Onfi is the brand name for the medication clobazam, classified as a Schedule IV controlled substance due to its potential for abuse and dependence. It is approved for use with other medications to treat seizures related to Lennox-Gastaut syndrome (LGS). Onfi is available in tablet and oral suspension forms, and as an oral film in some regions.
How Onfi Works
As a benzodiazepine, Onfi is believed to work by enhancing the inhibitory effect of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain. By binding to GABA-A receptors, Onfi increases GABA's effect, helping to calm overactive nerves and stabilize brain activity to prevent seizures.
The Role of Its Active Metabolite
Onfi is metabolized into an active form called N-desmethylclobazam. This metabolite has a significantly longer half-life (around 82 hours including the active metabolite) compared to Onfi's half-life of about 18 hours. This means the metabolite contributes to the drug's effects for a longer duration, influencing the time it takes to reach stable levels in the body and the dosage titration process.
Important Safety Information and Warnings
Onfi includes three FDA boxed warnings highlighting serious risks.
FDA Boxed Warnings
- Concomitant Use with Opioids: Combining Onfi with opioids can lead to severe drowsiness, respiratory depression, coma, and death. This combination should be avoided unless other options are insufficient.
- Abuse, Misuse, and Addiction: Onfi carries a high risk of abuse and addiction, even at prescribed doses. Misuse of benzodiazepines can result in overdose and death.
- Dependence and Withdrawal Reactions: Long-term use can cause physical dependence. Suddenly stopping Onfi can cause life-threatening withdrawal symptoms, including increased seizures, hallucinations, and suicidal ideation. Gradual tapering is necessary for discontinuation.
Other Serious Side Effects
- Serious Skin Reactions: Rare but serious skin reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been linked to Onfi. These reactions are life-threatening and may include rash, blistering, fever, or swelling.
- Mood Changes and Suicidal Thoughts: As with other antiepileptic drugs, Onfi can increase the risk of suicidal thoughts or behaviors in some individuals. Patients should be monitored for mood or behavioral changes.
Onfi Administration and Dosage
Onfi is generally taken twice daily, with or without food. Tablets can be crushed and mixed with applesauce for easier administration if needed. {Link: Drugs.com https://www.drugs.com/dosage/onfi.html}.
Comparison of Onfi with Other Antiepileptic Drugs
| Feature | Onfi (clobazam) | Banzel (rufinamide) | Vimpat (lacosamide) |
|---|---|---|---|
| Drug Class | Benzodiazepine anticonvulsant | Dibenzazepine anticonvulsant | Miscellaneous anticonvulsant |
| Primary Indication | Adjunctive treatment for LGS | Adjunctive treatment for LGS | Adjunctive treatment for partial-onset seizures |
| Typical Dose Frequency | Twice daily | Twice daily | Twice daily |
| Generic Available | Yes (clobazam) | Yes | Yes |
| Half-life | Approximately 82 hours (including active metabolite) | Approximately 10 hours | Approximately 13 hours |
| Controlled Substance | Schedule IV | Not Controlled | Schedule V |
| Common Side Effects | Sleepiness, drooling, constipation, aggression | Dizziness, fatigue, nausea, headaches | Dizziness, memory problems, headaches |
Conclusion
Onfi (clobazam) serves as a valuable adjunctive treatment for Lennox-Gastaut syndrome seizures in adults and children. It works by enhancing GABA's inhibitory effects and has a significant, long-acting metabolite. Despite its effectiveness, it carries important risks, including potential for abuse, dependence, and severe withdrawal upon sudden discontinuation. Careful dosing, gradual tapering, and following healthcare provider instructions are essential to optimize benefits and mitigate risks. For more information on medications, consult reliable resources such as {Link: MedlinePlus https://medlineplus.gov/druginfo/meds/a612008.html}.
