Yes

Antianxiety Agent, Miscellaneous

Management of anxiety disorders

C-IV

D

Acute intermittent porphyria; hypersensitivity to meprobamate, related compounds (including carisoprodol), or any component; pre-existing CNS depression; narrow-angle glaucoma; severe uncontrolled pain; pregnancy

Physical and psychological dependence and abuse may occur; abrupt cessation may precipitate withdrawal. Use with caution in patients with depression or suicidal tendencies, or in patients with a history of drug abuse. May cause CNS depression, which may impair physical or mental abilities. Patients must be cautioned about performing tasks which require mental alertness (ie, operating machinery or driving). Effects with other sedative drugs or ethanol may be potentiated. Not recommended in children <6 years of age; allergic reaction may occur in patients with history of dermatological condition (usually by fourth dose). Use with caution in patients with renal or hepatic impairment, or with a history of seizures. Use caution in the elderly as it may cause confusion, cognitive impairment, or excessive sedation.

Cardiovascular: Syncope, peripheral edema, palpitations, tachycardia, arrhythmia

Central nervous system: Drowsiness, ataxia, dizziness, paradoxical excitement, confusion, slurred speech, headache, euphoria, chills, vertigo, paresthesia, overstimulation

Dermatologic: Rashes, purpura, dermatitis, Stevens-Johnson syndrome, petechiae, ecchymosis

Gastrointestinal: Diarrhea, vomiting, nausea

Hematologic: Leukopenia, eosinophilia, agranulocytosis, aplastic anemia

Neuromuscular & skeletal: Weakness

Ocular: Blurred vision, impairment of accommodation

Renal: Renal failure

Respiratory: Wheezing, dyspnea, bronchospasm, angioneurotic edema

Symptoms of overdose include drowsiness, lethargy, ataxia, coma, hypotension, shock, death

Treatment is supportive following attempts to enhance drug elimination. Hypotension should be treated with I.V. fluids and/or Trendelenburg positioning. Dialysis and hemoperfusion have not demonstrated significant reductions in blood drug concentrations.

Increased toxicity: CNS depressants (ethanol) may increase CNS depression

Affects the thalamus and limbic system; also appears to inhibit multineuronal spinal reflexes

Onset of sedation: Oral: Within 1 hour

Distribution: Crosses the placenta; appears in breast milk

Metabolism: Promptly in the liver

Half-life: 10 hours

Elimination: In urine (8% to 20% as unchanged drug) and feces (10% as metabolites)

Oral:

Sustained release: 200 mg twice daily

Adults: 400 mg 3-4 times/day, up to 2400 mg/day

Sustained release: 400-800 mg twice daily

Dosing interval in renal impairment:

Cl_cr 10-50 mL/minute: Administer every 9-12 hours

Cl_cr <10 mL/minute: Administer every 12-18 hours

Hemodialysis: Moderately dialyzable (20% to 50%)

Dosing adjustment in hepatic impairment: Probably necessary in patients with liver disease

Alcohol: Additive CNS effect, avoid use

Mental status

Therapeutic: 6-12 mg/mL (SI: 28-55 mmol/L); Toxic: >60 mg/mL (SI: >275 mmol/L)

No information available to require special precautions

<1% of patients experience stomatitis

Take exactly as directed (do not increase dose or frequency); may cause physical and/or psychological dependence. Do not chew or crush extended release capsule. Do not use excessive alcohol or other prescription or OTC medications (especially pain medications, sedatives, antihistamines, or hypnotics) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience drowsiness, lightheadedness, impaired coordination, dizziness, or blurred vision (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea, vomiting, or dry mouth (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); or diarrhea (boiled milk, yogurt, or buttermilk may help). Report persistent CNS effects, skin rash or irritation, changes in urinary pattern, wheezing or respiratory difficulty, or worsening of condition. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication; use appropriate barrier contraceptive measures. Breast-feeding is not recommended.

Assist with ambulation

Monitor mental status

Capsule, sustained release: 200 mg, 400 mg

Tablet: 200 mg, 400 mg, 600 mg

Hassan E, "Treatment of Meprobamate Overdose With Repeated Oral Doses of Activated Charcoal," Ann Emerg Med, 1986, 15(1):73-6.

Jacobsen D, Wiik-Larsen E, Saltvedt E, et al, "Meprobamate Kinetics During and After Terminated Hemoperfusion in Acute Intoxications," J Toxicol Clin Toxicol, 1987, 25(4):317-31.

Volturo GA, "Meprobamate and Bezoar Formation," Ann Emerg Med, 1987, 16(4):472-3.