|
This information has been developed and provided by an independent third-party source. Merck & Co., Inc. does not endorse and is not responsible for the accuracy of the content, or for practices or
standards of non-Merck sources.
Medication Safety Issues
Sound-alike/look-alike issues:
Meprobamate may be confused with Mepergan, meperidine
Equanil may be confused with Elavil®
Pronunciation
(me proe BA mate)
U.S. Brand Names
Index Terms
Generic Available
Yes
Canadian Brand Names
Pharmacologic Category
Use: Labeled Indications
Management of anxiety disorders
Use: Dental
Treatment of muscle spasm associated with acute temporomandibular joint (TMJ) pain; management of dental anxiety disorders
Use: Unlabeled/Investigational
Demonstrated value for muscle contraction, headache, premenstrual tension, external sphincter spasticity, muscle rigidity, opisthotonos-associated with tetanus
Restrictions
C-IV
Pregnancy Risk Factor
D
Lactation
Enters breast milk/not recommended
Breast-Feeding Considerations
Breast milk concentrations are higher than plasma; effects are unknown.
Contraindications
Hypersensitivity to meprobamate, related compounds (including carisoprodol), or any component of the formulation; acute intermittent porphyria; pre-existing CNS depression; narrow-angle glaucoma; severe uncontrolled pain; pregnancy
Warnings/Precautions
Concerns related to adverse effects:
• Allergic reactions: May occur in patients with history of dermatological condition (usually by fourth dose).
• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).
Disease-related concerns:
• Depression: Use with caution in patients with depression or suicidal tendencies.
• Drug abuse: Use with caution in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Tolerance, psychological and physical dependence may occur with prolonged use.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Renal impairment: Use with caution in patients with renal impairment.
• Seizure disorder: Use with caution in patients with a history of seizure disorder.
Concurrent drug therapy issues:
• Sedatives: Effects may be potentiated when used with other sedative drugs or ethanol.
Special populations:
• Elderly: Use with caution in the elderly; may cause confusion, cognitive impairment, or excessive sedation.
• Pediatrics: Safety and efficacy have not been established in children <6 years of age.
Other warnings/precautions:
• Abrupt discontinuation: May precipitate withdrawal.
Adverse Reactions
Frequency not defined.
Cardiovascular: Syncope, peripheral edema, palpitation, tachycardia, arrhythmia
Central nervous system: Drowsiness, ataxia, dizziness, paradoxical excitement, confusion, slurred speech, headache, euphoria, chills, vertigo, paresthesia, overstimulation
Dermatologic: Rashes, purpura, dermatitis, Stevens-Johnson syndrome, petechiae, ecchymosis
Gastrointestinal: Diarrhea, vomiting, nausea
Hematologic: Leukopenia, eosinophilia, agranulocytosis, aplastic anemia
Neuromuscular & skeletal: Weakness
Ocular: Blurred vision, impairment of accommodation
Renal: Renal failure
Respiratory: Wheezing, dyspnea, bronchospasm, angioneurotic edema
Drug Interactions
Yohimbine: May diminish the therapeutic effect of Antianxiety Agents. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase CNS depression).
Herb/Nutraceutical: Avoid valerian, St John's wort, kava kava, gotu kola (may increase CNS depression).
Mechanism of Action
Affects the thalamus and limbic system; also appears to inhibit multineuronal spinal reflexes
Pharmacodynamics/Kinetics
Onset of action: Sedation: ~1 hour
Distribution: Crosses placenta; enters breast milk
Metabolism: Hepatic
Half-life elimination: 10 hours
Excretion: Urine (8% to 20% as unchanged drug); feces (10% as metabolites)
Dosage
Oral:
Children 6-12 years: Anxiety: 100-200 mg 2-3 times/day
Adults: Anxiety: 400 mg 3-4 times/day, up to 2400 mg/day
Dosing interval in renal impairment:
Clcr 10-50 mL/minute: Administer every 9-12 hours
Clcr <10 mL/minute: Administer every 12-18 hours
Hemodialysis: Moderately dialyzable (20% to 50%)
Dosing adjustment in hepatic impairment: Probably necessary in patients with liver disease
Dental Usual Dosing
Muscle spasm (TMJ) pain or anxiety: Adults: Oral: 400 mg 3-4 times/day, up to 2400 mg/day
Monitoring Parameters
Mental status
Reference Range
Therapeutic: 6-12 mcg/mL (SI: 28-55 ?mol/L); Toxic: >60 mcg/mL (SI: >275 ?mol/L)
Patient Education
Take exactly as directed; do not increase dose or frequency. Drug may cause physical and/or psychological dependence. Do not use alcohol or other prescription or OTC medications (especially pain medications, sedatives, antihistamines, or hypnotics) without consulting prescriber. Maintain adequate hydration unless instructed to restrict fluid intake. You may experience drowsiness, lightheadedness, impaired coordination, dizziness, or blurred vision (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea, vomiting, or dry mouth (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); or diarrhea. Report persistent CNS effects, skin rash or irritation, changes in urinary pattern, wheezing or respiratory difficulty, or worsening of condition. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication; use appropriate contraceptive measures. Breast-feeding is not recommended.
Geriatric Considerations
Meprobamate is not considered a drug of choice in the elderly because of its potential to cause physical and psychological dependence. Interpretive guidelines from the Centers for Medicare and Medicaid Services (CMS) strongly discourage the use of meprobamate in residents of long-term care facilities.
Additional Information
Withdrawal should be gradual over 1-2 weeks. Benzodiazepine and buspirone are better choices for treatment of anxiety disorders.
Anesthesia and Critical Care Concerns/Other Considerations
Withdrawal should be gradual over 1-2 weeks. Benzodiazepines and buspirone are better choices for treatment of anxiety disorders.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Nursing: Physical Assessment/Monitoring
Assess other medications the patient may be taking for effectiveness and interactions. Assess for history of addiction; long-term use can result in dependence, abuse, or tolerance; periodically evaluate need for continued use. Monitor therapeutic effectiveness and adverse reactions or overdose at beginning of therapy and periodically with long-term use. Monitor for CNS depression. Taper dosage slowly when discontinuing. Assess knowledge/teach patient appropriate use, interventions to reduce side effects, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet: 200 mg, 400 mg
Miltown®: 200 mg, 400 mg [DSC]
Pricing: U.S. (www.drugstore.com)
Tablets (Meprobamate)
200 mg (30): $42.99
400 mg (100): $149.97
Tablets (Miltown)
200 mg (30): $69.83
References
Hassan E, “Treatment of Meprobamate Overdose With Repeated Oral Doses of Activated Charcoal,” Ann Emerg Med, 1986, 15(1):73-6.
Jacobsen D, Wiik-Larsen E, Saltvedt E, et al, “Meprobamate Kinetics During and After Terminated Hemoperfusion in Acute Intoxications,” J Toxicol Clin Toxicol, 1987, 25(4):317-31.
Volturo GA, “Meprobamate and Bezoar Formation,” Ann Emerg Med, 1987, 16(4):472-3.
International Brand Names
Lexi-Comp.com
Last full review/revision July 2009
Content last modified July 2009
| 
