BROMAZEPAM

Indication

Anxiety, Panic attacks

Administration

May be taken with or without food.

Adult Dose

Adult: PO Initial: 6-18 mg/day in divided doses. Higher doses have occasionally been given to hospitalized patients. The dose should be reduced by at least half in elderly patients and those with hepatic impairment.

Renal Dose

Renal impairment: No dosage adjustment is needed.

Contraindication

Preexisting CNS depression or coma, resp depression, acute pulmonary insufficiency or sleep apnea; severe hepatic impairment; not indicated for chronic psychosis, phobic or obsessional states; may precipitate suicide or aggressive behavior, not used alone to treat depression or anxiety associated with depression; glaucoma.

Mode of Action

Bromazepam is a benzodiazepine with general properties similar to diazepam. It is used in the treatment of anxiety occuring alone or associated with insomnia.

Precaution

Chronic pulmonary insufficiency; elderly or debilitated patients; muscle weakness, impaired liver or kidney function; drowsiness may affect skilled tasks; monitor cardio-respiratory function when used for deep sedation; patients with personality disorders or organic brain changes; pregnancy and lactation; history of alcohol or drug addiction due to risk of dependence. resp depression and hypotension with parenteral administration, therefore this route should only be used when facilities for reversing resp depression are available.

Side Effect

Drowsiness, sedation, muscle weakness, and ataxia; less frequently vertigo, headache, confusion, depression, slurred speech, changes in libido, tremor, visual disturbances, urinary retention, GI disturbances, changes in salivation and amnesia; rarely, jaundice, blood disorders, and hypersensitivity reactions; pain and thrombophlebitis; raised liver enzyme values; paradoxical excitation.

Interaction

May enhance the activity w/ CYP450 inhibitor (e.g. azole antifungals, macrolides, HIV protease inhibitors, Ca channel blockers). Elevated plasma levels w/ disulfiram or cimetidine. Additive CNS depressant effects w/ barbiturates, sedatives, analyst, anxiolytics, hypnotics, phenothiazines, other antipsychotics, and skeletal muscle relaxants. May potentiate anticholinergic effects of atropine, antihistamines, and antidepressants. Increased psychic drug dependence w/ narcotic analgesics.