Alternatives to Onfi If You Can't Fill Your Prescription

When Onfi (clobazam) is unavailable at your pharmacy, the stakes are high. Onfi is a seizure medication — for patients with Lennox-Gastaut syndrome (LGS) and other forms of epilepsy, missing doses can lead to breakthrough seizures or dangerous withdrawal. But before you despair, it's important to know that options do exist.

Important warning: Never stop Onfi suddenly or switch to an alternative without your neurologist's guidance. Abrupt discontinuation of Onfi can cause withdrawal seizures, status epilepticus (prolonged, life-threatening seizures), hallucinations, and severe muscle cramps. Any transition to an alternative must be supervised by a physician.

First: Have You Tried All Onfi Formulations and Pharmacies?

Before considering alternatives, exhaust your options to find Onfi itself. Onfi comes in three formulations — tablets (10 mg, 20 mg), oral suspension (2.5 mg/mL), and Sympazan oral film (5 mg, 10 mg, 20 mg) — and each has a somewhat different supply chain. If one is unavailable, another may not be. Also try independent and specialty pharmacies, which often have more consistent stock. See our full guide: How to find Onfi in stock near you.

Closest Alternative: Clonazepam (Klonopin)

Clonazepam (brand name Klonopin) is the most pharmacologically similar alternative to clobazam. Both are benzodiazepines that enhance the effect of GABA in the brain to reduce seizure activity. Clonazepam is widely available in generic form and typically costs $10–$30 per month — much less than Onfi.

Key differences to discuss with your doctor:

• Clonazepam is a 1,4-benzodiazepine and typically causes more sedation than clobazam (a 1,5-benzodiazepine)
• Dosing is not equivalent — your neurologist will need to calculate the appropriate crossover dose
• Clonazepam is also Schedule IV and may have similar dispensing restrictions
• It is widely available at virtually all pharmacies, making it a reliable backup

FDA-Approved Alternatives for Lennox-Gastaut Syndrome

Several other medications have FDA approval specifically for LGS seizures and may be considered as alternatives or adjuncts to Onfi:

Rufinamide (Banzel) — FDA-approved specifically for LGS as adjunctive therapy. It works through a different mechanism (sodium channel modulation) and does not carry the same withdrawal risks as benzodiazepines. Generally well tolerated in children and adults.

Valproate/Valproic Acid (Depakote, Depakene) — A broad-spectrum anti-seizure medication widely used in LGS. Available as tablets, sprinkle capsules, and extended-release formulations. Widely available and inexpensive in generic form. Requires monitoring of blood levels and liver function.

Lamotrigine (Lamictal) — Another broad-spectrum AED commonly used in LGS. Available as generic tablets and chewable dispersible tablets. Requires careful dose titration to avoid serious skin reactions. Widely available and often very affordable.

Cannabidiol (Epidiolex) — FDA-approved for seizures in LGS and Dravet syndrome in patients 1 year of age or older. Note: Epidiolex inhibits CYP2C19, which increases clobazam metabolite levels — so if you're transitioning from Onfi, be sure your neurologist is aware of this interaction.

Felbamate (Felbatol) — FDA-approved for LGS but reserved for refractory cases due to a rare but serious risk of aplastic anemia and liver failure. Requires strict monitoring and informed consent. Typically only used when multiple other medications have failed.

What Is Not a Good Substitute for Onfi

Not all anti-seizure medications work the same way, and some that are effective for other epilepsy types may not be appropriate for LGS. For example, medications like gabapentin or pregabalin are generally not used for LGS. Only a neurologist or epileptologist experienced with LGS can determine the safest alternative for an individual patient.

How to Have the Conversation With Your Neurologist

When you contact your neurologist about an Onfi shortage, be prepared to tell them:

• How many days of medication you have left
• Which pharmacies you have already contacted
• Your current Onfi dose and formulation
• Any other seizure medications you currently take (for crossover dosing calculations)

The Bottom Line

Alternatives to Onfi exist, but they must be carefully selected and supervised by your neurologist. The most pharmacologically similar option is clonazepam. For LGS specifically, rufinamide, valproate, and lamotrigine are all FDA-approved options. Before jumping to alternatives, however, exhaust all options to locate Onfi — try medfinder to check pharmacies near you quickly and efficiently. Your seizure control depends on consistent medication — whatever the source.