Bromazepam is a benzodiazepine with an anxiolytic, sedative, anticonvulsant and muscle relaxant action.
Bromazepam - Chemical Structure
Indications
For what it uses
The use of bromazepam is indicated for the treatment of:
- Anxiety;
- Tension and other somatic or psychiatric manifestations associated with anxiety syndrome;
- Insomnia.
Warnings
Bromazepam should be used with extreme caution in patients with a history of alcohol and / or drug abuse.
The duration of bromazepam therapy should always be as short as possible.
Following prolonged use of bromazepam, tolerance may develop. In other words, the hypnotic effects induced by bromazepam itself may decrease.
Bromazepam should not be used alone for the treatment of anxiety related to depression.
Elderly patients, patients with chronic respiratory failure and patients with liver failure should take a reduced dose of bromazepam, due to the possible side effects that may occur.
A lot of caution should be used when administering the drug in patients with renal or cardiac insufficiency and in patients with low blood pressure.
Bromazepam compromises the ability to drive or use machines. Therefore, these activities must be avoided.
Interactions
Bromazepam-induced sedation is increased by concomitant alcohol intake . Therefore, this association must be avoided.
The depressive action on the central nervous system (CNS) induced by bromazepam can be increased by the simultaneous administration of drugs also capable of depressing the CNS. Among these, we recall:
- Antipsychotic drugs;
- Hypnotic, sedative and anxiolytic drugs;
- Antidepressant drugs;
- Opioid analgesic drugs;
- Antiepileptic drugs;
- Anesthetic drugs;
- Sedative antihistamine drugs.
The concomitant use of bromazepam and opioid analgesics could also favor the increase of euphoria and - consequently - the increase of psychic dependence.
Particular care should be taken in the concomitant administration of bromazepam and drugs that induce respiratory depression.
The plasma concentration of bromazepam can be increased by the concomitant administration of drugs, such as:
- Azole antifungal drugs, such as - for example - ketoconazole and itraconazole ;
- Antiviral drugs protease inhibitors, such as - for example - ritonavir ;
- Macrolide antibiotics, such as - for example - erythromycin and clarithromycin .
Cimetidine (a drug used in the treatment of gastric ulcer) may increase the elimination time of bromazepam.
Theophylline and aminophylline may decrease the therapeutic efficacy of bromazepam.
Side effects
Bromazepam can induce many side effects, although not all patients experience them. This is due to the different sensitivity that each individual has towards the drug.
The following are the main adverse effects that can occur during treatment with bromazepam.
Addiction
Bromazepam - like all benzodiazepines - can lead to the development of physical and mental dependence. The risk of developing dependence is directly proportional to the dose of drug administered and to the duration of the treatment.
Patients with a history of alcohol and / or drug abuse are at greater risk of developing addiction.
Once physical dependence has been established, abrupt cessation of treatment causes withdrawal symptoms. These symptoms are:
- Depression;
- derealization;
- depersonalization;
- Anxiety;
- Confusion;
- Nervousness;
- Restlessness;
- Irritability;
- dysphoria;
- Hallucinations;
- Delusions;
- Epileptic shocks;
- Insomnia;
- Mood changes;
- Sweating;
- Diarrhea;
- Headache;
- Muscle pains;
- Hypersensitivity and intolerance to sounds (hyperacusis);
- Hypersensitivity to light and physical contact.
Therefore, gradual interruption of treatment is recommended.
Anterograde amnesia
Bromazepam therapy may cause anterograde amnesia.
The development of this amnesia usually occurs a few hours after the drug is given. Therefore, after taking the drug, patients should be able to sleep continuously for at least 8 hours.
Memory can be compromised if the patient wakes up at the time of maximum activity of the drug.
Insomnia or rebound anxiety
When bromazepam therapy is stopped, insomnia or rebound anxiety may occur. That is to say, the symptoms for which the use of the drug was prescribed have returned to an aggravated state.
Rebound symptoms may be accompanied by mood swings and restlessness.
The risk of developing these symptoms is greater when the treatment is stopped abruptly, therefore, the interruption of therapy must take place gradually.
Psychiatric disorders
Paradoxical symptoms may arise during treatment with bromazepam. These symptoms are:
- Restlessness;
- agitation;
- Irritability;
- Aggression;
- Anger;
- Anger;
- Hallucinations;
- Delusions;
- Psychosis;
- Memory disorders;
- Changes in behavior.
Furthermore, bromazepam can cause emotional disturbances, libido changes and confusion.
Nervous system disorders
Bromazepam therapy can cause headaches, dizziness, drowsiness, decreased alertness, dizziness and ataxia.
Cardiac disorders
Treatment with bromazepam can cause heart failure and cardiac arrest.
Eye disorders
Bromazepam therapy can cause blurred vision and diplopia (double vision).
Lung and respiratory tract disorders
Treatment with bromazepam can cause apnea, respiratory depression and worsening sleep apnea.
Gastrointestinal disorders
Nausea, vomiting and constipation may occur during bromazepam therapy.
Skin and subcutaneous tissue disorders
Treatment with bromazepam can cause rashes, itching and hives.
Other side effects
Other side effects that may occur during bromazepam therapy are:
- Allergic reactions - even serious - in sensitive subjects;
- Angioedema;
- Fatigue;
- Muscle weakness;
- Urinary retention.
Overdose
The symptoms that can occur following bromazepam overdose are:
- Lethargy;
- lightheadedness;
- Mental confusion;
- Drowsiness;
- Dysarthria;
- Changes in coordination;
- Ataxia;
- hypotonia;
- Hypotension;
- Respiratory depression;
- Coma.
In the event of an overdose of bromazepam the vital signs of the patients must be constantly monitored.
If the patient is conscious, vomiting should be induced within an hour of taking the drug. If, on the other hand, the patient is unconscious, a gastric lavage should be performed. If there is no improvement after gastric lavage, activated charcoal can be given to reduce the absorption of the drug.
Flumazenil, a benzodiazepine receptor antagonist, can also be administered for the treatment of hyperdosage.
In any case, if you suspect you have taken an overdose of medication, you must contact a doctor immediately and contact the nearest hospital.
Action mechanism
Bromazepam is a benzodiazepine and - as such - stimulates the GABAergic system, ie the γ-aminobuttiric acid system. GABA is the main inhibitory neurotransmitter of the brain and performs its biological functions by binding to specific receptors: GABA-A, GABA-B and GABA-C.
A binding site for benzodiazepines is present on the GABA-A receptor. Bromazepam - by binding to this site - activates the receptor and promotes the cascade of inhibitory signals induced by GABA.
Mode of Use - Posology
Bromazepam is available for oral administration in the form of tablets, hard capsules and oral drops.
The dosage of bromazepam must be established by the doctor on an individual basis.
However, the dose of bromazepam usually given is 1.5-3 mg two or three times a day.
The duration of treatment must be as short as possible.
Elderly patients and patients with reduced liver function may need a reduction in the dose of bromazepam usually administered.
Pregnancy and breastfeeding
Bromazepam should not be given to pregnant women, unless the doctor considers it absolutely necessary.
Infants whose mothers take bromazepam during the last period of pregnancy may experience the following symptoms:
- hypotonia;
- Difficulty in sucking;
- Respiratory depression;
- Apnea;
- Hypothermia;
- Withdrawal symptoms, when bromazepam is taken by the mother in high doses.
Because bromazepam is excreted in breast milk, breastfeeding mothers should not take the medicine.
Contraindications
The use of bromazepam is contraindicated in the following cases:
- Known hypersensitivity to bromazepam or to other benzodiazepines;
- In patients with myasthenia gravis;
- In patients suffering from severe respiratory failure;
- In patients with sleep apnea syndrome;
- In patients with severe hepatic impairment;
- In patients with narrow-angle glaucoma;
- In patients with acute alcohol intoxication or hypnotic drugs, analgesics, neuroleptics or antidepressants;
- During breastfeeding.
