Nitrazepam
Mechanism :
Nitrazepam is a benzodiazepine. Benzodiazepines presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system. All benzodiazepines cause a dose-related central nervous system depressant activity.
Indication :
- Infantile spasm
- Myoclonic seizures
- Periodic epileptic spasms after infancy
Contraindications :
Lorazepam is contraindicated in patients with hypersensitivity to benzodiazepines or to any components of the formulation, in acute narrow-angle glaucoma, pre-existing CNS depression, coma, acute pulmonary insufficiency or sleep apnea. Encephalopathy may be precipitated in patients with severe hepatic insufficiency.
Dosing :
Oral: Initially 0.25 mg/kg every 12 hourly doses followed by maintenance of 0.5 mg/kg every 12 hourly;
Max: 1 mg/kg/day. Total daily dose may be given in 3 divided doses. Achieve target maintenance dose in 2-3 weeks.
Adverse Effect :
The common side effects seen are drowsiness, ataxia, irritability, light-headedness, dysarthria and disinhibition. Occasionally, confusion, hangover, headache, dizziness, blurred vision, depression and hallucinations have been seen. Withdrawal symptoms on long term usage: muscle cramps, tremor, irritability, convulsions and perceptual distortions.
Interaction :
CNS depressants: Anaesthetics, Opioids, Antihistamines, Baclofen, Barbiturates, Antipsychotics, Anxiolytics, Antidepressants: Enhanced effectiveness.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function. Start with small doses |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| HD | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unlikely to be dialysed. Dose as in normal renal function |
Hepatic Dose :
Mild-to-moderate impairment: There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.
Severe impairment: Use is contraindicated.