Bromazepam

Benzodiazepines have been associated with anterograde amnesia (Nelson, 1999).

May cause CNS depression, which may impair physical or mental abilities; effects may be potentiated by other CNS depressants, psychoactive medication, or ethanol. Patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

Paradoxical reactions, including hyperactive or aggressive behavior, have been reported with benzodiazepines (Mancuso, 2004).

An increased risk for hazardous sleep-related activities such as sleep-driving, cooking and eating food, and making phone calls while asleep have been noted with benzodiazepines (Dolder, 2008). Disease-related concerns:

Use is not recommended in patients with depressive disorders or psychosis.

Use with caution in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Tolerance, psychological and physical dependence may occur with prolonged use.

Use with caution in patients with mild or moderate hepatic impairment. Use is contraindicated in severe impairment

Use with caution in patients with renal impairment.

May cause respiratory depression; use with caution particularly in patients with preexisting or chronic respiratory disease and concomitantly with other respiratory depressive agents. Use is contraindicated with severe disease. Special populations:

Use with caution in debilitated patients.

Use with extreme caution in patients who are at risk of falls (elderly); benzodiazepines have been associated with falls and traumatic injury. Dosage form specific issues:

May contain lactose; do not use with galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption syndromes. Concurrent drug therapy issues:

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Other warnings/precautions:

Does not have analgesic, antidepressant, or antipsychotic properties.

Rebound or withdrawal symptoms may occur following abrupt discontinuation or large decreases in dose. Use caution when reducing dose or withdrawing therapy; decrease slowly and monitor for withdrawal symptoms. Flumazenil may cause withdrawal in patients receiving long-term benzodiazepine therapy.