Bromazepam is only found in individuals that have used or taken this drug. It is one of the benzodiazepines that is used in the treatment of anxiety disorders. It is a Schedule IV drug in the U. S. and Canada and under the Convention on Psychotropic Substances. Bromazepam binds to the GABA receptor GABA, causing a conformational change and increasing inhibitory effects of GABA. Other neurotransmitters are not influenced.

Bromazepam is a lipophilic, long-acting benzodiazepine and with the sedative, hypnotic, anxiolytic and skeletal muscle relaxant properties. It does not possess any antidepressant qualities. Bromazepam shares with other benzodiazepines the risk of abuse, misuse, psychological and/or physical dependence.

Mechanism of Action of Bromazepam

Bromazepam binds to the GABA receptor GABA_A, causing a conformational change and increasing inhibitory effects of GABA. Other neurotransmitters are not influenced.

Bromazepam is a “classical” benzodiazepine; other classical benzodiazepines include; diazepam, clonazepam, oxazepam, lorazepam, nitrazepam, flurazepam, and clorazepate. Its molecular structure is composed of a diazepine connected to a benzene ring and a pyridine ring, the benzene ring having a single nitrogen atom that replaces one of the carbon atoms in the ring structure. It is a 1,4-benzodiazepine, which means that the nitrogens on the seven-sided diazepine ring are in the 1 and 4 positions.

Bromazepam binds to the GABA receptor GABA_A, causing a conformational change and increasing the inhibitory effects of GABA. Other neurotransmitters are not influenced bromazepam is a long-acting benzodiazepine and is lipophilic and metabolized hepatically via oxidative pathways. It does not possess any antidepressant or antipsychotic qualities. After nighttime administration of bromazepam, a highly significant reduction of gastric acid secretion occurs during sleep followed by a highly significant rebound in gastric acid production the following day.

Indications of Bromazepam

1st choice drug of hypertensive inducive  anxiety & insomnia

• Short-term treatment of insomnia,
• Short-term treatment of anxiety or panic attacks, if a benzodiazepine is required,
• Alcohol- and opiate-withdrawal syndrome
• Hypnotic disorder in the short-term management of insomnia, as a sedative and premedicant,
• Anticonvulsant
• Anxiety disorders
• Feeling anxious
• Refractory epilepsy
• Refractory seizure disorders
• Skeletal muscle spasm
• For the short-term treatment of insomnia, short-term treatment of anxiety or panic attacks, if a benzodiazepine is required, and the alleviation of the symptoms of alcohol- and opiate-withdrawal.

Contra-Indications of Bromazepam

• Allergic to bromazepam or any ingredients of the medication
• Allergic to any other benzodiazepines
• Myasthenia gravis
• Narrow-angle glaucoma
• Severe breathing difficulties
• Severe liver disease
• Sleep apnea
• Severe respiratory insufficiency including chronic obstructive airway
• Sleep apnoea syndrome.
• s disease with incipient respiratory failure,
• Severe hepatic impairment.

Dosage of Bromazepam

Strengths: 3 mg

Anxiety

• 6-18 mg daily in divided doses. Doses up to 60 mg daily have been used.
• Max initial dose: 3 mg daily in divided doses.
• 6-18 mg/day in divided doses. Max: 60 mg/day.

Side Effects of Bromazepam

The most common

• Confusion
• Irritability and aggression
• Anxiety
• Drowsiness
• Dry mouth
• Abdominal or stomach pain
• cold or flu symptoms such as stuffy nose, sore throat, fever;
• Constipation
• dizziness or lightheadedness
• blurred vision
• hiccups
• coughing
• pain, redness, or hardening of the skin at the injection site
• Nausea , vomiting,
• painful or swollen gums
• numbness or heavy feeling in the jaw
• stomach pain,
• a headache,
• reversible hair loss or thinning, and
• fever

Common

• chills or fever
• headache, severe and throbbing
• joint or back pain
• muscle aching or cramping
• muscle pains or stiffness
• chest pressure or squeezing pain in chest
• excessive sweating
• sudden drowsiness or need to sleep
• coughing up blood
• liver problems–nausea, upper stomach pain, itching, tired feeling, loss of appetite,

Rare

• Anxiety
• change in vision
• chest pain or tightness
• confusion
• a cough
• Agitation
• arm, back, or jaw pain
• blurred vision
• chest pain or discomfort
• convulsions
• extra heartbeats
• hallucinations
• a headache
• irritability
• lightheadedness
• cold and clammy skin
• fast and shallow breathing
• swelling of your feet, legs, or hands purple spot on your skin caused by internal bleeding
• fast or abnormal heart rate or palpitations
• loss of appetite
• lower back, side, or stomach pain
• mental depression
• muscle pain or cramps
• Swelling of your feet or ankles
• Shortness of breath
• Nausea, fever, dark urine, loss of appetite
• Depression
• Ataxia
• Somnolence (difficulty staying awake)
• Mental confusion
• Hypotension
• Respiratory arrest
• Vasomotor collapse

Drug  Interactions of Bromazepam

Bromazepam may interact with following drugs, supplements, & may change the efficacy of drugs

• Antacids
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• aripiprazole
• “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• baclofen
• barbiturates (e.g., butalbital, phenobarbital)
• benzodiazepines (e.g.diazepam, lorazepam)
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• carbamazepine
• estradiol (birth control pills)
• gabapentin
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• mirtazapine
• Oral contraceptives (birth control pills)
• muscle relaxants
• phenytoin
• proton pump inhibitors (e.g., lansoprazole, omeprazole)
• quinolone antibiotics (e.g., ciprofloxacin, ofloxacin)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
• tapentadol
• theophylline
• tramadol
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)

Pregnancy & Lactation of Bromazepam

FDA Pregnancy category D

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you take bromazepam and suspect you are pregnant or plan to become pregnant, a classification that means that bromazepam has been shown to cause harm to the unborn child. The Hoffman LaRoche product information leaflet warns against breastfeeding while taking bromazepam. There has been at least one report of sudden infant death syndrome linked to breastfeeding while consuming bromazepam.

Lactation

This medication may pass into breast milk. If you are a breastfeeding mother and are taking bromazepam, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding. Bromazepam is not recommended for use by children or adolescents under 18 years of age.

References