Caution in usage of clobazam in elderly patients

Abstract

Clobazam, one of the newer benzodiazepines, is now used extensively as first add on therapy in focal epilepsy.A 67-year-old diabetic and hypertensive gentleman with a history of frontal contusion one year ago, presented with clustering of seizures. He was started on clobazam 20 mg, and levetiracetam 1000 mg/day. Recurrence of seizures prompted a dose escalation of clobazam to 40 mg/day. The patient developed hepatic encephalopathy and his decompensation was probably precipitated by the use of high dose of clobazam. Clobazam was thus gradually tapered off along with hepatic precoma regimen, and other supportive measures leading to an uneventful recovery.Caution must be taken while administering clobazam to elderly and debilitated patients or those with organic brain syndrome as they are more prone to the central nervous system (CNS) depressant activity of benzodiazepines. Since clobazam requires dealkylation and hydroxylation prior to conjugation, it should be used with caution in patients with hepatic involvement.