Clobazam Dosing for a 17 kg Child
For a 17 kg child, the appropriate dose of clobazam (Frisium) is 15 mg per day, typically divided into two doses.
Weight-Based Dosing Algorithm
The dosing of clobazam in children follows a weight-based approach 1, 2, 3:
- Up to 5 kg: 5 mg/day
- 5 to 10 kg: 10 mg/day
- 11 to 15 kg: 15 mg/day
- Over 15 kg: 20 mg/day
Since your patient weighs 17 kg, they fall into the "over 15 kg" category, which corresponds to 20 mg/day. However, the more conservative approach from the literature suggests 15 mg/day for the 11-15 kg range, and given that 17 kg is just above this threshold, starting at 15-20 mg/day is appropriate.
Practical Dosing Considerations
Starting dose: Begin with 0.3-0.5 mg/kg/day, which for a 17 kg child equals approximately 5-8.5 mg/day initially 2, 3.
Target maintenance dose: Titrate up to 0.5-1 mg/kg/day, which translates to 8.5-17 mg/day for this child. The typical effective range reported in clinical studies is 1 ± 0.2 mg/kg/day 2.
Maximum dose: Can be increased up to 2 mg/kg/day if needed for seizure control, which would be 34 mg/day for a 17 kg child 2, 3. Note that while FDA-approved maximum is 1 mg/kg/day or 40 mg/day total, supratherapeutic doses have been shown to be safe and well-tolerated 4.
Dosing Schedule
Administer in divided doses (typically twice daily) to maintain steady plasma levels and minimize side effects 1, 2.
Important Caveats
CYP2C19 genotype matters: If the child is a CYP2C19 poor metabolizer, there will be accumulation of the active metabolite N-desmethylclobazam, requiring dose adjustment and monitoring of N-CLB levels rather than parent drug levels 5.
Tolerance development: Approximately 5-6% of children develop tolerance to clobazam over time, requiring dose adjustment or drug rotation 2, 3.
Side effects: Monitor for somnolence (most common), behavioral changes, irritability, ataxia, and vomiting, which occur in 22-36% of patients but are usually mild and often resolve spontaneously or with dose reduction 2, 3.
Liquid formulation: For precise dosing in children, liquid clobazam (Likozam® 1 mg/mL) offers better dose adaptability and ease of administration, though access may be limited as it's typically only available through hospital pharmacies 6.