Bromazepam

Brand Names: Lexotanil

Drug Class: Benzodiazepine derivative, Anxiolytic, Sedative-hypnotic

Overview

Bromazepam is a benzodiazepine derivative with anxiolytic, sedative, hypnotic, skeletal muscle relaxant, and anticonvulsant properties. It acts on the central nervous system by enhancing the effect of the neurotransmitter GABA, resulting in calming effects. It is used primarily for short-term management of anxiety disorders and associated symptoms.

Mechanism of Action

Bromazepam potentiates the effects of gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system, by binding to specific sites on the GABA-A receptor. This enhances GABA-mediated chloride ion channel opening, leading to neuronal hyperpolarization and reduced neuronal excitability.

Indications

  • Short-term management of anxiety disorders
  • Symptomatic relief of anxiety associated with depressive symptoms
  • Management of acute alcohol withdrawal symptoms (in some regions)

Dosage

Adults: Typically 1.5-3 mg two to three times daily. Maximum daily dose: 6-12 mg (varies by indication and patient response). Elderly/debilitated patients: Lower initial doses (0.75-1.5 mg daily) with gradual titration. Duration should be as short as possible, generally not exceeding 8-12 weeks including tapering.

Contraindications

  • Hypersensitivity to bromazepam or other benzodiazepines
  • Myasthenia gravis
  • Severe respiratory insufficiency
  • Sleep apnea syndrome
  • Severe hepatic impairment
  • Acute narrow-angle glaucoma

Side Effects

  • Drowsiness, sedation, fatigue
  • Dizziness, ataxia
  • Confusion, memory impairment
  • Headache
  • Dry mouth, gastrointestinal disturbances
  • Paradoxical reactions (agitation, aggression)
  • Dependence, withdrawal symptoms
  • Respiratory depression (especially with overdose or in combination with other CNS depressants)

Interactions

  • Alcohol: Enhanced CNS depression
  • Other CNS depressants (opioids, barbiturates, other benzodiazepines): Increased sedation and respiratory depression
  • CYP3A4 inhibitors (ketoconazole, erythromycin): May increase bromazepam levels
  • CYP3A4 inducers (rifampicin, carbamazepine): May decrease bromazepam levels
  • Antidepressants, antipsychotics: Additive CNS effects