meprobamate

Therapeutic Classification: antianxiety agents, sedative/hypnotics

Pharmacologic Classification: carbamates

Indications ⬆ ⬇

BEERS REMS

Anxiety disorders (provides sedation).

Action ⬆ ⬇

Produces CNS depression by acting at multiple sites in the CNS.

Therapeutic effects:

Sedation.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed to tissues

Metabolism/Excretion: Metabolized by the liver.

Half-Life: 6–16 hr.

Time/Action Profile ⬆ ⬇

(sedation)

ROUTE	ONSET	PEAK	DURATION
PO	<1 hr	1–3 hr	6–12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Comatose patients or those with pre-existing CNS depression;
Uncontrolled severe pain;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Severe renal impairment;
Hepatic impairment;
History of suicide attempt or drug abuse;
Geri: Appears on Beers list. ↑ risk of sedation and physical dependence in older adults. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension

Derm: pruritus, rash, urticaria

EENT: blurred vision

GI: anorexia, diarrhea, nausea, vomiting

Neuro: ataxia, drowsiness

Misc: hypersensitivity reactions, physical dependence, psychological dependence, tolerance

Interactions ⬆ ⬇

Drug-drug:

Additive CNS depression with other CNS depressants, including alcohol, antihistamines, opioid analgesics, and other sedative/hypnotics.

Drug-Natural Products:

Concomitant use of kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.

Route/Dosage ⬆ ⬇

PO (Adults ): 400 mg 3–4 times daily (not to exceed 2400 mg/day).
PO (Children 6–12 yr): 100–200 mg 2–3 times daily.

Renal Impairment

PO (Adults ): CCr 10–50 mL/min: Administer every 12 hr; CCr <10 mL/min: Administer every 12–18 hr.

Availability ⬆ ⬇

(Generic available)

Tablets: 200 mg; 400 mg

Assessment ⬆ ⬇

Assess degree and manifestations of anxiety before and periodically throughout therapy.
Monitor BP and pulse rate before and during initial therapy.
Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient.
Geri: Assess fall risk and institute fall prevention strategies.

Lab Test Considerations:

Assess CBC periodically during therapy.
- May cause false ↑ in urinary steroid concentrations.

Implementation ⬆ ⬇

PO: May be administered with food to minimize GI irritation.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication exactly as directed. Take missed dose if remembered within 1 hr; if remembered later, do not take. Do not double doses. Abrupt discontinuation may precipitate pre-existing symptoms or withdrawal reactions within 12–48 hr (vomiting, ataxia, muscle twitching, confusion, hallucinations, convulsions). Symptoms usually subside within 12–48 hr.
May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until effects of drug are known.
Caution patient to change positions slowly to minimize orthostatic hypotension.
Advise patient to avoid concurrent use of alcohol or other CNS depressants.
Instruct females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.
Advise patient to notify health care professional if skin rash, sore throat, or fever occurs.
Emphasize the importance of participation in psychotherapy if recommended by health care professional and follow-up exams to evaluate progress.

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Pronunciation ⬇

Classifications ⬆ ⬇