid102.10
Compare prices for Onfi & other drugs at GoodRx





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