Bromazepam
Drug class: Benzodiazepine, BDZs
Bromazepam (LEXOTAN) （中文: 溴西泮） is an intermediate-acting benzodiazepine. It is used in the short-term treatment of anxiety disorders, occuring alone or associated with insomnia.
Pronunciation[edit]
Drug Names[edit]
| Generic Name 藥名 | HA Code 藥物代碼 | Classification藥物分類 |
|---|---|---|
| Bromazepam Tablet 1.5 mg | BROM01 | DDA |
| Bromazepam Tablet 3 mg | BROM02 | DDA |
Mechanism of Action[edit]
- Bromazepam is a benzodiazepine.
- Gama-Aminobutyric acid (GABA) is an inhibitory neurotransmitter, acting on the GABA receptors in the central nervous system (CNS), thus inhibiting the nerve impulses.
- Bromazepam acts on the benzodiazepine receptors in the brain and the spinal cord. Benzodiazepine receptors in the CNS are linked with GABA receptors as a complex.
- Bromazepam by binding to the benzodiazepine receptors results in activation of the GABA-benzodiazepine receptor complex, resulting in inhibition of nerve impulses, overall depression of brain and spinal cord.
- Thus Bromazepam use helps to promote muscle relaxation, reduce anxiety, control of convulsions and promote sleep.
Dosage[edit]
| Short-term use in anxiety | By mouth
When the total dose is low (eg. 3 or 6 mg), to give the total dose in the evening |
|---|
Side Effects[edit]
Sedative drugs, including alprazolam, have been associated with an increased risk of death.
Possible side effects include:
| Very common (>10% of incidence)
or Common (1-10% of incidence) |
|
|---|---|
| Infrequent (0.1 -1% of incidence) |
|
| Rare (<0.1% of incidence) |
|
Minor elevations of liver enzymes occurred in about 3% of patients.
Overdosage can produce CNS depression and coma.
Paradoxical reactions
Although unusual, the following paradoxical reactions have been shown to occur:
- aggression, rage
- mania, agitation, and restlessness
- hallucinations, inappropriate behavior
- twitches and tremor
Pharmacokinetics[edit]
| Oral bioavailability | Bromazepam is well absorbed after oral doses. |
|---|---|
| Onset of action | Bromazepam is well absorbed after oral doses.
Peak plasma concentrations are reached between 0.5 and 4 hours of a dose. |
| Metabolism | Bromazepam is metabolized in the liver |
| Elimination half-life | Bromazepam is eliminated in the urine.
It has an elimination half-life of about 17 hours (range 11 – 22 hours). |
Drug Management[edit]
Monitoring[edit]
- changes in mood, the development or worsening depression, and/or any thoughts or behaviour of suicide.
- Although hypotension has occurred rarely, should monitor blood pressure and pulse regularly
- An increased risk of falls and fractures in elderly, so fall prevention is needed
- Some patients develop blood dyscrasias, and have raised liver enzymes, so periodic blood counts and liver function tests are recommended
Dependence and Withdrawal[edit]
- Benzodiazepines should be prescribed for short periods only (e.g. 2 -4 weeks).
- Dependence is particularly likely in patients with a history of alcohol or drug abuse and in those with marked personality disorders.
- Tolerance develops to the sedative effects of benzodiazepines. After as little as one week of therapy, withdrawal symptoms can appear.
- Bromazepam should therefore be withdrawn by tapering the dose to minimize occurrence of withdrawal symptoms.
- The time needed for withdrawal can vary from about 4 weeks to 4 months or more.
Drug interaction[edit]
nhanced sedation or respiratory and cardiovascular depression may occur if bromazepam is given with other drugs that have CNS-depressant properties; these include alcohol, antidepressants, sedative antihistamines, antipsychotics, and opioid analgesics.
Caution[edit]
- particular care in pregnancy,
- elderly, due to increased susceptibility to side-effects, especially loss of coordination and drowsiness
- people with history of alcohol dependence or abuse
- people with history of drug dependence or abuse
- people with psychiatric disorders
- avoid prolonged use and abrupt withdrawal thereafter
Contra-indications[edit]
Bromazepam is contraindicated in patients with:
- severe hepatic impairment
- sleep apnoea syndrome
- chronic obstructive airways disease (COPD) with incipient respiratory failure
- Myasthenia gravis
- Acute narrow-angle glaucoma
Hepatic impairment[edit]
- Start with smaller initial doses or reduce dose.
- Can precipitate coma.
Renal impairment[edit]
- Start with small doses in severe impairment.
Pregnancy[edit]
Avoid use of bromazepam during pregnancy .
Breast-feeding[edit]
Use during breast feeding is not recommended.
Driving and skilled tasks[edit]
May impair judgment and increase reaction time, and so affect ability to drive or operate machinery. Patients should be warned not to operate dangerous machinery or motor vehicles until it is known that they do not become drowsy from Bromazepam therapy.
FAQ[edit]
How should I take the tablet?[edit]
If you get nauseous after taking bromazepam on an empty stomach, try taking it with food.
What should I avoid while taking?[edit]
Do not eat grapefruit or drink grapefruit juice.
Do not drink any alcohol or use recreational drugs while taking alprazolam
What happen if I overdose?[edit]
Contact your primary care doctor. If emergency situation, call 999
What happen if I miss a dose?[edit]
Take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
