Nitrazepam - Revision history

Ctol2: /* What happen if I overdose? */

2020-10-20T06:33:21Z

What happen if I overdose?

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	==== What happen if I overdose? ====		==== What happen if I overdose? ====
	Contact your primary care doctor.		Contact your primary care doctor.
	If emergency situation, call 999		If emergency situation, call 999.

	==== What happen if I miss a dose? ====		==== What happen if I miss a dose? ====
	Take it as soon as you		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.		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.

Ctol2: /* Renal impairment */

2020-10-20T06:33:10Z

Renal impairment

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	===Renal impairment===		===Renal impairment===
	*Start with small doses in severe impairment.		Start with small doses in severe impairment.

	===Pregnancy===		===Pregnancy===

Ctol2: /* Contra-indications */

2020-10-20T06:33:01Z

Contra-indications

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	===Contra-indications===		===Contra-indications===
	Use of nitrazepam should be avoided, when possible, in individuals with:		Use of nitrazepam should be avoided, when possible, in individuals with:
	*~~severe~~ hepatic impairment		*Severe hepatic impairment
	*~~sleep~~ apnoea		*Sleep apnoea
	*~~chronic~~ obstructive airways disease (COPD)		*Chronic obstructive airways disease (COPD)
	*Myasthenia gravis		*Myasthenia gravis
	*Acute narrow-angle glaucoma		*Acute narrow-angle glaucoma
	*Chronic schizophrenia		*Chronic schizophrenia
	Nitrazepam is recommended to be avoided in patients who drive or operate machinery, as it can impaired driving skills up to 17 hours after dosing.		Nitrazepam is recommended to be avoided in patients who drive or operate machinery, as it can impaired driving skills up to 17 hours after dosing.

	===Hepatic impairment===		===Hepatic impairment===

Ctol2: /* Caution */

2020-10-20T06:32:33Z

Caution

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	===Caution===		===Caution===
	*~~particular~~ care in pregnancy,		*Particular care in pregnancy,
	*~~elderly~~, due to increased susceptibility to side-effects, especially loss of coordination and drowsiness		*Elderly, due to increased susceptibility to side-effects, especially loss of coordination and drowsiness
	*in patients with hepatic or renal impairment, who may require reduced doses		*In patients with hepatic or renal impairment, who may require reduced doses
	*~~people~~ with history of alcohol dependence or abuse		*People with history of alcohol dependence or abuse
	*~~people~~ with history of drug dependence or abuse		*People with history of drug dependence or abuse
	*~~people~~ with psychiatric disorders		*People with psychiatric disorders
	*~~avoid~~ prolonged use and abrupt withdrawal thereafter		*Avoid prolonged use and abrupt withdrawal thereafter

	===Contra-indications===		===Contra-indications===

Ctol2: /* Drug interaction */

2020-10-20T06:31:04Z

Drug interaction

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	\|-		\|-
	\|style="text-align: left"\|		\|style="text-align: left"\|
	Alcohol,		*Alcohol,
	Hypnotics/sedative (e.g. barbiturates)		*Hypnotics / sedative (e.g. [[barbiturates]])
	Antidepressants (e.g. fluoxetine, citalopram, paroxetine, sertraline, amitriptyline)		*Antidepressants (e.g. [[fluoxetine]], [[citalopram]], [[paroxetine]], [[sertraline]], [[amitriptyline]])
	Sedative histamines (e.g. chlorpheniramine, dimenhydrinate, diphenhydramine)		*Sedative histamines (e.g. [[chlorpheniramine]], [[dimenhydrinate]], [[diphenhydramine]])
	Antipsychotic (e.g. chlorpromazine, clozapine, haloperidol, clozapine, quetiapine, risperidone)		*Antipsychotic (e.g. [[chlorpromazine]], [[clozapine]], [[haloperidol]], [[clozapine]], [[quetiapine]], [[risperidone]])
	\|May worsens the side effects such as drowsiness , dizziness and respiratory depression		\|May worsens the side effects such as drowsiness , dizziness and respiratory depression
	\|-		\|-
	\|style="text-align: left"\|		\|style="text-align: left"\|
	Cimetidine		*[[Cimetidine]]
	Omeprazole		*[[Omeprazole]]
	Oxcarbazepine, ~~topiramate~~, ~~valproate~~		*[[Oxcarbazepine]], [[Topiramate]], [[Valproate]]
	Ketoconazole		*[[Ketoconazole]]
	Itraconazole		*[[Itraconazole]]
	Isoniazid		*[[Isoniazid]]
	Erythromycin, ciprofloxacin		*[[Erythromycin]], [[ciprofloxacin]]
	Propranolol		*[[Propranolol]]
	~~fluoxetine~~		*[[Fluoxetine]]
	\|Prolong the action of nitrazepam by inhibiting its elimination		\|Prolong the action of nitrazepam by inhibiting its elimination
	\|-		\|-
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	\|-		\|-
	\|style="text-align: left"\|		\|style="text-align: left"\|
	Rifampicin		*[[Rifampicin]]
	Phenytoin		*[[Phenytoin]]
	Carbamazepine		*[[Carbamazepine]]
	~~phenobarbitone~~		*[[Phenobarbitone]]
	\|All these drugs increase the metabolism of nitrazepam, thus decreasing drug levels and effects		\|All these drugs increase the metabolism of nitrazepam, thus decreasing drug levels and effects
	\|-		\|-
	\|style="text-align: left"\|		\|style="text-align: left"\|
	Steroid (e.g. Dexamethasone)		*Steroid (e.g. [[Dexamethasone]])
	St John’s wort		*St John’s wort
	\|Increase the metabolism of nitrazepam, thus decreasing nitrazepam plasma levels and effects		\|Increase the metabolism of nitrazepam, thus decreasing nitrazepam plasma levels and effects
	\|-		\|-
	\|style="text-align: left"\| Theophylline		\|style="text-align: left"\| [[Theophylline]]
	\|May inhibit the action of nitrazepam		\|May inhibit the action of nitrazepam
	\|-		\|-
	\|style="text-align: left"\| Levodopa (e.g. Sinemet)		\|style="text-align: left"\| [[Levodopa]] (e.g. [[Sinemet]])
	\|nitrazepam may block the action of levodopa used in the treatment of Parkinson’s disease.		\|nitrazepam may block the action of levodopa used in the treatment of Parkinson’s disease.
	\|}		\|}

Ctol2: /* Drug Management */

2020-10-20T06:24:13Z

Drug Management

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	==Drug Management==		==Drug Management==
	====Monitoring====		====Monitoring====
	*Blood pressure, pulse and respiratory rate are recommended		*Blood pressure, pulse and respiratory rate are recommended.
	*Elderly may be sensitivity to nitrazepam’s effects. Impairment of memory, cognitive function, and psychomotor performance and behavior disinhibition may be common. Long-term use commonly exacerbates underlying dementia in elderly patients.		*Elderly may be sensitivity to nitrazepam’s effects. Impairment of memory, cognitive function, and psychomotor performance and behavior disinhibition may be common. Long-term use commonly exacerbates underlying dementia in elderly patients.
	*Nitrazepam may make elderly patients feel dizzy, increasing risk of falls, so fall prevention is needed		*Nitrazepam may make elderly patients feel dizzy, increasing risk of falls, 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		*Some patients develop blood dyscrasias, and have raised liver enzymes, so periodic blood counts and liver function tests are recommended.
	*Some patients develop blood dyscrasias, and have raised liver enzymes, so periodic blood counts and liver function tests are recommended
	*changes in mood, the development or worsening depression, and/or any thoughts or behaviour of suicide.		*changes in mood, the development or worsening depression, and/or any thoughts or behaviour of suicide.

Ctol2: /* Pharmacokinetics */

2020-10-20T06:23:52Z

Pharmacokinetics

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	\|-		\|-
	!style="text-align: left"\| Onset of action		!style="text-align: left"\| Onset of action
	\|Peak plasma concentrations occur about 2 to 3 hours after ingestion		\|Peak plasma concentrations occur about 2 to 3 hours after ingestion.
	\|-		\|-
	!style="text-align: left"\| Metabolism		!style="text-align: left"\| Metabolism
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	\|		\|
	Nitrazepam is excreted in the urine. Up to about 20% of an oral dose is found in the faeces.		Nitrazepam is excreted in the urine. Up to about 20% of an oral dose is found in the faeces.

	The half-life of nitrazepam is between 16.5 and 48.3 hours. In young people, nitrazepam has a half-life of about 29 hours, and a much longer half-life of 40 hours in the elderly.		The half-life of nitrazepam is between 16.5 and 48.3 hours. In young people, nitrazepam has a half-life of about 29 hours, and a much longer half-life of 40 hours in the elderly.

	Nitrazepam’s half-life in the cerebrospinal fluid, 68 hours, indicates its extremely slow elimination from the cerebrospinal fluid.		Nitrazepam’s half-life in the cerebrospinal fluid, 68 hours, indicates its extremely slow elimination from the cerebrospinal fluid.
	\|}		\|}

Ctol2: /* Side Effects */

2020-10-20T06:22:58Z

Side Effects

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	'''Overdosage''' can produce CNS depression and coma.		'''Overdosage''' can produce CNS depression and coma.

	'''Paradoxical reactions (the opposite of what is to be expected) may occur'''. Symptoms include		'''Paradoxical reactions (the opposite of what is to be expected) may occur'''. Symptoms include
	*Aggression, rage;		*Aggression, rage;
	*Mania, agitation, and restlessness;		*Mania, agitation, and restlessness;

Ctol2: /* Side Effects */

2020-10-20T06:22:32Z

Side Effects

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	Nitrazepam is an unsuitable hypnotic for the elderly as it causes:		Nitrazepam is an unsuitable hypnotic for the elderly as it causes:

	*Impairments in body balance and standing steadiness in individuals who wake up at night		*Impairments in body balance and standing steadiness in individuals who wake up at night;
	*As a result, leading to falls and hip fractures		*As a result, leading to falls and hip fractures;
	*It induces general mental deterioration		*It induces general mental deterioration;
	*Inability to walk		*Inability to walk;
	*Incontinence		*Incontinence;
	*Confusion and disorientation		*Confusion and disorientation.

	The nitrazepam-induced symptoms can lead to a misdiagnosis of dementia.		The nitrazepam-induced symptoms can lead to a misdiagnosis of dementia.

Ctol2: /* Side Effects */

2020-10-20T06:22:14Z

Side Effects

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	{\| class = "wikitable"		{\| class = "wikitable"
	!style="text-align: left"\| Very common (>10% of incidence)		!style="text-align: left"\| Very common (>10% of incidence)
	or''' Common '''(1-10% of incidence)		or '''Common'''(1-10% of incidence)
	\|		\|
	*Shakiness and unsteady walk (especially in the elderly)		*Shakiness and unsteady walk (especially in the elderly)
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	'''Paradoxical reactions (the opposite of what is to be expected) may occur'''. Symptoms include		'''Paradoxical reactions (the opposite of what is to be expected) may occur'''. Symptoms include
	*~~aggression~~, rage		*Aggression, rage;
	*~~mania~~, agitation, and restlessness		*Mania, agitation, and restlessness;
	*~~hallucinations~~, inappropriate behavior		*Hallucinations, inappropriate behavior;
	*~~twitches~~ and tremor		*Twitches and tremor.

	==Pharmacokinetics==		==Pharmacokinetics==