Names and pronunciation
(kar-eye-soe-proe′dole) Soma
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Drug reference
(kar-eye-soe-proe′dole) Soma
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Func. class.: Skeletal muscle relax- ant, central acting
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Chem. class.: Meprobamate congener Controlled Substance Schedule IV
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Do not confuse: Soma/Soma Compound
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ACTION: Depresses CNS by blocking interneuronal activity in descending reticular formation, spinal cord, thereby producing sedation and possibly altering pain perception
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USES: Relieving pain, stiffness with musculoskeletal disorders
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CONTRAINDICATIONS: Hyper- sensitivity to these products or carba- mates, intermittent porphyria Precautions: Pregnancy, breastfeeding, geriatric patients, Asian patients, renal/hepatic disease, substance abuse, seizure disorder, CNS depression, abrupt discontinuation
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SIDE EFFECTS CNS: Dizziness, weakness, drowsiness, headache, insomnia, irritability CV: Postural hypotension, tachycardia GI: Nausea, vomiting, hiccups, epigastric discomfort HEMA: Eosinophilia, leukopenia INTEG: Rash, facial flushing, erythema multiforme RESP: Asthmatic attacks SYST: Angioedema, anaphylaxis
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INTERACTIONS • Do not use together with meprobamate Increase: CNS depression—alcohol, tri- cyclics, barbiturates, sedatives, hypnotics; avoid concurrent use Increase: CNS depression, addiction: opiates Increase: carisoprodol metabolite, decreasing carisoprodol effect—CYP2C19 inhibitors (FLUoxetine, fluvoxaMINE, isoni- azid, modafinil) Decrease: carisoprodol metabolism, increasing carisoprodol effect—CYP219 inducers (rifAMPin) Drug/Herb Increase: CNS depression—kava, valerian Increase: metabolism of carisoprodol— St. John’s wort Drug/Lab Test Increase: eosinophils Increase: RBC, WBC, platelets
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TREATMENT OF OVERDOSE: Dialysis, lavage HIGH ALERT
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DOSAGE AND ROUTES • Adult/adolescent ≥16 yr: PO 250-350 mg qid, max 3 wk of use
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Available forms: Tablets 250, 350 mg
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Administer: • With meals for GI symptoms • For short term (2-3 wk), potential for habituation • Store in tight container at room tem- perature
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Assess: • Pain, stiffness, mobility, activities of daily living at baseline and throughout treatment • Idiosyncratic reaction: (weakness, dizziness, blurred vision, confusion, eu- phoria), anaphylaxis within a few minutes or hours of first to fourth dose, withhold and notify prescriber, usually seen in poor CYP2C19 metabolizers • Allergic reactions: rash, fever, respi- ratory distress, anaphylaxis, angioedema • CNS depression: dizziness, drowsiness, psychiatric symptoms, abuse potential • Abrupt discontinuation: withdrawal reactions do occur but may be mild, de- pendence may occur • Beers: avoid in older adults; may cause sedation, anticholinergic effects; may decrease urinary flow, cause reten- tion (men)
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Evaluate: • Therapeutic response: decreased pain, spasticity; increased ROM
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • There is a high incidence of depen- dence when using this product • To avoid hazardous activities if drows- iness, dizziness occur; not to drive while taking product; to avoid rapid position changes, postural hypotension occurs, not to use for >2-3 wk • To avoid using OTC medications (cough preparations, antihistamines) unless directed by prescriber; not to take with alcohol, other CNS depressants; that there is a high incidence of dependence when using this product • Idiosyncratic reaction: to report weakness, dizziness, blurred vision, confu- sion, euphoria; if these occur, to withhold product and call prescriber • To report allergic reaction immedi- ately: rash, swelling of tongue/lips, hives, dyspnea • To take with food or milk for GI symptoms • Do not take with opiates with CNS de- pressants, benzodiazepine, alcohol • Pregnancy/breastfeeding: If preg- nancy is planned or suspected or if breastfeeding
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PHARMACOKINETICS PO: Onset ½ hr; peak 4 hr; duration 4-6 hr; extensively metabolized by liver, substrate of CYP2C19 , some Asians, Blacks, Whites are poor metabolizers; excreted in urine; crosses placenta; excreted in breast milk (large amounts); half-life 8 hr
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• Adult/adolescent ≥16 yr: PO 250-350 mg qid, max 3 wk of use
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