Does clobazam help agitation?

From the Guidelines

Clobazam, a benzodiazepine medication, is likely to be effective in reducing agitation in various clinical settings, given the overall efficacy of benzodiazepines in managing agitation 1.

Key Points

• Benzodiazepines, including clobazam, have been shown to be valuable in reducing agitation and are at least as effective as conventional antipsychotics like haloperidol 1.
• While specific studies on clobazam are not mentioned in the provided evidence, the efficacy of benzodiazepines as a class in reducing agitation supports its potential use for this purpose 1.
• The use of benzodiazepines, including clobazam, should be considered in the context of their potential benefits and risks, including the risk of dependence and withdrawal 1.
• In clinical practice, benzodiazepines like clobazam may be used for short-term management of agitation, with careful consideration of the dose and duration of treatment to minimize adverse effects 1.
• It is essential to weigh the benefits of using clobazam against its potential risks, especially in vulnerable populations such as older adults or those with a history of substance abuse 1.

Clinical Considerations

• The dose of clobazam for agitation is not specified in the provided evidence, but typical doses of benzodiazepines for agitation range from 2 to 4 mg for lorazepam, which may guide the dosing of clobazam 1.
• Treatment durations for agitation with benzodiazepines, including clobazam, can vary from several days to weeks, depending on the clinical context and patient response 1.

From the Research

Clobazam and Agitation

• Clobazam is a 1,5-benzodiazepine with anxiolytic properties, which has been used to treat various types of anxiety disorders, including panic attacks and agitation associated with anxiety disorders 2, 3.
• Studies have shown that clobazam can be effective in reducing anxiety and panic attacks in patients with anxiety disorders, with response rates ranging from 60% to 75% reduction in panic attacks 2.
• Clobazam has also been shown to have a positive effect on state anxiety, with significant reductions in rating scores on anxiety scales such as the Hamilton Anxiety Scale (HAS) and Wittenborn Psychiatric Rating Scales (WPRS) 3.
• Additionally, clobazam has been found to have a rapid onset of action, with significant improvements in anxiety symptoms observed early in treatment 3.

Mechanism of Action

• Clobazam acts by allosterically activating the GABAA receptor, which is responsible for its anxiolytic and anticonvulsant effects 4, 5.
• Clobazam has a high affinity for the GABAA receptor, which is thought to contribute to its efficacy in reducing anxiety and seizure activity 4.
• The drug is also metabolized to an active metabolite, N-desmethylclobazam, which has a longer half-life than the parent compound and contributes to its therapeutic effects 5.

Clinical Use

• Clobazam is approved for the treatment of seizures associated with Lennox-Gastaut syndrome, but it has also been used off-label for the treatment of anxiety disorders, including panic attacks and agitation 6, 4.
• The dosage of clobazam used in clinical practice can vary depending on the indication and patient population, but typical doses range from 5-40 mg per day 4.
• Clobazam is generally well-tolerated, with a safety profile similar to that of other benzodiazepines, but with less sedation and psychomotor impairment 6, 4.