OXAZEPAM

OXAZEPAM
(ox-a'ze-pam)
Ox-Pam , Serax, Zapex 
Classifications: anxiolytic; sedative-hypnotic; benzodiazepine;
Therapeutic: antianxiety; sedative-hypnotic

Prototype: Lorazepam
Pregnancy Category: D
Controlled Substance: Schedule IV

Availability

10 mg, 15 mg, 30 mg capsules; 15 mg tablets

Action

Benzodiazepine derivative related to lorazepam. Effects are mediated by the inhibitory neurotransmitter GABA. Acts on the thalamic, hypothalamic, and limbic levels of CNS.

Therapeutic Effect

Has anxiolytic, sedative, hypnotic, and skeletal muscle relaxant effects.

Uses

Management of anxiety and tension associated with a wide range of emotional disturbances. Also to control acute withdrawal symptoms in chronic alcoholism.

Contraindications

Hypersensitivity to oxazepam and other benzodiazepines; respiratory depression; psychoses, suicidal ideation; acute alcohol intoxication; acute-angle glaucoma; pregnancy (category D), lactation, children <6 y.

Cautious Use

Older adult and debilitated patients; impaired kidney and liver function; addiction-prone patients; COPD; history of seizures; history of suicide; mental depression; bipolar disorder.

Route & Dosage

Anxiety
Adult: PO 10–30 mg t.i.d. or q.i.d.

Acute Alcohol Withdrawal
Adult: PO 15–30 mg t.i.d. or q.i.d.

Administration

Oral
  • Give with food if GI upset occurs.
  • Store in tightly closed container at 15°–30° C (59°–86° F) unless otherwise specified.

Adverse Effects (≥1%)

CNS: Drowsiness, dizziness, mental confusion, vertigo, ataxia, headache, lethargy, syncope, tremor, slurred speech, paradoxic reaction (euphoria, excitement). GI: Nausea, xerostomia, jaundice. Skin: Skin rash, edema. CV: Hypotension, edema. Hematologic: Leukopenia. Urogenital: Altered libido.

Interactions

Drug: Alcohol, cns depressants, anticonvulsants potentiate CNS depression; cimetidine increases oxazepam plasma levels, increasing its toxicity; may decrease antiparkinsonism effects of levodopa; may increase phenytoin levels; smoking decreases sedative and antianxiety effects. Herbal: Kava, valerian may potentiate sedation.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Peak: 2–3 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: Primarily in urine, some in feces. Half-Life: 2–8 h.

Nursing Implications

Assessment & Drug Effects

  • Observe older adult patients closely for signs of overdosage. Report to physician if daytime psychomotor function is depressed.
  • Monitor for increased signs and symptoms of suicidality.
  • Lab tests: Perform liver function and white blood cell counts on a regular planned basis.
  • Note: Excessive and prolonged use may cause physical dependence.

Patient & Family Education

  • Report promptly any mild paradoxic stimulation of affect and excitement with sleep disturbances that may occur within the first 2 wk of therapy. Dosage reduction is indicated.
  • Do not change dose or dose schedule and refrain from using drug to treat a self-diagnosed condition.
  • Consult physician before self-medicating with OTC drugs.
  • Do not drive or engage in potentially hazardous activities until response to drug is known.
  • Do not drink alcoholic beverages while taking oxazepam. The CNS depressant effects of each agent may be intensified.
  • Contact physician if you intend to or do become pregnant during therapy about discontinuing the drug.
  • Withdraw drug slowly following prolonged therapy to avoid precipitating withdrawal symptoms (seizures, mental confusion, nausea, vomiting, muscle and abdominal cramps, tremulousness, sleep disturbances, unusual irritability, hyperhidrosis).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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