Antiseizure medication (ASM) shortages are a global problem that have a negative impact on outcomes such as seizure control in patients with epilepsy (PWE). In the case of clobazam (CLB) shortage, there is no study regarding the management strategy. This study aims to investigate the alteration in seizure frequency and the occurrence of side effects in PWE undergoing an abrupt switch from clobazam (CLB) to clonazepam (CLZ), during CLB shortage. A retrospective study was conducted from electronic health records at our neurology outpatient clinic from January to July 2022. Change in seizure frequency and percentage of CLZ-associated side effects were determined as primary and secondary outcomes, respectively. Potential drug-drug interactions (Level C and above) were evaluated by using Lexicomp Drug Interaction Checker. The analysis included a total of 29 adult patients (15F, median age: 29). The switching ratio was 10 mg CLB for every 1 mg CLZ (10:1). Seizure frequency was higher during the CLZ period compared to the CLB period (p < 0.05), but no status epilepticus cases were observed. All patients exhibited potential drug-drug interactions, leading to reduced CLZ levels in 12 cases. A total of 36 CLZ-associated side effects were identified, with fatigue (19.4 %), drowsiness (16.6 %), and somnolence (13.8 %) being the most prevalent. A positive and strong correlation was found between CLZ dose and the number of side effects (r: 0.556; p: 0.002). The abrupt switch from CLB to CLZ was observed to increase seizure frequency without leading to status epilepticus in PWE. CLZ-associated side effects were found to be tolerable despite the abrupt switch. Future studies may explore the effect of alternative switching ratios.

中文翻译：

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因药物短缺而从氯巴占转为氯硝西泮的患者的癫痫发作控制和并发症

抗癫痫药物 (ASM) 短缺是一个全球性问题，会对癫痫患者 (PWE) 的癫痫发作控制等结果产生负面影响。在氯巴占（CLB）短缺的情况下，目前还没有关于管理策略的研究。本研究旨在调查在 CLB 短缺期间从氯巴占 (CLB) 突然转换为氯硝西泮 (CLZ) 的 PWE 中癫痫发作频率的变化和副作用的发生情况。根据 2022 年 1 月至 7 月在我们的神经科门诊进行的电子健康记录进行了一项回顾性研究。癫痫发作频率的变化和 CLZ 相关副作用的百分比分别被确定为主要和次要结果。使用 Lexicomp 药物相互作用检查器评估潜在的药物相互作用（C 级及以上）。该分析总共包括 29 名成年患者（15F，中位年龄：29）。转换比率为每 1 mg CLZ 对应 10 mg CLB (10:1)。与 CLB 期间相比，CLZ 期间的癫痫发作频率较高 (p < 0.05)，但未观察到癫痫持续状态病例。所有患者均表现出潜在的药物相互作用，导致 12 例患者 CLZ 水平降低。总共发现了 36 种 CLZ 相关副作用，其中最常见的是疲劳（19.4%）、嗜睡（16.6%）和嗜睡（13.8%）。 CLZ 剂量与副作用数量之间存在正相关性（r：0.556；p：0.002）。在 PWE 中，观察到从 CLB 突然转换为 CLZ 会增加癫痫发作频率，但不会导致癫痫持续状态。尽管突然转换，但发现 CLZ 相关的副作用是可以忍受的。未来的研究可能会探讨替代转换比率的影响。