Clonazepam and Clobazam

Brief Overview:

Clonazepam (Klonopin®) and clobazam (Onfi®) belong to a class of medications called benzodiazepines, which include several other anti-seizure medications such as lorazepam (Ativan®), diazepam (Diastat®, Valium®), clorazepate (Tranxene®), and many others. In general, this class of medications does not appear to be very effective in the treatment of infantile spasms, but is commonly reported to reduce the "intensity" of individual spasms. There is concern that these medications may mask the appearance of spasms without adequately addressing associated electrical abnormalities in the brain (hypsarrhythmia). Neither drug works especially quickly and should not be given with the intent to quickly abolish a cluster of spasms. This is in contrast to other members of this drug family (e.g. Ativan®, Diastat®), which are both frequently prescribed to abort clusters of seizures (non-spasms). 

Clobazam and clonazepam are supplied in tablets (which can be cut or crushed) and clonazepam is also available in the form of a "wafer" which can dissolve in the mouth.  


For clonazepam, typical dosages range from 0.1 to 0.3 mg/kg/day, divided in 2 to 3 doses each day. Clobazam dosage ranges from 0.5 to 1.5 mg/kg/day, divided in 2 daily doses. The length of a treatment course varies greatly among patients and practitioners, but is usually months in duration, assuming a substantial response is observed in the initial weeks of therapy.

Side Effects:

Clonazepam and clobazam (and indeed, all benzodiazepines) are notorious for causing sedation—and in rare cases—they may paradoxically cause agitation. Anecdotal reports indicate that clobazam is somewhat less sedating than other benzodiazepines. This class of medications should not be discontinued suddenly as abrupt withdrawal may provoke seizures. You should contact your physician immediately in the event any of these side effects are observed or suspected.


These medications should be administered only under the direct supervision of a physician.

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