Bromazepam (marketed under several brand names, including Relaxin, Lexotan, Brazepam, Bromaze, and Lectopam) is a benzodiazepine derivative drug, developed in the 1970s. It has mainly anxiolytic and at higher doses also sedative, hypnotic and skeletal muscle relaxant properties.
Bromazepam (marketed under several brand names, including Relaxin, Lexotan, Brazepam, Bromaze, and Lectopam) is a benzodiazepine derivative drug, developed in the 1970s. It has mainly anxiolytic and at higher doses also sedative, hypnotic and skeletal muscle relaxant properties.
Indications
- Short-term treatment of anxiety or panic attacks, if a benzodiazepine is required.
- Premedication to alleviate anxiety before surgery.
Side-effects
All common side-effects of benzodiazepines have been noted. Consult the article under diazepam. Bromazepam 3 times 6 mg daily for 2 weeks taken alone impaired learning capacities significantly in humans in an experiment. In combination with alcohol the impairments of learning capacity became even more pronounced. Impairments to memory functions are common with bromazepam and include a reduced working memory and reduced ability to process environmental information. Impaired memory, visual information processing and sensory data and impaired psychomotor performance. Deterioration of cognition including attention capacity and impaired co-ordinative skills. Unsteadiness after taking bromazepam is however less pronounced than other benzodiazepines such as lorazepam. Impaired reactive and attention performance, which may impair driving skills.
Drowsiness and decrease in libido. Occasionally benzodiazepines can induce extreme alterations in memory such as anterograde amnesia and amnesic automatism which may have medico-legal consequences. Such reactions usually only occur at the higher dose end of the prescribing spectrum.
Up to 30% treated on a long-term basis develop a form of dependence, i.e. these patients cannot stop the medication without experiencing physical and/or psychological benzodiazepine withdrawal symptoms.
Leukopenia and liver-damage of the cholostatic type with or without jaundice (icterus) have additionally been seen; the original manufacturer Roche recommends regular laboratory examinations to be performed routinely.
Ambulatory patients should be warned that Bromazepam may impair the ability to drive vehicles and to operate machinery. The impairment is worsened by consumption of alcohol, because both act as central nervous system depressants. During the course of therapy, tolerance to the sedative effect usually develops.
Tolerance, dependence and withdrawal
Bromazepam shares with other benzodiazepines the risk of abuse, misuse, psychological dependence and/or physical dependence. A withdrawal study demonstrated both psychological dependence and physical dependence on bromazepam including marked rebound anxiety after 4 weeks chronic use. Those whose dose was gradually reduced experienced no withdrawal.
Patients treated with bromazepam for generalised anxiety disorder were found to experience withdrawal symptoms such as a worsening of anxiety, as well as the development of physical withdrawal symptoms when abruptly withdrawn from bromazepam. Abrupt or over rapid withdrawal from bromazepam after chronic use even at therapeutic prescribed doses may lead to a severe withdrawal syndrome including status epilepticus and a condition resembling delerium tremens.
Animal studies have shown that chronic administration of diazepam or bromazepam causes a decrease in spontaneous locomotor activity and the turnover of noradrenaline and dopamine and serotonin, decreased activity of tyrosine hydroxylase and increased levels of the catecholamines. During withdrawal of bromazepam or diazepam a fall in tryptophan, 5-hydroxytryptamine levels occurs as part of the benzodiazepine withdrawal syndrome.
