Home Drug Guide Clorazepate Dipotassium

Drug Guide

Generic Name

Clorazepate Dipotassium

Brand Names Tranxene, Tranxene Sd, Gen-xene

Classification

Therapeutic: Antianxiety agent, anticonvulsant

Pharmacological: Benzodiazepine

FDA Approved Indications

Anxiety disorders
Partial seizures

Mechanism of Action

Clorazepate enhances the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, producing sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties.

Dosage and Administration

Adult: Initially, 7.5-15 mg 2-4 times daily; dosage may be increased gradually based on response and tolerability. Typical maintenance doses range from 15-60 mg daily in divided doses.

Pediatric: Use is not established; contraindicated in children.

Geriatric: Start with lower doses, such as 3.75-7.5 mg daily, due to increased sensitivity and risk of sedation and falls.

Renal Impairment: Adjust dose cautiously; monitor for increased sensitivity.

Hepatic Impairment: Use with caution; dose adjustment may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized in the liver to active metabolites.

Excretion: Excreted primarily in the urine.

Half Life: Approximately 40 hours in healthy adults, but can be longer in the elderly.

Contraindications

Hypersensitivity to benzodiazepines
Acute narrow-angle glaucoma

Precautions

History of substance abuse, severe respiratory impairment, hepatic impairment, pregnancy, lactation, elderly, or debilitated patients. Use cautiously in patients prone to falls or with suicidal tendencies.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Ataxia (Common)

Adverse Reactions - Serious

Respiratory depression (Rare)
Anterograde amnesia (Rare)
Dependence and withdrawal symptoms (Serious with prolonged use)

Drug-Drug Interactions

CNS depressants (alcohol, opioids, other sedatives) increase risk of sedation and respiratory depression.
Other benzodiazepines, barbiturates, antipsychotics, antidepressants.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, level of sedation, respiratory function, and for signs of dependence.

Diagnoses:

Risk for falls
Risk for dependence
Altered sleep pattern

Implementation: Administer with meals if GI upset occurs; avoid alcohol and other CNS depressants; monitor for excessive sedation.

Evaluation: Assess effectiveness in reducing anxiety or seizures; monitor for adverse effects and dependency.

Patient/Family Teaching

Do not operate heavy machinery or drive until response is known.
Avoid alcohol and other CNS depressants.
Recognize signs of overdose and dependence.
Take medication exactly as prescribed, and do not suddenly stop without medical advice.

Special Considerations

Black Box Warnings:

Risk of sedation, respiratory depression, and dependence or abuse.

Genetic Factors: None specific.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Extreme sedation, confusion, coma, respiratory depression, hypotension.

Treatment: Supportive care, airway management, dopamine or flumazenil administration (for benzodiazepine overdose), monitor vital signs, and provide respiratory support as needed.

Storage and Handling

Storage: Store at room temperature, away from moisture, heat, and light.

Stability: Stable under recommended storage conditions.