TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: CLOBZ    
Clobazam and Metabolite, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Monitoring clobazam therapy

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Clobazam is a broad spectrum, antiepileptic drug used to for various types of seizures, Lennox-Gastaut syndrome (a type of childhood onset epilepsy), and migraine prophylaxis. Clobazam blocks voltage-dependent sodium channels, potentiates gamma-aminobutyric acid (GABA) activity at some of the GABA receptors, and inhibits potentiation of the glutamate receptor and carbonic anhydrase enzyme, all which contribute to its antiepileptic and antimigraine efficacy.

 

In general, clobazam shows favorable pharmacokinetics with good absorption (1-4 hours for the immediate-release formulation), low protein binding, and minimal hepatic metabolism. Elimination is predominantly renal, and it is excreted unchanged in the urine with an elimination half-life of approximately 21 hours. As with other anticonvulsant drugs eliminated by the renal system, patients with impaired renal function exhibit decreased clobazam clearance and a prolonged elimination half-life.

 

Serum concentrations of other anticonvulsant drugs are not significantly affected by the concurrent administration of clobazam, with the exception of patients on phenytoin whose serum concentrations can increase after the addition of clobazam. Other drug-drug interactions include the coadministration of phenobarbital, phenytoin, or carbamazepine, which can result in decreased clobazam concentrations. In addition, concurrent use of posaconazole and clobazam may result in the elevation of clobazam serum concentrations. Therefore, changes in cotherapy with these medications (phenytoin, carbamazepine, posaconazole, or phenobarbital) may require dose adjustment of clobazam and therapeutic drug monitoring can be helpful. The most common adverse drug effects associated with clobazam include: weight loss, loss of appetite, somnolence, dizziness, coordination problems, memory impairment, and paresthesia.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

CLOBAZAM

Therapeutic Range: 30-300 ng/mL

 

NORCLOBAZAM

Therapeutic Range: 300-3,000 ng/mL

Interpretation Provides information to assist in interpretation of the test results

The results of this test should be interpreted in conjunction with the patient's physical signs, symptoms, and other laboratory test results.

 

Most individuals display optimal response to clobazam when serum levels of clobazam are between 30 and 300 ng/mL and N-desmethylclobazam are between 300 and 3000 ng/mL. Risk of toxicity is increased when clobazam levels are above 500 ng/mL or N-desmethlyclobazam levels are above 5000 ng/mL.

 

Some individuals may respond well outside of these ranges or may display toxicity within the therapeutic range, thus, interpretation should include clinical evaluation.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

No significant cautionary statements

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Hiemke C, Bergemann N, Clement HW, et al: Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: Update 2017. Pharmacopsychiatry. 2018 Jan;51(1-02):9-62

2. Patslos PN, Berry DJ, Bourgeois BF, et al: Antiepileptic drugs-best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia. 2008 Jul;49(7):1239-1276

3. Johannessen SI, Tomsom T: Pharmacokinetic variability of newer antiepileptic drugs: when is monitoring needed? Clin Pharmacokinet. 2006;45(11):1061-1075