General

Pronunciation
me-proe-BA-mate

Trade Name(s)

• Apo-Meprobamate [Canada]

• Equanil

• Miltown

Controlled Substance Schedule
IV

Pregnancy Category
Category D

Ther. class.
antianxiety agents
sedative/hypnotics

Pharm. class.
carbamates

Indications

Anxiety disorders (provides sedation)

Action

Produces CNS depression by acting at multiple sites in the CNS

Therapeutic Effect(s):
Sedation

Pharmacokinetics

Absorption: Well absorbed after oral administration

Distribution: Widely distributed. Crosses the placenta; enters breast milk in high concentrations

Metabolism and Excretion: Metabolized by the liver

Half-life: 6–16 hr

TIME/ACTION PROFILE (sedation)

ROUTE	ONSET	PEAK	DURATION
PO	<1 hr	1–3 hr	6–12 hr
PO-ER	unknown	unknown	12 hr

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity

• Comatose patients or those with pre-existing CNS depression

• Uncontrolled severe pain

• Pregnancy and lactation

Use Cautiously in:

• Hepatic dysfunction or severe renal impairment

• History of suicide attempt or drug abuse

• Geri: Appears on Beers list and is associated with falls. Dosage reduction suggested

Adverse Reactions/Side Effects

CNS: drowsiness.

EENT: blurred vision.

CV: hypotension.

GI: anorexia, diarrhea, nausea, vomiting.

Derm: pruritus, rashes, urticaria.

Neuro: ataxia.

Misc: hypersensitivity reactions, physical dependence, psychological dependence, tolerance.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug
Additive CNS depression with other CNS depressants, including alcohol, antihistamines, opioid analgesics, and other sedative/hypnotics

Drug-Natural Products
Concomitant use of kava, valerian, skullcap, chamomile, or hops can increase CNS depression

Route/Dosage

• PO (Adults): 400 mg 3–4 times daily or 600 mg twice daily.
Extended-release capsules—400–800 mg twice daily (not to exceed 2400 mg/day).

• PO (Children 6–12 yr): 100–200 mg 2–3 times daily.
Extended-release capsules—200 mg twice daily.

Availability

• Tablets: 200 mg, 400 mg, 600 mg

• In combination with: aspirin (Equagesic). See combination drugs

Assessment

• Assess degree and manifestations of anxiety before and periodically throughout therapy

• Monitor blood pressure and pulse rate before and during initial therapy

• Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient

• Geri: Assess fall risk and institute fall prevention strategies.

Lab Test Considerations

• Assess CBC periodically during course of therapy

» May cause false elevations in urinary steroid concentrations

Potential Nursing Diagnoses

• Anxiety (Indications)

• Risk for injury (Side Effects)

• Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

PO: May be administered with food to minimize GI irritation

Patient/Family Teaching

• Instruct patient to take medication exactly as directed. If a dose is missed, take if remembered within 1 hr; if remembered later, do not take. Do not double doses. Abrupt discontinuation may precipitate pre-existing symptoms or withdrawal reactions within 12–48 hr (vomiting, ataxia, muscle twitching, confusion, hallucinations, convulsions). Symptoms usually subside within 12–48 hr

• May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until effects of drug are known

• Caution patient to change positions slowly to minimize orthostatic hypotension

• Geri: Caution patient to reduce fall risk in the home.

• Advise patient to avoid concurrent use of alcohol or other CNS depressants

• Instruct patient to notify health care professional if pregnancy is planned or suspected

• Advise patient to notify health care professional if skin rash, sore throat, or fever occurs

• Emphasize the importance of participation in psychotherapy if recommended by health care professional and follow-up exams to evaluate progress

Evaluation/Desired Outcomes

• Decrease in the signs and symptoms of anxiety

• Sedation. Medication's efficacy should be reassessed periodically. Therapy is generally of less than 4 mo duration

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