General
Pronunciation
me-proe-BA-mate
Trade Name(s)
Apo-Meprobamate [Canada]
Equanil
Miltown
Controlled Substance ScheduleIV
Pregnancy CategoryCategory DTher. class.antianxiety agentssedative/hypnoticsPharm. 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: 616 hr
TIME/ACTION PROFILE (sedation)
| ROUTE | ONSET | PEAK | DURATION |
| PO | <1 hr | 13 hr | 612 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 34 times daily or 600 mg twice daily.
Extended-release capsules400800 mg twice daily (not to exceed 2400 mg/day).
PO (Children 612 yr): 100200 mg 23 times daily.
Extended-release capsules200 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 1248 hr (vomiting, ataxia, muscle twitching, confusion, hallucinations, convulsions). Symptoms usually subside within 1248 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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