Home Drug Guide Prazepam

Drug Guide

Generic Name

Prazepam

Brand Names Centrax

Classification

Therapeutic: Anxiolytic, Benzodiazepine

Pharmacological: Benzodiazepine

FDA Approved Indications

Anxiety

Mechanism of Action

Prazepam enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, leading to sedative, anxiolytic, anticonvulsant, and muscle relaxant properties.

Dosage and Administration

Adult: Typically 5-20 mg two to three times daily, adjusted based on response and tolerability.

Pediatric: Not generally recommended for pediatric use.

Geriatric: Start with a lower dose, e.g., 5 mg daily, and titrate carefully due to increased sensitivity to benzodiazepines.

Renal Impairment: Use with caution; dose adjustment may be necessary.

Hepatic Impairment: Use with caution; dose reduction recommended.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed in body tissues.

Metabolism: Metabolized in the liver to active metabolites, mainly desmethyldiazepam.

Excretion: Excreted primarily in urine.

Half Life: Long half-life, approximately 20-50 hours, contributing to sustained effects.

Contraindications

Hypersensitivity to prazepam or other benzodiazepines.
Respiratory depression.
Myasthenia gravis.
Acute narrow-angle glaucoma.

Precautions

History of substance abuse.
Liver impairment.
Pregnancy and lactation: Use only if potential benefit justifies the potential risk to fetus or nursing infant.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Ataxia (Less common)

Adverse Reactions - Serious

Respiratory depression (Rare)
Anterograde amnesia (Less common)
Paradoxical reactions (e.g., agitation, increased anxiety) (Rare)

Drug-Drug Interactions

Other CNS depressants (alcohol, opioids, sedatives)
Cimetidine (may increase levels)
Rifampin (may decrease levels)

Drug-Food Interactions

Alcohol (enhanced sedative effect)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess for history of substance abuse, respiratory status, and liver function.

Diagnoses:

Risk for injury due to sedation or impaired coordination.
Risk for addiction or dependence.

Implementation: Monitor for therapeutic effects and adverse reactions. Use lowest effective dose for shortest duration.

Evaluation: Effectiveness in reducing anxiety; absence of adverse effects or signs of dependence.

Patient/Family Teaching

Avoid alcohol and CNS depressants.
Do not operate heavy machinery until response is known.
Do not discontinue abruptly to prevent withdrawal.

Special Considerations

Black Box Warnings:

Potential for abuse, dependence, and withdrawal reactions.

Genetic Factors: Consider genetic variations affecting metabolism (e.g., CYP450 enzymes).

Lab Test Interference: None significant.

Overdose Management

Signs/Symptoms: Drowsiness, confusion, diminished reflexes, respiratory depression in severe cases.

Treatment: Supportive care, airway management, monitoring. Flumazenil may be used as an antagonist in specific cases, with caution.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.