CLORAZEPATE DIPOTASSIUM


Drug Name

Generic Name : clorazepate dipotassium

Brand Name:  Apo-Clorazepate (CAN), Novo-Clopate (CAN), Tranxene-SD, Tranxene-SD Half Strength, Tranxene-T-tab

Classification: Benzodiazepine, Anxiolytic, Antiepileptic
Pregnancy Category D 
Controlled Substance C-IV

Dosage & Route
Individualize dosage; increase dosage gradually to avoid adverse effects. Drug is available only in oral forms.


Adults 
Anxiety: Usual dose is 30 mg/day PO in divided doses tid; adjust gradually within the range of 15–60 mg/day; also may be given as a single daily dose hs with a maximum starting dose of 15 mg. For maintenance, give the 22.5-mg PO tablet in a single daily dose as an alternate form for patients stabilized on 7.5 mg PO tid; do not use to initiate therapy; the 11.25-mg tablet may be given as a single daily dose.
Adjunct to antiepileptic medication: Maximum initial dose is 7.5 mg PO tid. Increase dosage by no more than 7.5 mg every wk, do not exceed 90 mg/day.
Acute alcohol withdrawal: Day 1: 30 mg PO initially, then 30–60 mg in divided doses. Day 2: 45–90 mg PO in divided doses. Day 3: 22.5–45 mg PO in divided doses. Day 4: 15–30 mg PO in divided doses. Thereafter, gradually reduce dose to 7.5–15 mg/day PO, and stop as soon as condition is stable.

Pediatric Patients 
Adjunct to antiepileptic medication:
·        12 yr: Use adult dosage.
·        9–12 yr: Maximum initial dose is 7.5 mg PO bid; increase dosage by no more than 7.5 mg every wk, and do not exceed 60 mg/day.
·        < 9 yr: Not recommended.

Geriatric Patients or Patients with Debilitating Disease 
Anxiety: Initially, 7.5–15 mg/day PO in divided doses. Adjust as needed and tolerated.

Therapeutic actions 
Exact mechanisms not understood; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those necessary to cause sedation, ataxia.

Indications 
Management of anxiety disorders or for short-term relief of symptoms of anxiety
Symptomatic relief of acute alcohol withdrawal
Adjunctive therapy for partial seizures

Adverse effects 
Drowsiness, muscular hypotonia, anterograde amnesia, tremor, GI upsets.

Contraindications 
Contraindicated with hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; pregnancy (risk of congenital malformations, neonatal withdrawal syndrome); labor and delivery (“floppy infant” syndrome); lactation (infants tend to become lethargic and lose weight).
Use cautiously with impaired liver or renal function, debilitation; elderly patients.

Nursing considerations
CLINICAL ALERT! Name confusion has occurred between clorazepate and clofibrate; use caution.

Assessment 
History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication; pregnancy; lactation; impaired liver or renal function; debilitation
Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; R, adventitious sounds; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests

Interventions 
WARNING: Taper dosage gradually after long-term therapy, especially in epileptics.
Arrange for patients with epilepsy to wear medical alert identification, indicating disease and medication usage.

Teaching points 
·        Take drug exactly as prescribed; do not stop taking drug (long-term therapy) without consulting your health care provider.
·        Avoid alcohol, sleep-inducing, or over-the-counter drugs.
·        Avoid pregnancy while taking this drug; using barrier contraceptives is advised. If you become pregnant, do not stop the drug; contact your health care provider.
·        You may experience these side effects: Drowsiness, dizziness (may be transient; avoid driving a car or engaging in other dangerous activities); GI upset (take with food); fatigue; depression; dreams; crying; nervousness; depression, emotional changes; bed-wetting, urinary incontinence.
·        Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.



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