clorazepate dipotassium Nursing Considerations & Management

Drug Name

Generic Name : clorazepate dipotassium

Brand Name:  Apo-Clorazepate (CAN), Novo-Clopate (CAN), Tranxene-SD, Tranxene-SD Half Strength, Tranxene-T-tab

Classification: Benzodiazepine, Anxiolytic, Antiepileptic

Pregnancy Category D
Controlled Substance C-IV

Dosage & Route
  • Individualize dosage; increase dosage gradually to avoid adverse effects. Drug is available only in oral forms.
Adults
  • Anxiety: Usual dose is 30 mg/day PO in divided doses tid; adjust gradually within the range of 15–60 mg/day; also may be given as a single daily dose hs with a maximum starting dose of 15 mg. For maintenance, give the 22.5-mg PO tablet in a single daily dose as an alternate form for patients stabilized on 7.5 mg PO tid; do not use to initiate therapy; the 11.25-mg tablet may be given as a single daily dose.
  • Adjunct to antiepileptic medication: Maximum initial dose is 7.5 mg PO tid. Increase dosage by no more than 7.5 mg every wk, do not exceed 90 mg/day.
  • Acute alcohol withdrawal: Day 1: 30 mg PO initially, then 30–60 mg in divided doses. Day 2: 45–90 mg PO in divided doses. Day 3: 22.5–45 mg PO in divided doses. Day 4: 15–30 mg PO in divided doses. Thereafter, gradually reduce dose to 7.5–15 mg/day PO, and stop as soon as condition is stable.
Pediatric Patients
  • Adjunct to antiepileptic medication:
    • > 12 yr: Use adult dosage.
    • 9–12 yr: Maximum initial dose is 7.5 mg PO bid; increase dosage by no more than 7.5 mg every wk, and do not exceed 60 mg/day.
    • < 9 yr: Not recommended.
Geriatric Patients or Patients with Debilitating Disease
  • Anxiety: Initially, 7.5–15 mg/day PO in divided doses. Adjust as needed and tolerated.
Therapeutic actions
  • Exact mechanisms not understood; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those necessary to cause sedation, ataxia.
Indications
  • Management of anxiety disorders or for short-term relief of symptoms of anxiety
  • Symptomatic relief of acute alcohol withdrawal
  • Adjunctive therapy for partial seizures
Adverse effects
  • Drowsiness, muscular hypotonia, anterograde amnesia, tremor, GI upsets.
Contraindications
  • Contraindicated with hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; pregnancy (risk of congenital malformations, neonatal withdrawal syndrome); labor and delivery (“floppy infant” syndrome); lactation (infants tend to become lethargic and lose weight).
  • Use cautiously with impaired liver or renal function, debilitation; elderly patients.
Nursing considerations

CLINICAL ALERT! Name confusion has occurred between clorazepate and clofibrate; use caution.

Assessment
  • History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication; pregnancy; lactation; impaired liver or renal function; debilitation
  • Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; R, adventitious sounds; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests
Interventions
  • WARNING: Taper dosage gradually after long-term therapy, especially in epileptics.
  • Arrange for patients with epilepsy to wear medical alert identification, indicating disease and medication usage.
Teaching points
  • Take drug exactly as prescribed; do not stop taking drug (long-term therapy) without consulting your health care provider.
  • Avoid alcohol, sleep-inducing, or over-the-counter drugs.
  • Avoid pregnancy while taking this drug; using barrier contraceptives is advised. If you become pregnant, do not stop the drug; contact your health care provider.
  • You may experience these side effects: Drowsiness, dizziness (may be transient; avoid driving a car or engaging in other dangerous activities); GI upset (take with food); fatigue; depression; dreams; crying; nervousness; depression, emotional changes; bed-wetting, urinary incontinence.
  • Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.
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