Clobazam (also known by the brand names Onfi, Frisium, and Urbanol) is a benzodiazepine drug and is approved for the treatment of anxiety and seizures. It is also approved for use in treating Lennox-Gastaut Syndrome, a type of epilepsy where individuals experience different types of seizures and often have an intellectual impairment.1,2 Clobazam has an extended half-life, so it’s longer-acting than some other benzodiazepines.
Benzodiazepines are a class of depressants that increase the levels of gamma-aminobutyric acid (GABA) in the central nervous system. GABA is the major inhibitory neurotransmitter in the brain and spinal cord, and functions to modulate or reduce the activity of the central nervous system. The GABA-enhancing effects of benzodiazepines make them useful in the treatment of conditions resulting from overactivity in the brain and spinal cord. These can include seizures, anxiety disorders, issues with insomnia, and muscle tension issues. In addition, some benzodiazepines are used in the treatment of withdrawal from alcohol and other drugs.1
Clobazam is categorized as a Schedule IV controlled substance by the United States Drug Enforcement Administration.3 This means that while the drug has practical medicinal uses, it also carries the risk for abuse and the development of dependence. Abuse of clobazam is not as common as abuse of other more popular benzodiazepines, such as Xanax, Ativan, and Valium. But that doesn’t mean people don’t abuse the drug. Even early in its development and marketing, the World Health Organization reported cases of people taking too much of the drug to produce an illicit effect.4
Effects of Clobazam Use and Abuse
The journal Addiction reports that several different effects occur when a person uses clobazam recreationally. These effects are generally experienced by recreational users of clonazepam and other benzodiazepines.4
Potential short-term effects include the following:
- Decrease in muscular coordination and the ability to perform tasks
- Difficulty performing complex skills, such as driving
- Impairment of higher brain functions, including learning and memory
- Paradoxical effects that include increased anxiety and aggression
- Sedation that continues even after tolerance has developed
Potential long-term effects include the following:
- General cognitive decline, including a decline in learning and memory
- Issues with performing routine tasks
- Poor overall mental health
- Poorer quality sleep in some individuals
- Potential immune system impairments
- The development of physical dependence
Several studies have indicated that the possibility of developing a physical dependence on clobazam. Repeated use of clobazam results in the potential to develop both tolerance and withdrawal, even in individuals who use it for medicinal purposes.5
Individuals who use benzodiazepines recreationally are more likely to take larger amounts of the drugs and use them in combination with other substances, particularly alcohol. The use of alcohol and clobazam together results in the enhancement of the central nervous system depressant effects and side effects of both substances.5
The withdrawal syndrome associated with clobazam is similar to the withdrawal syndrome that occurs with other benzodiazepines. These can include anything from nausea and vomiting, along with rebound anxiety, rebound insomnia, delirium, hallucinations, and the potential to develop seizures, which can be life-threatening.
How to Determine if Someone Is Abusing Clobazam
Repeated recreational use of benzodiazepines can lead to the development of a substance use disorder. Therefore, it’s important to be able to spot potential signs of abuse as early as possible. Those who abuse clobazam might display some of the following warning signs.6,7
- Confusion (more likely in heavy users, people who combine benzodiazepine use with other drugs, and elderly people)
- Dementia-like symptoms (more likely in heavy users and elderly people)
- Excessive sweating
- Issues with balance
- Issues with memory
- Lethargy and drowsiness
- Mood swings
- Nausea (in some cases, vomiting)
- Poor coordination
- Poor judgment
- Reduced inhibitions
- Slowed or shallow breathing
- Slurred speech (the appearance of being intoxicated with alcohol but no smell of alcohol)
- Visual problems
If a person attempts to obtain clobazam illegally or shop for a doctor to get more prescriptions, they might be developing a more serious tolerance to the drug. Additionally, heavy users might forge prescriptions, steal medication, or spend more time with known drug users. As with all addictions, those who abuse clobazam might isolate themselves and give up activities that were once important.
The American Psychiatric Association lists the formal diagnostic criteria for an anxiolytic use disorder, which is the formal label for a substance use disorder to benzodiazepines. These criteria are designed to be used by mental health professionals in the diagnosis of substance use disorders and include such behaviors as:
- Continuing to use the drug despite knowing that it is causing issues with health, psychological functioning, or other areas of life
- Cravings the drug
- Failing to meet important obligations as a result of one’s drug use
- Giving up important activities to use the drug
- Repeatedly using more of the drug than intended
- Repeatedly using the drug in dangerous situations (while driving, drinking alcohol, etc.)
- The development of tolerance
- Withdrawal symptoms when going without the drug
Negative consequences that are associated with drug use includes issues at work, issues at school, financial issues, legal issues, or issues in personal relationships.
How to Choose the Right Treatment Program for Clobazam Abuse
There is a significant potential for an individual who abuses clobazam to develop a physical dependence on the drug. Withdrawal symptoms can have potentially fatal effects, so it’s extremely important that an individual seeking treatment for clobazam abuse to consult with a physician first before discontinuing the drug.
For many, the most beneficial route to detox from clobazam abuse is to begin a physician-assisted withdrawal management program. During this process, a physician will monitor the person’s recovery and administer medications, including longer-acting benzodiazepines, to slowly wean the person off the drug with minimal effects. For many, a physician will administer other medications to be used in conjunction with the weaning-off process.
Recovery is much more than simply detoxing from clobazam. A person needs to become involved and active in a formal substance use disorder treatment program that includes therapy, social support participation, and psychoeducation. Because many individuals who abuse benzodiazepines also abuse other drugs, it is important that the person be fully assessed to determine the presence of any other substance use disorders and any co-occurring psychological disorders like depression. Co-occurring disorders must be treated at the same time for the individual to recover fully.
Treatment for formal substance use disorders is a long-term process. Since there is no cure for addiction, it is a disorder that must be effectively managed for life. This means those in recovery often participate in some form of aftercare, generally on a decreasing basis, for the rest of their lives. In short, recovery from this substance should be thought of as a journey.
- Arya, R., Anand, V., Garg, S., Michael, B. Clobazam monotherapy for partial-onset or generalized-onset seizures. Cochrane Database Syst Rev. 2014 Oct 4;(10):CD009258.
- Epilepsy Foundation. (2020). Lennox-Gastaut Styndrom (LGS).
- S. Drug Enforcement Administration. Drug Scheduling.
- Lader, M. Benzodiazepines revisited—will we ever learn? Addiction, (2011), 106, 2086–2109.
- Tolbert, D., Harris, S., Bekersky, I. et. al. Withdrawal-related adverse events from clinical trials of clobazam in Lennox-Gastaut syndrome. Epilepsy Behav. (2014) Aug;37:11-5.
- Gitlow, S. (2007). Substance Use Disorders: A Practical Guide. Lippincott Williams & Wilkins, Philadelphia, PA.
- Sevarino, K. (2013). Treatment of Substance Use Disorders. Taylor & Francis, Oxfordshire, U.K.