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Nursing Notes and Community Drug Name Dosages Generic Name : Individualize dosage; clorazepate increase dosage gradually dipotassium to avoid adverse effects. Brand Name: ApoClorazepate (CAN), Novo-Clopate (CAN), Tranxene-SD, Tranxene-SD Half Strength, TranxeneT-tab Classification: Benzodiazepine, Anxiolytic, Antiepileptic Pregnancy Category D Controlled Substance C-IV Drug is available only in oral forms. Adults Therapeutic Actions Indications

Anxiety: Usual dose is 30 mg/day PO in divided doses tid; adjust gradually within the range of 1560 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 3060 mg in divided doses. Day 2: 4590 mg PO in divided doses. Day 3: 22.545 mg PO in divided doses. Day 4: 15 30 mg PO in divided doses. Thereafter, gradually reduce dose to 7.515 mg/day PO, and stop as soon as condition is stable.

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.

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

Pediatric Patients

Adjunct to antiepileptic medication:

Take drug exactly as prescribed; do not stop taking drug (longterm 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.

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Nursing Notes and Community o > 12 yr: Use adult dosage. o 912 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. o < 9 yr: Not recommended. Geriatric Patients or Patients with Debilitating Disease

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.

Anxiety: Initially, 7.515 mg/day PO in divided doses. Adjust as needed and tolerated.

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