Names and pronunciation
(ox-ay′ze-pam)
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Drug reference
(ox-ay′ze-pam)
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Func. class.: Sedative/hypnotic; anxiolytic
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Chem. class.: Benzodiazepine, short acting Controlled Substance Schedule IV
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ACTION: Potentiates the actions of GABA, especially in the limbic system and the reticular formation
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USES: Anxiety, alcohol withdrawal
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Unlabeled uses: Insomnia
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CONTRAINDICATIONS: Preg- nancy, breastfeeding, children <6 yr, hypersensitivity to benzodiazepines, closed-angle glaucoma, psychosis Precautions: Geriatric patients, debili- tated patients, renal/hepatic disease, depression, suicidal ideation, dementia, sleep apnea, seizure disorder
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Black Box Warning: Depressants, res- piratory depression Black Box Warning: Increase: oxazepam effects, respiratory depression—CNS de- pressants, alcohol, disulfiram, opioids Decrease: oxazepam effects—oral con- traceptives, phenytoin, theophylline, val- proic acid Decrease: effects of levodopa Drug/Herb Increase: CNS depression—kava, mela- tonin, valerian Drug/Lab Test Increase: AST, ALT, serum bilirubin Decrease: WBC Black Box Warning: Respiratory de- pression: not to be used in preexisting respiratory depression; use cautiously in severe pulmonary disease; monitor res- pirations, avoid use with opioids or other CNS depressants • Mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness, se- dation, suicidal thoughts/behaviors • Physical dependency, withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness, tremors, seizures (long-term use) • Beers: avoid in older adults; delirium, cognitive impairment may occur • Pregnancy/breastfeeding: assess for pregnancy before use; do not use in preg- nancy; do not breastfeed
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SIDE EFFECTS CNS: Dizziness, drowsiness, confusion, headache, anxiety, tremors, fatigue, depression, insomnia, hallucinations, par- adoxical excitement, transient amnesia CV: Orthostatic hypotension, ECG changes, tachycardia, hypotension EENT: Blurred vision, tinnitus, mydriasis GI: Nausea, vomiting, anorexia, drug- induced hepatitis HEMA: Leukopenia INTEG: Rash, dermatitis, itching SYST: Dependence
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INTERACTIONS
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DOSAGE AND ROUTES Anxiety • Adult /child ≥12 yr: PO 10-15 mg tid- qid, max 120 mg/day • Geriatric: PO 10 mg daily-bid, max 60 mg/day tid Alcohol withdrawal • Adult: PO 15-30 mg tid-qid Severe anxiety syndrome, agitation, anxiety with depression • Adult/child >12 yr: PO 15-30 mg tid-qid
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Available forms: Caps 10, 15, 30 mg
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Administer: • Without regard to food • Taper product (0.5 mg q3days) before discontinuing
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Assess: • CBC and LFTs periodically in longer- term therapy
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Evaluate: • Therapeutic response: decreased anxi- ety, restlessness, insomnia
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That product may be taken without regard to food • That medication is not to be used for everyday stress or used >4 mo unless directed by prescriber; not to take more than prescribed dose because product may be habit forming • To avoid OTC preparations (cough, cold, hay fever) unless approved by pre- scriber • To avoid driving, activities that re- quire alertness because drowsiness may occur • To avoid alcohol, other psychotropic products unless directed by prescriber • Not to discontinue product abruptly after long-term use • To rise slowly because fainting may occur, especially among geriatric pa- tients • That drowsiness may worsen at begin- ning of treatment • To notify prescriber if pregnancy is planned or suspected
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PHARMACOKINETICS Peak 2-4 hr; metabolized by liver; excreted by kidneys; half-life 5-15 hr; crosses pla- centa, breast milk; protein binding 97%
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• Geriatric: PO 10 mg daily-bid, max 60 mg/day tid Alcohol withdrawal
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