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





Copyright 2020, CaferMed LLC






































Comments











Post a Comment























Popular posts from this blog









Cenobamate (XCOPRI) visual mnemonics




















Image







Excerpt from  Cafer's Mood Stabilizers and Antiepileptics, available on Amazon Cenobamate (XCOPRI) “Cinnab on  Ex-co uple ” Pronunciation:  sen oh BAM ate / EX cop ree  ❖ Antiepileptic  ❖ GABA A  modulator  ❖ DEA Schedule V   FDA approved for:   ❖ Partial-onset seizures (adults)   Cenobamate (Xcopri) is the newest antiepileptic drug (AED) , released in 2020. There are some serious risks , side effects and kinetic drug/drug interactions.   Dosing is similar to lamotrigine (Lamictal), with a slow titration to a recommended dose  of 200 mg over 11 weeks . As with lamotrigine, maximum dose is 400 mg. The slow titration is necessary to avoid Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) , also known as multiorgan hypersensitivity. There were no cases of DRESS among over 1,000 patients with adherence to the slow titration schedule. Cenobamate shortens QT  interval and is contraindicated with Familial Short QT Syndrome. QTc interval under 300 is dangerous.   Dose-dependent








Read more










Pregabalin mascot & Black Friday Sale




















Image







Check out the Black Friday sale on Cafer's Psychopharmacology: Visualize to Memorize 270 Medication Mascots.  For a limited time, the paperback is $49.95  and the PDF version is $29.95  (regular price $89.95).  The PDF is formatted for ultra-rapid navigation with thousands of internal links. Included are medication mascots to assist you with memorization of trade name / generic name pairings. Here are excerpts from from 5-star Amazon reviews: ★★★★★ Love it I barely look at the pictures, honestly. I'm most impressed by the way the author explains everything through text, simply and efficiently. ★★★★★  GREAT PSYCH NO STUDENT EASY TO READ RESOURCE This breaks things down easily and is a great study resource for those needing something more concise and easier to read. ★★★★★  THIS BOOK helped me SO MUCH! First of all, I don’t write reviews but this book deserves it. I am in a CMHC graduate program where a class asked me to know most of the antipsychotics and antidepressants. It was 








Read more










Lumateperone (Caplyta)




















Image







Available on Amazon:  Cafer's Mood Stabilizers and Antiepileptic Drugs        Lumateperone (CAPLYTA) Pronunciation:  luma TEP er ohn / cap LIE ta  “’Lum inated  Cap lighter” Antipsychotics are represented  with spooky mascots. Year of US release: 2020  ❖ Antipsychotic (SGA) ❖ D2 antagonist - ⇩DA ❖ 5-HT2A antagonist - ⇧DA ❖ Glutamate modulator  FDA-approved for:  ❖ Schizophrenia  Lumateperone is a new antipsychotic that purportedly modulates glutamate  in addition to the usual SGA mechanism of blocking D2 and 5-HT2A receptors. However, the official prescribing information does not mention glutamate, suggesting the FDA saw insufficient evidence for lumateperone being a first-in-class novel antipsychotic. It appears to be equally effective as risperidone (Risperdal) with fewer side effects other than sedation (Citrome, 2016).  Lumateperone’s D2 receptor occupancy is lower than most other antipsychotics. This means extrapyramidal side effects are unlikely. The other antipsychotics with








Read more