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clorazepate
generic
Black Box Warnings .
Risks from Concomitant Opioid Use
concomitant benzodiazepine use w/ opioids may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation
Addiction, Abuse, and Misuse
benzodiazepines expose users to risk of abuse, misuse, and addiction, can lead to overdose or death; commonly involves concomitant use w/ other meds, alcohol, and/or illicit substances, which is assoc. w/ incr. frequency of serious adverse outcomes; assess risk for abuse, misuse, and addiction before prescribing and throughout tx
Dependence and Withdrawal Reactions
cont. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. w/ longer tx duration and higher daily dose; use gradual taper to D/C after cont. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening
Adult Dosing .
Dosage forms: TAB: 3.75 mg, 7.5 mg, 15 mg
anxiety
- [15-60 mg/day PO divided bid-tid]
- Alt: start 15 mg PO qhs, may adjust dose gradually; Info: start 7.5 mg PO qd-bid in elderly or debilitated pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
alcohol withdrawal, acute
- [7.5-15 mg/day PO divided bid-tid]
- Start: 30 mg PO x1, then 30-60 mg/day PO divided bid-tid on day 1, then 45-90 mg/day PO divided bid-tid on day 2, then 22.5-45 mg/day PO divided bid-tid on day 3, then 15-30 mg/day PO divided bid-tid on day 4, then gradually decr. to 7.5-15 mg/day PO divided bid-tid; Max: 90 mg/day
partial seizures, adjunct tx
- [individualize dose PO bid-tid]
- Start: up to 7.5 mg PO tid, may incr. by up to 7.5 mg/wk; Max: 90 mg/day; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [see below]
- renal impairment: no adjustment; Info: metabolite accumulation possible
- HD/PD: no adjustment; no supplement; Info: metabolite accumulation possible
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: TAB: 3.75 mg, 7.5 mg, 15 mg
partial seizures, adjunct tx
- [9-12 yo]
- Dose: individualize dose PO bid-tid; Start: up to 7.5 mg PO bid, may incr. by up to 7.5 mg/wk; Max: 60 mg/day; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
- [>12 yo]
- Dose: individualize dose PO bid-tid; Start: up to 7.5 mg PO tid, may incr. by up to 7.5 mg/wk; Max: 90 mg/day; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [not defined]