Meprobamate

 Action Produces CNS depressant action at multiple sites, including thalamic and limbic systems.

 Indications Management of anxiety.

 Contraindications Hypersensitivity to meprobamate or related compounds, such as carisoprodol; cute intermittent porphyria.

 Route/Dosage

ADULTS: TABLETS: PO 1.2–1.6 g/day in 3–4 divided doses. Sustained release capsules: PO 400–800 mg bid. CHILDREN 6–12 YR: TABLETS: PO 100–200 mg bid to tid. SUSTAINED RELEASE CAPSULES: PO 200 mg bid.

 Interactions

Alcohol, CNS depressants: May produce additive CNS depression.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; tachycardia; syncope; hypertension; hypotensive crisis; arrhythmias. CNS: Drowsiness; ataxia; euphoria; slurred speech; dizziness; headache; paradoxical excitement. GI: Nausea; vomiting; diarrhea. HEMA: Leukopenia; thrombocytopenia; agranulocytosis; aplastic anemia. OTHER: Hypersensitivity (eg, rash, itching, fever, chills, edema, bronchospasm, anaphylaxis, erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, bullous dermatitis); exacerbation of porphyria symptoms.

 Precautions

Pregnancy: Category D. Use with extreme caution, if at all. Lactation: Excreted in breast milk. Children: Do not give to children < 6 yr; safety and efficacy not established. Do not give 600 mg tablet to children. Dependence: Physical and psychological dependence and abuse may occur. Avoid prolonged use, especially in patients prone to addiction. Abrupt discontinuation after prolonged or excessive use may precipitate withdrawal symptoms with risk of seizures. Elderly or debilitated patients: Use lowest effective dose to avoid oversedation. Hypersensitivity: Usually seen between first and fourth dose in patients without previous exposure. Renal or hepatic impairment: Use drug with caution to avoid accumulation.

 Administration/Storage

• Do not alter medication form prior to administration.
• Store in dry, cool place.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Monitor results of liver and renal function tests throughout therapy.
• Watch patient take medication to ensure that it is swallowed.
• Notify healthcare provider if tachycardia, syncope, or palpitations occur.
• Monitor blood studies and CBC during long-term therapy.
• Notify healthcare provider if patient experiences signs of hypersensitivity, and withhold drug.
• Assess for signs of drowsiness, ataxia, lethargy, itching, rash or stupor and report findings to healthcare provider.
• Assist patient with ambulation during beginning of therapy.
• Institute safety measures (eg, siderails).
• Monitor mental status: mood, sensorium, affect, sleeping patterns.
• Monitor pulse and lying and standing BP; if BP is < 0 mm Hg, withhold drug and notify healthcare provider.

 Patient/Family Education

• Instruct patient not to crush or chew tablets or capsules.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Explain potential side effects, and encourage patient to notify healthcare provider if signs of itching, rash, fever, drowsiness, dizziness, difficulty walking, nausea, vomiting, diarrhea, palpitations, shortness of breath, or sore throat occur.
• Caution patient to change position slowly to minimize orthostatic hypotension.
• Caution patient not to discontinue taking drug abruptly because doing so may precipitate preexisting symptoms or withdrawal reactions.
• Advise female patients that if they become pregnant or intend to become pregnant to consult their physician about continued use of this drug.