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Loprazolam: Indications, Dosing, Side Effects and Interactions
Loprazolam clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Loprazolam: Indications, Dosing, Side Effects and Interactions
Loprazolam clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Insomnia (short-term use)**
- **Adult** (By Mouth): 1 mg once daily, then increased to 1.5-2 mg once daily if required, dose to be taken at bedtime, for debilitated patients, use elderly dose.
- **Elderly** (By Mouth): 0.5-1 mg once daily, dose to be taken at bedtime.
Cautions
Avoid prolonged use (and abrupt withdrawal thereafter); debilitated patients (reduce dose); elderly (reduce dose); history of alcohol dependence or abuse; history of drug dependence or abuse; myasthenia gravis; personality disorder (within the fearful group-dependent, avoidant, obsessive-compulsive) may increase risk of dependence; respiratory disease Cautions, further information Paradoxical effects A paradoxical increase in hostility and aggression may be reported by patients taking benzodiazepines. The effects range from talkativeness and excitement to aggressive and antisocial acts. Adjustment of the dose (up or down) sometimes attenuates the impulses. Increased anxiety and perceptual disorders are other paradoxical effects. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for a duration of 4 weeks or longer (no indication for longer treatment; risk of adverse events; all benzodiazepines should be withdrawn gradually if taken for more than 2 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly) with acute or chronic respiratory failure i.e. PaO 2 < 8 kPa with or without PaCO 2 > 6.5 kPa (risk of exacerbation of respiratory failure) in patients prone to falls (sedative, may cause reduced sensorium and impair balance) Cautions For loprazolam Acute porphyrias ; hypoalbuminaemia; muscle weakness Cautions, further information Paradoxical effects A paradoxical increase in hostility and aggression may be reported by patients taking benzodiazepines. The effects range from talkativeness and excitement to aggressive and antisocial acts. Adjustment of the dose (up or down) sometimes attenuates the impulses. Increased anxiety and perceptual disorders are other paradoxical effects.
Contraindications
Acute pulmonary insufficiency; marked neuromuscular respiratory weakness; not for use alone to treat chronic psychosis; not for use alone to treat depression (or anxiety associated with depression); obsessional states; phobic states; sleep apnoea syndrome; unstable myasthenia gravis Contra-indications For loprazolam Respiratory depression
Side effects
Common or very common Alertness decreased; anxiety; ataxia (more common in elderly); confusion (more common in elderly); depression; dizziness; drowsiness; dysarthria; fatigue; headache; hypotension; mood altered; muscle weakness; nausea; respiratory depression (particularly with high dose and intravenous use-facilities for its treatment are essential); sleep disorders; tremor; vision disorders; withdrawal syndrome Uncommon Agitation (more common in children and elderly); anterograde amnesia; behaviour abnormal; hallucination; libido disorder; rash Rare or very rare Aggression (more common in children and elderly); blood disorder; delusions; jaundice; paradoxical drug reaction; restlessness (with sedative and peri-operative use); urinary retention Frequency not known Drug dependence Overdose Benzodiazepines taken alone cause drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma. For details on the management of poisoning, see Benzodiazepines, under Emergency treatment of poisoning . Side-effects For loprazolam Frequency not known Adjustment disorder; cognitive disorder; gastrointestinal disorder; muscle tone decreased; speech disorder; suicidal ideation
Interactions
**Other interactions (3):**
- Loprazolam may be potentiated by alcohol or other drugs acting on the CNS or with Cisapride.
- Combination with CNS depressants e.g.
- The risk of a withdrawal syndrome occurring is increased when loprazolam is combined with other benzodiazepines prescribed as anxiolytics or hypnotics.
Pregnancy
Risk of neonatal withdrawal symptoms when used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression.
Breast feeding
Benzodiazepines are present in milk, and should be avoided if possible during breast-feeding.
Hepatic impairment
In general, manufacturers advise caution in mild to moderate impairment; avoid in severe impairment. Benzodiazepines with a shorter half-life are considered safer. Dose adjustments In general, manufacturers advise dose reduction in mild to moderate impairment, adjust dose according to response.
Renal impairment
In general, manufacturers advise caution (risk of increased cerebral sensitivity to benzodiazepines). Dose adjustments In general, manufacturers advise to consider dose reduction.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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