Oxazepam

Revision as of 21:49, 7 January 2015 by Stefano Giannoni (talk | contribs)
Jump to navigation Jump to search

{{DrugProjectFormSinglePage |authorTag=Stefano Giannoni [1] |genericName=Oxazepam |aOrAn=a |drugClass=Benzodiazepine |indicationType=treatment |indication=anxiety disorders and anxiety with alcohol withdrawal syndrome |adverseReactions=drowsiness. |blackBoxWarningTitle=TITLE |blackBoxWarningBody=Condition Name: (Content) |fdaLIADAdult=====Anxiety==== Because of the flexibility of this product and the range of emotional disturbances responsive to it, dosage should be individualized for maximum beneficial effects.

|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of Oxazepam in adult patients. |offLabelAdultNoGuideSupport=====Insomnia====

  • Insomnia: 15 mg before bedtime. [1]

|fdaLIADPed=This product is not indicated in pediatric patients under 6 years of age. Absolute dosage for pediatric patients 6 to 12 years of age is not established. |offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of Oxazepam in pediatric patients. |offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of Oxazepam in pediatric patients. |contraindications=*History of previous hypersensitivity reaction to oxazepam.

  • Oxazepam is not indicated in psychoses.

|warnings=*As with other CNS-acting drugs, patients should be cautioned against driving automobiles or operating dangerous machinery until it is known that they do not become drowsy or dizzy on oxazepam therapy.

  • Patients should be warned that the effects of alcohol or other CNS-depressant drugs may be additive to those of oxazepam, possibly requiring adjustment of dosage or elimination of such agents.

Physical and Psychological Dependence

  • Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (convulsions, tremor, abdominal and muscle cramps, vomiting, and sweating), have occurred following abrupt discontinuance of oxazepam.
  • The more severe withdrawal symptoms have usually been limited to those patients who received excessive doses over an extended period of time.
  • Generally milder withdrawal symptoms (e.g., dysphoria and insomnia) have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months.
  • Consequently, after extended therapy, abrupt discontinuation should generally be avoided and a gradual dosage-tapering schedule followed.
  • Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving oxazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.

|clinicalTrials=The necessity for discontinuation of therapy due to undesirable effects has been rare. Transient, mild drowsiness is commonly seen in the first few days of therapy. If it persists, the dosage should be reduced. In few instances, dizziness, vertigo, headache, and rarely syncope have occurred either alone or together with drowsiness. Mild paradoxical reactions, i.e., excitement, stimulation of affect, have been reported in psychiatric patients; these reactions may be secondary to relief of anxiety and usually appear in the first two weeks of therapy.

Other side effects occurring during oxazepam therapy include rare instances of minor diffuse skin rashes-morbilliform, urticarial, and maculopapular, nausea, lethargy, edema, slurred speech, tremor, and altered libido. Such side effects have been infrequent and are generally controlled with reduction of dosage. A case of an extensive fixed drug eruption also has been reported.

Although rare, leukopenia and hepatic dysfunction including jaundice have been reported during therapy. Periodic blood counts and liver-function tests are advisable. Ataxia with oxazepam has been reported in rare instances and does not appear to be specifically related to dose or age.

Although the following side reactions have not as yet been reported with oxazepam, they have occurred with related compounds (chlordiazepoxide and diazepam): paradoxical excitation with severe rage reactions, hallucinations, menstrual irregularities, change in EEG pattern, blood dyscrasias including agranulocytosis, [[blurred vision, diplopia, incontinence, stupor, disorientation, fever, and euphoria.

Transient amnesia or memory impairment has been reported in association with the use of benzodiazepines. |useInPed=Safety and effectiveness in pediatric patients under 6 years of age have not been established. Absolute dosage for pediatric patients 6 to 12 years of age is not established. |useInGeri=*Clinical studies of oxazepam were not adequate to determine whether subjects aged 65 and over respond differently than younger subjects.

  • Age (<80 years old) does not appear to have a clinically significant effect on oxazepam kinetics.
  • Clinical circumstances, some of which may be more common in the elderly, such as hepatic or renal impairment, should be considered.
  • Greater sensitivity of some older individuals to the effects of oxazepam (e.g., sedation, hypotension, paradoxical excitation) cannot be ruled out.
  • In general, dose selection for oxazepam for elderly patients should be cautious, usually starting at the lower end of the dosing range.

|administration=*Oral |overdose=In the management of overdosage with any drug, it should be born in mind that multiple agents may have been taken.

Symptoms

Overdosage of benzodiazepines is usually manifested by varying degrees of central nervous system depression ranging from drowsiness to coma. In mild cases, symptoms include drowsiness, mental confusion and lethargy. In more serious cases, and especially when other drugs or alcohol were ingested, symptoms may include ataxia, hypotonia, hypotension, hypnotic state, stage one (1) to three (3) coma, and very rarely, death.

Management

Induced vomiting and/or gastric lavage should be undertaken, followed by general supportive care, monitoring of vital signs, and close observation of the patient. Hypotension, though unlikely, usually may be controlled with norepinephrine bitartrate injection. The value of dialysis has not been adequately determined for oxazepam.

The benzodiazepine antagonist flumazenil may be used in hospitalized patients as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. The complete flumazenil package insert including CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS should be consulted prior to use.

|drugBox=

Oxazepam
Clinical data
Routes of
administration
oral
ATC code
Legal status
Legal status
Identifiers
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
E number{{#property:P628}}
ECHA InfoCard{{#property:P2566}}Lua error in Module:EditAtWikidata at line 36: attempt to index field 'wikibase' (a nil value).
Chemical and physical data
FormulaC15H11ClN2O2
Molar mass286.71 g·mol−1
3D model (JSmol)
  (verify)

|mechAction=There is limited information regarding mechanism of action of oxazepam in the drug label. |structure=*Oxazepam is the first of a chemical series of compounds, the 3-hydroxybenzodiazepinones.

  • Oxazepam is 7 chloro-1,3-dihydro-3-hydroxy-5-phenyl-2H-1,4-benzodiazepin-2-one, and has the following structural formula:
  • Oxazepam is a white crystalline powder.

|PD=There is limited information regarding Pharmacodynamics of oxazepam in the drug label. |PK=*Pharmacokinetic testing in 12 volunteers demonstrated that a single 30 mg dose of a capsule, tablet or suspension will result in an equivalent extent of absorption.

  • For the capsule and tablet, peak plasma levels averaged 450 mg/mL and were observed to occur about 3 hours after dosing.
  • The mean elimination half-life for oxazepam was approximately 8.2 hours (range 5.7 to 10.9 hours).
  • This product has a single, major inactive metabolite in man, a glucuronide excreted in urine.

Age (<80 years old) does not appear to have a clinically significant effect on oxazepam kinetics.

  • A statistically significant increase in elimination half-life in the very elderly (>80 years of age) as compared to younger subjects has been reported, due to a 30% increase in volume of distribution, as well as a 50% reduction in unbound clearance ofoxazepam in the very elderly.

|nonClinToxic=There is limited information regarding nonclinical toxicology of oxazepam in the drug label. |howSupplied=Oxazepam capsules are available as follows:

  • 10 mg — Each pink opaque gelatin #4 capsule printed with
    and 067 in black ink on both cap and body contains 10 mg of Oxazepam, USP. Capsules are supplied in bottles of 100 (NDC 0228-2067-10) and 500 (NDC 0228-2067-50).
  • 15 mg — Each red opaque gelatin #4 capsule printed with
    and 069 in black ink on both cap and body contains 15 mg of Oxazepam, USP. Capsules are supplied in bottles of 100 (NDC 0228-2069-10) and 500 (NDC 0228-2069-50).
  • 30 mg — Each maroon opaque gelatin #4 capsule printed with
    and 073 in blue ink on both cap and body contains 30 mg of Oxazepam, USP. Capsules are supplied in bottles of 100 (NDC 0228-2073-10).

|storage=*Store at 25(C (77(F); excursions permitted to 15( to 30(C (59( to 86(F).

  • Keep tightly closed.
  • Dispense in a tight, light-resistant container as defined in the USP.

|packLabel=

|alcohol=Patients should be warned that the effects of alcohol or other CNS-depressant drugs may be additive to those of oxazepam, possibly requiring adjustment of dosage or elimination of such agents. |brandNames=*Serax }} {{#subobject:

 |Label Page=Oxazepam
 |Label Name=Oxazepam package.png

}}

{{#subobject:

 |Label Page=Oxazepam
 |Label Name=Oxazepam package 15mg.png

}}

  1. Feldmeier C, Kapp W (1983). "Comparative clinical studies with midazolam, oxazepam and placebo". Br J Clin Pharmacol. 16 Suppl 1: 151S–155S. PMC 1428094. PMID 6138069.
  2. Template:PubChem
  3. Greenblatt DJ (1981). "Clinical pharmacokinetics of oxazepam and lorazepam". Clin Pharmacokinet. 6 (2): 89–105. PMID 6111408. |access-date= requires |url= (help)