A benzodiazepine used in epilepsy

Clobazam

A benzodiazepine used mainly as an add-on treatment to help control epileptic seizures, which must not be stopped suddenly.

What is Clobazam?

Clobazam is a benzodiazepine used mainly as an add-on treatment to help control epileptic seizures, and sometimes for short-term severe anxiety. It calms overactive electrical activity in the brain. Because tolerance and dependence can develop and stopping suddenly can trigger seizures, it is taken regularly as prescribed and reduced only gradually.

Class: Benzodiazepines & Z-drugs · Brands: Frisium

Education and reference only. This is a plain-language guide to Clobazam — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review
Class: Benzodiazepines & Z-drugs → Brands: Frisium
Clobazam (Benzodiazepines & Z-drugs) — Meds Global Health reference card with 2D molecular structure
Clobazam — Benzodiazepines & Z-drugs. The image shows the active ingredient's 2D molecular structure.

What it is

Clobazam is a benzodiazepine, but unlike most members of the group it is used mainly as an add-on ('adjunctive') treatment for epilepsy, helping to control seizures alongside other anti-epileptic medicines. It is sometimes also used for severe anxiety in the short term. Like other benzodiazepines it is calming and sedating, and it can lead to tolerance and dependence, so it is used carefully and not stopped abruptly.

How it works

Clobazam boosts the action of GABA, the brain's main calming (inhibitory) neurotransmitter. By making GABA's effect stronger, it reduces overactive electrical signalling in the brain, which helps prevent or reduce seizures and produces a calming, sedating effect. Over time the brain can adapt to its presence (tolerance), which is why the seizure-protecting effect can lessen and why stopping suddenly can leave the brain over-excitable and prone to seizures.

Company & origin

Originated / developed by: Hoechst (now part of Sanofi).

Clobazam is a benzodiazepine, but unlike most of the group it is mainly used as an add-on treatment for epilepsy rather than for anxiety or sleep. It is a '1,5-benzodiazepine', a slightly different chemical structure to the more familiar diazepam-type medicines.

What it treats

Conditions Clobazam is used for

EpilepsyA tendency to have recurrent seizures caused by bursts of abnormal electrical activity in …

Practical use

How to take Clobazam

General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.

  • Take it regularly as prescribed as part of your epilepsy treatment — do not change or skip it on your own.
  • Never stop it suddenly; stopping must be done gradually under medical guidance, as abrupt withdrawal can trigger seizures.
  • Avoid alcohol, which dangerously adds to drowsiness and slowed breathing.
  • Take care with driving and operating machinery, especially when starting or changing the amount, as it can make you drowsy.
  • Tell your prescriber if it seems to be working less well over time rather than increasing it yourself.
  • Do not run out — order repeat supplies in good time, as missing doses can affect seizure control.

Weighing it up

Advantages & disadvantages of Clobazam

Advantages

  • A useful add-on that can improve seizure control when other anti-epileptic medicines alone are not enough.
  • Works quickly to calm overactive brain activity.
  • Available as tablets and a liquid, which helps when swallowing tablets is difficult.

Disadvantages

  • Tolerance can develop, so its seizure-protecting effect may lessen over time.
  • Dependence can develop, and it must never be stopped suddenly because of the risk of withdrawal seizures.
  • Sedating, which can affect alertness, driving and daily activities.
  • Should not be combined with alcohol, and adds to the effect of other sedating medicines.

Practical use

Good to know

Clobazam must never be stopped suddenly. In epilepsy, abrupt stopping can trigger seizures, including prolonged or repeated seizures, so it is always reduced slowly under medical guidance. With regular use, tolerance (a reduced effect) and dependence can develop, so it is reviewed regularly. It is sedating, so care is needed with driving and machinery, and alcohol should be avoided as it dangerously adds to drowsiness and slowed breathing. It can be habit-forming, and is used at the lowest helpful amount for the shortest appropriate time, particularly when used for anxiety.

Who should not take it / use with caution

  • People with severe breathing problems or sleep apnoea, or with severe liver impairment, used only with great caution.
  • People with a history of dependence on alcohol or other drugs, where it is used especially carefully.
  • Used cautiously in older people (more prone to drowsiness and falls), in muscle-weakness conditions such as myasthenia gravis, and in pregnancy.

Monitoring

  • Seizure control and response to treatment
  • Drowsiness, alertness and any signs of tolerance or dependence
  • Regular review of the continued need and a planned, gradual reduction if it is to be stopped

Side effects

  • Drowsiness, sedation, dizziness and tiredness, which are common, especially at the start.
  • Unsteadiness, slowed reactions, problems with concentration or memory, and sometimes drooling or behavioural changes.
  • With regular use, tolerance and dependence; withdrawal effects (including seizures) if stopped abruptly.

Key interactions

  • Alcohol and other sedating medicines — opioids, other benzodiazepines, sedating antihistamines — add dangerously to drowsiness and slowed breathing.
  • Other anti-epileptic medicines can affect its levels, and it can affect theirs, so combinations are managed carefully.
  • Medicines that affect the liver enzymes that break it down can raise or lower its levels.

Available as: Tablets and an oral liquid (suspension) taken by mouth.

Answers

Clobazam: frequently asked questions

Why must I not stop clobazam suddenly?

Stopping a benzodiazepine abruptly can cause withdrawal effects, and in epilepsy it can trigger seizures, including prolonged or repeated seizures that can be dangerous. Clobazam is always reduced slowly under medical guidance, never stopped in one go, even if you feel it is no longer helping.

Can clobazam stop working over time?

Yes. The brain can adapt to benzodiazepines (tolerance), so the seizure-protecting effect can lessen with regular use. If you notice it seems less effective, tell your prescriber rather than increasing it yourself, so your overall treatment can be reviewed.

Is clobazam addictive?

Benzodiazepines, including clobazam, can lead to dependence with regular use, where the body becomes used to the medicine. This is balanced against the benefit of seizure control. It is used at the lowest helpful amount, reviewed regularly, and reduced gradually rather than stopped suddenly when it is to be withdrawn.

Can I drink alcohol while taking clobazam?

No — alcohol should be avoided. Both clobazam and alcohol are sedating, and together they can dangerously increase drowsiness and slow your breathing. This combination also increases the risk of accidents and falls, so it is best avoided completely while taking clobazam.

Will clobazam make me drowsy?

Drowsiness and tiredness are common, especially when you first start or when the amount is increased. Take care with driving and operating machinery until you know how it affects you. If drowsiness is troublesome, tell your prescriber rather than stopping the medicine yourself.

The wider class

About Benzodiazepines & Z-drugs

Clobazam belongs to the benzodiazepines & z-drugs class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.

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Browse by body system

Mental healthConditions and medicines for mood, anxiety, psychosis, sleep and dependence — used alongsi…

Authoritative sources

  • BNF: Clobazam.
  • NICE CKS: Epilepsy medicines.

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