CAUTIONS, FURTHER INFORMATION The effectiveness of
clobazam may decrease significantly after weeks or
l INTERACTIONS → Appendix 1: clobazam
l SIDE-EFFECTS Appetite decreased . consciousness
impaired . constipation . drug abuse . dry mouth .fall . gait
unsteady . libido loss . movement disorders . muscle
spasms . nystagmus .respiratory disorder. severe
cutaneous adverse reactions (SCARs). skin reactions . speech impairment. weight increased
l BREAST FEEDING Benzodiazepines are present in milk, and
should be avoided if possible during breast-feeding.
Monitoring All infants should be monitored for sedation,
feeding difficulties, adequate weight gain, and
Dose adjustments Start with small doses in severe
▶ In children Routine 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.
l PRESCRIBING AND DISPENSING INFORMATION
Switching between formulations Care 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
Medicines for Children leaflet: Clobazam for preventing seizures
www.medicinesforchildren.org.uk/clobazam-preventingseizures-0
l NATIONAL FUNDING/ACCESS DECISIONS
NHS restrictions Clobazam is not prescribable in NHS
primary care except for the treatment of epilepsy; endorse
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: capsule, oral
CAUTIONARY AND ADVISORY LABELS 2, 8, 19
Clobazam 1 mg per 1 ml Clobazam 5mg/5ml oral suspension sugar
free sugar-free | 150 ml P £90.00 DT = £90.00dsugar-free
250 ml P £150.00dClobazam 10mg/5ml oral suspension sugar
free sugar-free | 150 ml P £95.00 DT = £95.00dsugar-free
(Rosemont Pharmaceuticals Ltd)
Clobazam 1 mg per 1 ml Perizam 1mg/ml oral suspension sugar-free
90.00d2mg/ml oral suspension sugar-free
(Martindale Pharmaceuticals Ltd)
▶ Zacco (Thame Laboratories Ltd)
Clobazam 1 mg per 1 ml Zacco 5mg/5ml oral suspension sugar-free
mg/5ml oral suspension sugar-free
| 150 ml P £87.00 DT = £95.00d
CAUTIONARY AND ADVISORY LABELS 2, 8, 19
Clobazam 10 mg Clobazam 10mg tablets | 30 tablet P £3.65 DT
Clobazam 10 mg Frisium 10mg tablets | 30 tablet P £2.51 DT =
▶ 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 necessary
All forms of epilepsy | Myoclonus
▶ Adult: Initially 1 mg once daily for 4 nights, dose to be
increased over 2–4 weeks, usual dose 4–8 mg daily,
adjusted according to response, dose usually taken at
night; may be given in 3–4 divided doses if necessary
▶ Elderly: Initially 500 micrograms once daily for 4
nights, dose to be increased over 2–4 weeks, usual dose
4–8 mg daily, adjusted according to response, dose
usually taken at night; may be given in 3–4 divided
Panic disorders (with or without agoraphobia) resistant to
l UNLICENSED USE Clonazepam doses in BNF may differ
from those in product literature. Use for panic disorders
(with or without agoraphobia) resistant to antidepressant
therapy is an unlicensed indication.
Clonazepam has been confused with clobazam; care
must be taken to ensure the correct drug is prescribed
l CONTRA-INDICATIONS Coma . current alcohol abuse . current drug abuse .respiratory depression
CAUTIONS, FURTHER INFORMATION The effectiveness of
clonazepam may decrease significantly after weeks or
l INTERACTIONS → Appendix 1: clonazepam
BNF 78 Epilepsy and other seizure disorders 337
l SIDE-EFFECTS Alopecia . bronchial secretion increased (in
dysfunction . skin reactions . speech impairment
l BREAST FEEDING Present in milk, and should be avoided if
possible during breast-feeding.
Monitoring All infants should be monitored for sedation,
feeding difficulties, adequate weight gain, and
Dose adjustments Start with small doses in severe
▶ In children Routine 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.
l PRESCRIBING AND DISPENSING INFORMATION The RCPCH
and NPPG recommend that, when a liquid special of
clonazepam is required, the following strength is used:
Switching between formulations Care 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 oral clonazepam product.
Medicines for Children leaflet: Clonazepam for preventing seizures
www.medicinesforchildren.org.uk/clonazepam-preventingseizures-0
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: orodispersible
tablet, oral suspension, oral solution
CAUTIONARY AND ADVISORY LABELS 2, 8
▶ Clonazepam (Non-proprietary)
Clonazepam 500 microgram Clonazepam 500microgram tablets |
| 100 tablet P £30.00 DT = £29.23d
CAUTIONARY AND ADVISORY LABELS 2, 8
EXCIPIENTS: May contain Ethanol
▶ Clonazepam (Non-proprietary)
Clonazepam 100 microgram per 1 ml Clonazepam
500micrograms/5ml oral solution sugar free sugar-free | 150
Clonazepam 400 microgram per 1 ml
solution sugar free sugar-free | 150 ml P £108.36 DT =
Status epilepticus (only if other measures fail)
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 75–125 mg for 1 dose, to be administered as a
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: Initially 100–150 mg, to be administered over
10–15 seconds usually as a 2.5% (25 mg/mL) solution,
followed by 100–150 mg after 0.5–1 minute if required,
dose to be given in fit and premedicated adults;
debilitated patients or adults over 65 years may require
a lower dose or increased administration time,
alternatively initially up to 4 mg/kg (max. per dose
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: Initially 100–150 mg, to be administered over
10–15 seconds usually as a 2.5% (25 mg/mL) solution,
followed by 100–150 mg after 0.5–1 minute if required,
dose to be given in fit and premedicated adults;
debilitated patients or adults over 65 years may require
a lower dose or increased administration time,
alternatively initially up to 4 mg/kg (max. per dose
Reduction of raised intracranial pressure if ventilation
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 1.5–3 mg/kg, repeated if necessary
Thiopental sodium should only be administered by, or
under the direct supervision of, personnel experienced
in its use, with adequate training in anaesthesia and
airway management, and when resuscitation equipment
l CONTRA-INDICATIONS Acute porphyrias p. 1058 . myotonic dystrophy
cardiac output. hypovolaemia .reconstituted solution is
highly alkaline (extravasation causes tissue necrosis and
l INTERACTIONS → Appendix 1: thiopental
▶ Common or very common Arrhythmia . myocardial
▶ Frequency not known Appetite decreased . circulatory
collapse . cough . electrolyte imbalance . extravasation
necrosis . hypotension .respiratory disorders . skin
l PREGNANCY May depress neonatal respiration when used
l BREAST FEEDING Breast-feeding can be resumed as soon
as mother has recovered sufficiently from anaesthesia.
l HEPATIC IMPAIRMENT Manufacturer advises caution.
Dose adjustments Manufacturer advises dose reduction.
l RENAL IMPAIRMENT Caution in severe impairment.
Driving and skilled tasks Patients given sedatives and
analgesics during minor outpatient procedures should be
very carefully warned about the risk of driving or
undertaking skilled tasks afterwards. For a short general
338 Epilepsy and other seizure disorders BNF 78
anaesthetic the risk extends to at least 24 hours after
administration. Responsible persons should be available to
take patients home. The dangers of taking alcohol should
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: solution for
Powder for solution for injection
▶ Thiopental sodium (Non-proprietary)
Thiopental sodium 500 mg Thiopental 500mg powder for solution
for injection vials | 10 vial P £69.00 | 25 vial P £172.50
▶ Adult: 1–4 mg daily in divided doses, for debilitated
▶ Elderly: 0.5–2 mg daily in divided doses
Short-term use in insomnia associated with anxiety
▶ Adult: 1–2 mg daily, to be taken at bedtime
▶ BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS
▶ Adult: 25–30 micrograms/kg every 6 hours if required;
usual dose 1.5–2.5 mg every 6 hours if required,
intravenous injection to be administered into a large
vein, only use intramuscular route when oral and
intravenous routes not possible
Conscious sedation for procedures
▶ Adult: 2–3 mg, to be taken the night before operation;
2–4 mg, to be taken 1–2 hours before operation
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 50 micrograms/kg, to be administered
30–45 minutes before operation
▶ Adult: 50 micrograms/kg, to be administered
60–90 minutes before operation
▶ Adult: 2–3 mg, to be taken the night before operation;
2–4 mg, to be taken 1–2 hours before operation
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 50 micrograms/kg, to be administered
30–45 minutes before operation
▶ Adult: 50 micrograms/kg, to be administered
60–90 minutes before operation
Status epilepticus | Febrile convulsions | Convulsions
▶ BY SLOW INTRAVENOUS INJECTION
▶ Child 1 month–11 years: 100 micrograms/kg (max. per
dose 4 mg) for 1 dose, then 100 micrograms/kg after
10 minutes (max. per dose 4 mg) if required for 1 dose,
to be administered into a large vein
▶ Child 12–17 years: 4 mg for 1 dose, then 4 mg after
10 minutes if required for 1 dose, to be administered
▶ Adult: 4 mg for 1 dose, then 4 mg after 10 minutes if
required for 1 dose, to be administered into a large vein
▶ In children Not licensed for use in febrile convulsions. Not
licensed for use in convulsions caused by poisoning.
Benzodiazepines should only be administered for
anaesthesia by, or under the direct supervision of,
personnel experienced in their use, with adequate
training in anaesthesia and airway management.
l CONTRA-INDICATIONS Avoid injections containing benzyl
alcohol in neonates . chronic psychosis (in adults). CNS
depression . compromised airway . hyperkinesis . not for
use alone to treat depression (or anxiety associated with
depression) (in adults). obsessional states . phobic states . respiratory depression
l CAUTIONS Muscle weakness . organic brain changes . parenteral administration
▶ Paradoxical effects A paradoxical increase in hostility and
aggression may be reported by patients taking
benzodiazepines. The effects range from talkativeness and
excitement to aggressive and antisocial acts. Adjustment
of the dose (up or down) sometimes attenuates the
impulses. Increased anxiety and perceptual disorders are
▶ Special precautions for parenteral administration When given
parenterally, facilities for managing respiratory depression
with mechanical ventilation must be available. Close
observation required until full recovery from sedation.
l INTERACTIONS → Appendix 1: lorazepam
▶ Uncommon Allergic dermatitis . constipation . sexual
▶ Rare or very rare Agranulocytosis . hyponatraemia . pancytopenia . SIADH .thrombocytopenia
▶ With oral use Saliva altered
▶ With parenteral use Leucopenia
l BREAST FEEDING Benzodiazepines are present in milk, and
should be avoided if possible during breast-feeding.
Dose adjustments Start with small doses in severe
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use in children For intravenous injection,
dilute with an equal volume of Sodium Chloride 0.9% (for
neonates, dilute injection solution to a concentration of
100 micrograms/mL). Give over 3–5 minutes; max. rate
50 micrograms/kg over 3 minutes.
▶ With intramuscular use in adults For intramuscular injection,
solution for injection should be diluted with an equal
volume of water for injections or sodium chloride 0.9%
(but only use when oral and intravenous routes not
▶ With intravenous use in adults For slow intravenous injection,
solution for injection should preferably be diluted with an
equal volume of water for injections or sodium chloride
Driving and skilled tasks Patients given sedatives and
analgesics during minor outpatient procedures should be
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