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Horner – Apraclonidine — SCE Neurology MCQ

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HardNeuro-ophthalmologyHorner – ApraclonidineSCE Neurology

A child with Dravet syndrome takes valproate and clobazam. After stiripentol is introduced, seizures improve but marked somnolence and hypotonia develop. What is the most source-concordant first pharmacological adjustment?

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Correct answer: E — Reduce clobazam by about 25% each week while reassessing toxicity and seizure control

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

B is correct: stiripentol inhibits clobazam metabolism, raising clobazam about two- to threefold and norclobazam about fivefold; somnolence, hypotonia or irritability should prompt stepwise clobazam reduction, described as 25% weekly. A risks withdrawal and is mechanistically wrong. C reverses the interaction. D worsens toxicity. E adds another sedative inducer instead of correcting the established pharmacokinetic cause.

Reference: Diacomit 500 mg powder for oral suspension SmPC: https://www.medicines.org.uk/emc/product/10308/smpc