Clobazam (Page 3 of 9)

5.8 Neonatal Sedation and Withdrawal Syndrome

Use of clobazam tablets late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in the neonate [see Use in Specific Populations (8.1)]. Monitor neonates exposed to clobazam tablets during pregnancy or labor for signs of sedation and monitor neonates exposed to clobazam tablets during pregnancy for signs of withdrawal; manage these neonates accordingly.

6 ADVERSE REACTIONS

Clinically significant adverse reactions that appear in other sections of the labeling include the following:

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

During its development for the adjunctive treatment of seizures associated with LGS, clobazam tablets was administered to 333 healthy volunteers and 300 patients with a current or prior diagnosis of LGS, including 197 patients treated for 12 months or more. The conditions and duration of exposure varied greatly and included single- and multiple-dose clinical pharmacology studies in healthy volunteers and two double-blind studies in patients with LGS (Study 1 and 2) [see Clinical Studies (14)]. Only Study 1 included a placebo group, allowing comparison of adverse reaction rates on clobazam tablets at several doses to placebo.

Adverse Reactions Leading to Discontinuation in an LGS Placebo Controlled Clinical Trial (Study 1)

The adverse reactions associated with clobazam tablets treatment discontinuation in ≥1% of patients in decreasing order of frequency included lethargy, somnolence, ataxia, aggression, fatigue, and insomnia.

Most Common Adverse Reactions in an LGS Placebo Controlled Clinical Trial (Study 1)

Table 3 lists the adverse reactions that occurred in ≥5% of clobazam tablets-treated patients (at any dose), and at a rate greater than placebo-treated patients, in the randomized, double-blind, placebo-controlled, parallel group clinical study of adjunctive AED therapy for 15 weeks (Study 1).

Table 3. Adverse Reactions Reported for ≥5% of Patients and More Frequently than Placebo in Any Treatment Group
PlaceboN=59% Clobazam Tablets Dose Level All Clobazam TabletsN=179 %
Low *N=58% Medium N=62% High N=59%
*
Maximum daily dose of 5 mg for ≤30 kg body weight; 10 mg for >30 kg body weight
Maximum daily dose of 10 mg for ≤30 kg body weight; 20 mg for >30 kg body weight
Maximum daily dose of 20 mg for ≤30 kg body weight; 40 mg for >30 kg body weight
Gastrointestinal Disorders
Vomiting 5 9 5 7 7
Constipation 0 2 2 10 5
Dysphagia 0 0 0 5 2
General Disorders and Administration Site Conditions
Pyrexia 3 17 10 12 13
Irritability 5 3 11 5 7
Fatigue 2 5 5 3 5
Infections and Infestations
Upper respiratory tract infection 10 10 13 14 12
Pneumonia 2 3 3 7 4
Urinary tract infection 0 2 5 5 4
Bronchitis 0 2 0 5 2
Metabolism and Nutrition Disorders
Decreased appetite 3 3 0 7 3
Increased appetite 0 2 3 5 3
Nervous System Disorders
Somnolence or Sedation 15 17 27 32 26
Somnolence 12 16 24 25 22
Sedation 3 2 3 9 5
Lethargy 5 10 5 15 10
Drooling 3 0 13 14 9
Ataxia 3 3 2 10 5
Psychomotor hyperactivity 3 3 3 5 4
Dysarthria 0 2 2 5 3
Psychiatric Disorders
Aggression 5 3 8 14 8
Insomnia 2 2 5 7 5
Respiratory Disorders
Cough 0 3 5 7 5

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