Zepam 3 | 1 Strip

✔️ Mode of Action

Bromazepam is a benzodiazepine, pharmacologically similar to diazepam. It enhances the effect of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter, producing anxiolytic, sedative, and muscle-relaxant effects.

✔️ Dosage

Adults

Oral: Initial dose 6–18 mg/day in divided doses.

In hospitalized patients, higher doses may be required.

In elderly or hepatic impairment: start with half the usual dose.

Renal Impairment

No dosage adjustment required.

✔️ Interaction

• CYP450 inhibitors (azole antifungals, macrolides, HIV protease inhibitors, calcium channel blockers) → increase bromazepam levels
• Disulfiram, cimetidine → elevated plasma levels
• Additive CNS depression with: barbiturates, sedatives, anesthetics, anxiolytics, hypnotics, phenothiazines, antipsychotics, skeletal muscle relaxants
• May enhance the anticholinergic effects of atropine, antihistamines, and antidepressants
• Increased dependence risk with narcotic analgesics

✔️ Contraindications

• CNS depression or coma
• Respiratory depression, acute pulmonary insufficiency, or sleep apnea
• Severe hepatic impairment
• Chronic psychosis, phobic or obsessive states (not effective)
• Depression or anxiety linked with depression (may worsen suicide/aggression risk)
• Narrow-angle glaucoma

✔️ Side Effects

Common: drowsiness, sedation, muscle weakness, ataxia

Occasional: vertigo, headache, confusion, depression, slurred speech, libido changes, tremor, visual disturbances, urinary retention, GI upset, altered salivation, amnesia

Rare: jaundice, blood disorders, hypersensitivity reactions, thrombophlebitis, elevated liver enzymes, paradoxical excitation

✔️ Use cautiously in:

• Elderly or debilitated patients
• Chronic pulmonary insufficiency
• Muscle weakness
• Hepatic or renal impairment
• May cause drowsiness → avoid driving or skilled tasks
• Monitor cardio-respiratory function if used for deep sedation
• Risk of dependence in patients with a history of alcohol or drug abuse
• Parenteral administration: may cause respiratory depression and hypotension → use only with resuscitation facilities available
• Avoid during pregnancy and lactation unless strictly necessary