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Psychotropic Medications

The document discusses several anti-anxiety agents including alprazolam, clonazepam, diazepam, and midazolam. For each drug, it provides the generic and brand names, routes of administration and typical dosages, mechanisms of action, indications, and contraindications.
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0% found this document useful (0 votes)
231 views37 pages

Psychotropic Medications

The document discusses several anti-anxiety agents including alprazolam, clonazepam, diazepam, and midazolam. For each drug, it provides the generic and brand names, routes of administration and typical dosages, mechanisms of action, indications, and contraindications.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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JOANNE BERNADETTE C.

AGUILAR BSN-3
1. Anti-anxiety agents - A drug used to treat symptoms of anxiety, such as feelings of fear, dread, uneasiness, and muscle
tightness, that may occur as a reaction to stress. Most antianxiety agents block the action of certain chemicals in the
nervous system. Also called anxiolytic and anxiolytic agent.
 Alprazolam - sold under the trade name Xanax, among others, is a short-acting benzodiazepine. It is most
commonly used in short term management of anxiety disorders, specifically panic disorder or generalized anxiety
disorder.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Alprazolam PO Alprazolam binds to stereospecific
benzodiazepine receptors on the postsynaptic
Brand Name: 0.25-0.5 mg tid, may be GABA neuron at several sites within the
altrox increased as necessary every 3- CNS, including the limbic system and
xanor 4 days to a total of 3 or 4 reticular formation. Enhancement of the
xanor XR mg/day. Treatment duration: 8- GABA inhibitory effect on neuronal
zolgen 12 weeks, including a tapering excitability results by increased neuronal
off process. membrane permeability to Cl ions, which
Indication for the Patient: Treatment for Short- results in hyperpolarisation (a less excitable
term management of anxiety state) and stabilisation. Benzodiazepine
receptors and effects appear to be linked to
Classification: the GABA-A receptors but does not bind to
Anxiolytics / Hypnotics & Sedatives GABA-B receptors.

Contraindications:
Myasthenia gravis, severe respiratory
insufficiency, sleep apnoea syndrome, acute
narrow-angle glaucoma. Severe hepatic
impairment. Concomitant use with potent
CYP3A4 inhibitors (e.g. ketoconazole,
itraconazole).
 Clonazepam - sold under the brand Klonopin among others, is a medication used to prevent and treat seizures, panic
disorder, and the movement disorder known as akathisia. It is a tranquilizer of the benzodiazepine class. It is taken
by mouth.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Clonazepam Intravenous Clonazepam reduces the nerve
Emergency management of status transmission in the motor cortex
Brand Name: epilepticus which suppresses the spike and
clonotril Adult: 1 mg via slow IV inj or infusion over at wave discharge in absence
rivotril least 2 minutes, repeated if necessary. Max: 10 seizures. Its mechanism is
mg. believed to be related to its ability
Indication for the Patient: Child: 500 mcg by slow IV inj over at least 2 to enhance the activity of GABA.
Treatment for panic disorder, emergency minutes or by infusion. Clinically, it improves focal
management of status epilepticus and epilepsy and generalised seizures.
epilepsy Oral
Classification: Panic disorder
Anxiolytics / Anticonvulsants Adult: Initially, 0.25 mg bid, increased after 3
days up to 1 mg/day. Max: 4 mg/day.
Contraindications:
 Patient w/ acute angle closure glaucoma, Oral
acute pulmonary insufficiency, severe Epilepsy
resp insufficiency, myasthenia gravis, Adult: Initially, 1 mg given at night for 4 days,
sleep apnoea syndrome. gradually increased over 2-4 wk. Maintenance:
4-8 mg/day. Max: 20 mg/day.
Child: ≤10 yr or ≤30 kg: Initially, 0.01-0.03
mg/kg/day but not to exceed 0.05 mg/kg/day
given in 2 or 3 divided doses. May be
increased by no more than 0.25-0.5 mg every
3rd day until seizure control is achieved.
Maintenance: 0.1-0.2 mg/kg/day divided 3
times daily. Max: 0.2 mg/kg/day.
Elderly: Initially, 0.5 mg at night for 4 days.
 Diazepam - used to treat anxiety, alcohol withdrawal, and seizures. It is also used to relieve muscle spasms and to
provide sedation before medical procedures. This medication works by calming the brain and nerves.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Diazepam Oral Diazepam is a long-acting
Severe anxiety benzodiazepine that exerts
Brand Name: Adult: 2-10 mg 2-4 times daily depending on anxiolytic, sedative,
anxiol the severity of symptoms. anticonvulsant, muscle relaxant
pamizep Child: 1-2.5 mg 3-4 times daily, increase and amnestic effect. It binds to
trankil gradually as needed and tolerated. stereospecific benzodiazepine
valzepam Elderly: Reduce to half of the dose. receptors on the postsynaptic
valium gamma-aminobutyric acid
vexepam Oral (GABA) neuron in different
Alcohol withdrawal syndrome regions of the central nervous
Indication for the Patient: Treatment Adult: 5-20 mg, may be repeated in 2-4 hours, system, e.g. brain and spinal cord
for severe anxiety, muscle spasms, and as necessary. Alternatively, 10 mg 3-4 times thereby, increasing the inhibitory
Alcohol withdrawal syndrome during the first 24 hours, reducing to 5 mg 3-4 effects of GABA which is
Classification: times daily as needed. involved in sleep induction,
Anxiolytics / Anticonvulsants / Elderly: Reduce to half of the dose. control of hypnosis, memory,
Hypnotics & Sedatives anxiety, epilepsy and neuronal
Oral excitability.
Contraindications: Muscle spasms
Acute or chronic severe respiratory Adult: 2-15 mg daily in divided doses, may
insufficiency, respiratory depression, increase up to 60 mg/day in severe spastic
myasthenia gravis, sleep apnoea, severe disorders (e.g. cerebral palsy).
hepatic insufficiency, acute narrow-angle Child: 2-40 mg daily in divided doses.
glaucoma, phobic or obsessional states, Elderly: Reduce to half of the dose.
chronic psychosis, hyperkinesis, acute
porphyria. Avoid alcohol. Infants <6
months.
 Midazolam - marketed under the trade name Versed, among others, is a benzodiazepine medication used for
anesthesia, procedural sedation, trouble sleeping, and severe agitation. It works by inducing sleepiness, decreasing
anxiety, and causing a loss of ability to create new memories

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Midazolam PO Midazolam binds to
stereospecific benzodiazepine
Brand Name: 7.5-15 mg at bedtime receptors on the postsynaptic
dormid GABA neuron at several sites
dormizol w/in the CNS, including the
midazolex limbic system, reticular
sedoz formation. Enhancement of the
inhibitory effect of GABA on
Indication for the Patient: neuronal excitability results by
Treatment for Short-term management of insomnia increased neuronal membrane
permeability to Cl ions, which
Classification: results in hyperpolarisation (a
Hypnotics & Sedatives less excitable state) and
stabilisation. Benzodiazepine
Contraindications: receptors and effects appear to
Severe resp failure or acute resp depression, acute be linked to the GABA-A
narrow-angle glaucoma, myasthenia gravis, sleep receptors.
apnoea syndrome; severe hepatic impairment (oral).
Concomitant use w/ potent CYP3A4 inhibitors.
 Oxazepam - s a short-to-intermediate-acting benzodiazepine. Oxazepam is used for the treatment of anxiety and insomnia and
in the control of symptoms of alcohol withdrawal syndrome.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Oxazepam Oral Oxazepam is a short-acting
Insomnia associated with anxiety benzodiazepine. It increases neuronal
Brand Name: Adult: 15-25 mg given 1 hr before bedtime. Up to membrane permeability to Cl ions by
serax, alepam 50 mg may be occasionally required. binding to stereospecific benzodiazepine
receptors on the postsynaptic GABA
Indication for the Patient: Oral neuron w/in the CNS (including the limbic
Treatment for Alcohol withdrawal syndrome and Alcohol withdrawal syndrome, Anxiety system, reticular formation) and
Insomnia associated w/ anxiety Adult: 15-30 mg 3 or 4 times daily. enhancing the GABA inhibitory effects
Elderly: Initially, 10 mg tid, increase up to 10-20 resulting in hyperpolarisation and
Classification: mg 3 or 4 times daily as necessary. stabilisation.
Anxiolytics

Contraindications:
contraindicated in any patient with a known
oxazepam hypersensitivity or known allergies to
any component of the formulation. Some tablet
preparations of oxazepam contain tartrazine dye
(FD&C yellow 5) that can cause allergic
reactions or asthmatic symptoms in patients with
tartrazine dye hypersensitivity.
2. Anti-depressants - are medications used to treat major depressive disorder, some anxiety disorders, some chronic pain
conditions, and to help manage some addictions. Common side-effects of antidepressants include dry mouth, weight gain,
dizziness, headaches, and sexual dysfunction.
 Citalopram - is used to treat depression. It may improve your energy level and feelings of well-being. Citalopram is known as a
selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of a certain natural
substance (serotonin) in the brain.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Citalopram Oral Description: Citalopram is bicyclic phthalane derivative
Depression, Depressive phase and a selective serotonin re-uptake inhibitor, w/ little or no
Brand Name: of bipolar disorder effect on noradrenaline, dopamine and GABA re-uptake.
feliz 20, tazen Adult: Initially, 20 mg/day, The inhibitory activity explains the antidepressant property
increased to max 40 mg/day of citalopram. It has no or very low affinity for 5-HT1AA,
Indication for the Patient: after at least 1 wk. 5-HT2A, D1 and D2 receptors, α1, α2, β-adrenergic,
Treatment for Depression; Depressive phase of Child: Contraindicated. histamine H1, muscarinic, cholinergic, benzodiazepine and
bipolar disorder and Panic disorder with or Elderly: 10 mg/day. Max: 20 opioid receptors.
without agoraphobia mg/day.

Classification: Oral
Anxiolytics/ Antidepressant Panic disorder with or
without agoraphobia
Contraindications: Adult: Initially, 10 mg/day,
Congenital long QT syndrome or QT interval increased to 20 mg/day after 1
prolongation; bradycardia, recent acute MI, wk.
uncompensated heart failure, hypokalaemia, Child: Contraindicated.
hypomagnesaemia. Concomitant admin or w/in 14 Elderly: 10 mg/day. Max: 20
days of discontinuing MAOI treatment. mg/day.
Concomitant use w/ drug that prolong QT
interval. Childn and adolescents <18 yr.
 Escitalopram - sold under the brand names Cipralex and Lexapro, among others, is an antidepressant of the selective serotonin
reuptake inhibitor class. Escitalopram is mainly used to treat major depressive disorder or generalized anxiety disorder. It is
taken by mouth.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Esciitalopram Oral Escitalopram selectively inhibits CNS neuronal re-
Panic disorder with or without uptake of serotonin (5-HT) and potentiates
Brand Name: agoraphobia serotonergic activity. It has minimal effects on
conjupram, ecsapro, escinal, escivex 5 Adult: Initially, 5 mg once daily, norepinephrine or dopamine neuronal re-uptake.
increased after a wk to 10 mg Onset: Depression: W/in 1 wk.
Indication for the Patient: once daily. Max: 20 mg daily.
Treatment for Depression; Anxiety; Obsessive Elderly: Half the adult dose.
compulsive disorder and Panic disorder with or
without agoraphobia Oral
Anxiety, Depression, Obsessive
Classification: compulsive disorder
Antidepressant Adult: 10 mg once daily,
increased after at least a wk if
Contraindications: needed. Max: 20 mg once daily.
Known QT interval prolongation or congenital long Elderly: Half the adult dose.
QT syndrome. Concomitant admin or w/in 14 days of
MAOIs withdrawal. Concomitant use w/ drugs that
prolong QT interval (e.g. pimozide).
 Fluoxetine - used to treat major depressive disorder, bulimia nervosa (an eating disorder), obsessive-compulsive disorder,
panic disorder, and premenstrual dysphoric disorder (PMDD).
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Fluoxetine Oral Fluoxetine selectively inhibits
Depression serotonin reuptake at the presynaptic
Brand Name: Adult: Initially, 20 mg once daily. May gradually neuronal membrane leading to
adep, deprizac, drafzin, magrilan, motivest, increase up to max 80 mg daily in 2 divided doses, if increased synaptic concentrations of
prodin, prozac no clinical response after several wk. serotonin, resulting in numerous
Child: ≥8 yr Initially, 10 mg daily, may increase to 20 functional changes associated w/
Indication for the Patient: mg daily after 1-2 wk. Low wt childn: Initially, 10 mg enhanced serotonergic
Treatment for Depression, daily, may increase to 20 mg daily after several wk, neurotransmission.
Obsessive compulsive disorder, Premenstrual only if clinical response is insufficient.
dysphoric disorder, Bulimia nervosa, Panic Elderly: Max: 60 mg daily.
disorder
Oral
Classification: Obsessive compulsive disorder
Antidepressant Adult: Initially, 20 mg once daily, increased up to 60
mg daily if no clinical response after several wk. Max:
Contraindications: 80 mg daily in 2 divided doses.
Concomitant admin or w/in 2 wk of MAOI Child: ≥7 yr Initially, 10 mg daily, may increase to 20
withdrawal. Concomitant use w/ pimozide or mg daily after 2 wk; increase further up to 60 mg daily
thioridazine. after several wk as necessary. Low-wt childn: Initially,
10 mg daily, may increase to 20-30 mg daily after
several wk, if required.
Elderly: Max: 60 mg daily.

Oral
Premenstrual dysphoric disorder
Adult: 20 mg daily continuously. Alternatively, 20 mg
daily to be started 14 days before
 Fluovoxamine - affects chemicals in the brain that may be unbalanced in people with obsessive-compulsive
symptoms. Fluvoxamine is used to treat social anxiety disorder (social phobia), or obsessive-compulsive disorders involving
recurring thoughts or actions.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Fluovoxamine Oral Fluvoxamine, an aralkylketone derivative,
Depression selectively inhibits serotonin re-uptake in
Brand Name: Adult: As conventional tab: Initially, 50 or 100 mg once CNS neuron with minimal or no effect on
luvox daily at bedtime, adjust dose within 3-4 weeks of therapy norepinephrine or dopamine re-uptake.
according to clinical response up to Max 300 mg daily. Onset: Depression: 4-8 weeks. Obsessive-
Indication : Doses >150 mg should be given in 2 or 3 divided doses. compulsive disorder: 8-12 weeks.
Treatment for Obsessive compulsive
disorder and depression Oral
Obsessive compulsive disorder
Classification: Adult: As conventional tab: Initially, 50 mg once daily at
Antidepressant bedtime gradually increase up to Max 300 mg daily.
Doses >150 mg should be given in 2 or 3 divided doses.
Contraindications: As extended-release tab: Initially, 100 mg once daily at
Unstable seizure disorder. Lactation. bedtime, increase if necessary in increments of 50 mg at
Concomitant admin or within 14 days of weekly intervals up to Max 300 mg once daily.
discontinuing MAOIs or fluvoxamine Child: As conventional tab: >8 years Initially, 25 mg once
treatment. Concomitant use with daily, increase as tolerated in increments of 25 mg every
alosetron, pimozide, thioridazine, 4-7 days until an effective dose is achieved. Max: 200 mg
tizanidine, cisapride, ramelteon, daily. Dose >50 mg should be given in 2 divided doses. If
terfenadine, astemizole, linezolid, the 2 divided doses are not equal, give the larger dose at
methylene blue IV. bedtime.
 Sertraline – is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Sertraline affects
chemicals in the brain that may be unbalanced in people with depression, panic, anxiety, or obsessive-compulsive symptoms.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Sertraline Oral Sertraline, a naphthalenamine-derivative
Panic disorder with or without agoraphobia, Posttraumatic antidepressant, selectively inhibits
Brand Name: stress disorder, Social anxiety disorder presynaptic serotonin (5-HT) reuptake. It
deperin, exulten, serenata, sernade, Adult: Initially, 25 mg once daily, increased to 50 mg has very weak effects on norepinephrine
startline, zolodin, zoloft once daily after 1 week. Subsequent doses may be and dopamine neuronal uptake.
increased, if necessary, in increments of 50 mg at intervals Onset: Depression: Within 1 week.
Indication : of at least 1 week. Maintenance: Use lowest effective
Treatment for Panic disorder with or dose, once optimal response is achieved. Max: 200 mg
without agoraphobia, Posttraumatic daily.
stress disorder, Social anxiety disorder,
Obsessive compulsive disorder, Oral
Depression and Premenstrual dysphoric Obsessive compulsive disorder
disorder Adult: Initially, 50 mg once daily, may be increased, if
necessary, in increments of 50 mg at intervals of at least 1
Classification: week. Maintenance: Use lowest effective dose, once
Antidepressant optimal response is achieved. Max: 200 mg daily.
Child: 6-12 years Initially, 25 mg once daily, may be
Contraindications: increased to 50 mg once daily after 1 week; 13-17 years
Concomitant use or within 14 days of Same as adult dose. Consider the body weight when
discontinuation of MAOIs. Concurrent increasing the dose. Max: 200 mg daily.
use with pimozide. Concomitant use of
sertraline oral concentrate solution with Oral
disulfiram. Depression
Adult: Initially, 50 mg once daily, may be increased, if
necessary, in increments of 50 mg at intervals of at least 1
week. Maintenance: Use lowest effective dose, once
optimal response is achieved. Max: 200 mg daily.
Treatment duration: At least 6 months.

Oral
Premenstrual dysphoric disorder
Adult: Continuous dosing: Initially, 50 mg once daily,
may increase by 50 mg each menstrual cycle if necessary.
Max: 150 mg daily. Luteal phase dosing: Initially, 50 mg
once daily for the 1st 3 days, may increase by 100 mg
daily. Maintenance: Use lowest effective dose, once
optimal response is achieved.
3. Mood-stabilizing agents - Mood stabilizers are medications used in the treatment of bipolar disorder, where a person's mood
changes from a depressed feeling to a high “manic” feeling or vice versa. These drugs can help reduce mood swings and prevent
manic and depressive episodes.
 Lithium - is one of the most widely used and studied medications for treating bipolar disorder. Lithium helps reduce the
severity and frequency of mania. It may also help relieve or prevent bipolar depression. Lithium also helps prevent future
manic and depressive episodes.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Lithium Oral Lithium's exact mechanism is unclear but it
Dose depends on the preparation used. Adjust doses to alters intraneuronal metabolism of
Brand Name: produce a serum-lithium concentration of 0.4-1 mmol/L. catecholamines and sodium transport in
litcab, microlit Camcolit® tab: Treatment: Initiate at 1-1.5 g/day; neurons and muscle cells.
Prevention: Initiate at 300-400 mg/day. Priadel® tab:
Indication : Treatment and prevention: Initial: 0.4-1.2 g/day in 1-2
Treatment for Bipolar disorder, Mania, divided doses. Priadel® syrup: Treatment and prevention:
Recurrent unipolar depression Initial: 1.04-3.12 g/day in 2 divided doses. Liskonum®
tab: Treatment: Initial: 450-675 mg twice daily;
Classification: Prevention: Initial: 450 mg twice daily.
Antipsychotics

Contraindications:
Severe renal and cardiac disease; severe
dehydration, sodium depletion,
debilitation.
 Carbamazepine - is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and nerve pain, such as
trigeminal neuralgia and diabetic neuropathy. Carbamazepine is also used to treat bipolar disorder.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Carbamazepine Oral Carbamazepine depresses activity in the
Epilepsy nucleus ventralis of the thalamus, reduces
Brand Name: Adult: Initially, 100-200 mg once daily or bid, gradually synaptic propagation of excitatory
carbastal increased by increments of up to 200 mg daily every wk. impulses or decreases summation of
carbilepp, epikor, lestremor, ,mezacar Maintenance: 0.8-1.2 g daily in divided doses. Max: 2 g temporal stimulation leading to neural
daily. discharge by limiting influx of Na ions
Indication : Child: 10-20 mg/kg daily in divided doses. Alternatively, across cell membrane or other unknown
Treatment for Epilepsy, Prophylaxis of <1 yr 100-200 mg daily. Max: 35 mg/kg daily; 1-5 yr 200- mechanisms. It stimulates the release of
bipolar disorder, Trigeminal neuralgia 400 mg daily. Max: 35 mg/kg daily; >5-10 yr 400-600 mg antidiuretic hormone (ADH) and
daily. Max: 1 g daily; >10-15 yr 0.6-1 g daily. Max: 1 g potentiates its action in promoting
Classification: daily. reabsorption of water.
Anticonvulsants
Oral
Contraindications: Prophylaxis of bipolar disorder
Patients w/ AV block, history of bone Adult: Initially, 400 mg daily in divided doses, increased
marrow depression or history of hepatic gradually as necessary. Maintenance: 400-600 mg daily in
porphyrias. Concurrent use w/ or w/in divided doses. Max: 1.6 g daily.
14 days of MAOI use. Concurrent use
w/ nefazodone. Oral
Trigeminal neuralgia
Adult: Initially, 100-200 mg bid, increased gradually as
needed. Maintenance: 400-800 mg daily in divided doses.
Max: 1.2 g daily.
Rectal
Epilepsy
Adult: Max: 250 mg 6 hrly for not more than 7 days in
patients incapable of oral treatment. When changing from
oral to rectal route, increase dose by approx 25%.
Child: Same as adult dose.

 Lamotrigine - is an anti-epileptic medication, also called an anticonvulsant. Lamotrigine is used alone or with other
medications to treat epileptic seizures in adults and children. Lamotrigine is also used to delay mood episodes in adults with
bipolar disorder (manic depression).
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Lamotrigine Oral Lamotrigine is a phenyltriazine
Bipolar disorder anticonvulsant agent. It stabilises
Brand Name: Adult: Monotherapy or adjunctive therapy w/o valproate presynaptic neuronal membranes by
lamictal, lamitor 50, lamotrix, motrigine and enzyme inducing antiepileptics: Initially, 25 mg once blocking voltage sensitive Na channels,
daily for 2 wk, then 50 mg daily in 1 or 2 divided doses subsequently inhibiting the release of
Indication : for 2 wk, then 100 mg daily in 1 or 2 divided doses for 1 excitatory amino acid neurotransmitters
Treatment for Bipolar disorder and wk, then increase to a target dose of 200 mg daily. (e.g. glutamate, aspartate) which are
epilepsy involved in the generation and spread of
Oral epileptic seizures. Its mechanism of action
Classification: Epilepsy in bipolar disorder is still unknown.
Antipsychotics/ anticonvulsants Adult: Monotherapy or adjunctive therapy w/o valproate
and enzyme-inducing antiepileptics: Initially, 25 mg once
Contraindications: daily for 2 wk, then 50 mg once daily for 2 wk.
Hypersensitivity to lamotrigine Thereafter, increase by max of 50-100 mg daily every 1-2
wk (immediate-release preparations), or increase by 50
mg daily at wkly interval for 3 wk then increase by 100
mg daily at wkly interval thereafter (extended-release
tab). Maintenance: 100-200 mg daily (immediate-release);
300-400 mg daily (extended-release).

 Valproate - are medications primarily used to treat epilepsy and bipolar disorder and to prevent migraine headaches. They are
useful for the prevention of seizures in those with absence seizures, partial seizures, and generalized seizures.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Valproate Oral Valproate is a generic term used to
Prophylaxis of migraine describe valproic acid, its salts and
Brand Name: Adult: As valproate semisodium: Initially, 250 mg bid. derivatives. It is available in various forms
depakote, epilim Max: 1 g/day; extended-release: 500 mg once daily for 7 including the sodium salts (valproate
days then increase to 1 g once daily. Usual range: 500- semisodium and sodium valproate), the
Indication : 1000 mg/day. amide derivative (valpromide), or as
Treatment for epilepsy and bipolar Elderly: Initiate at lower dose and increase slowly. valproic acid. Valproate is a carboxylic
disorder and to prevent migraine acid anticonvulsant. It has been suggested
headaches Oral that its antiepileptic activity is related to
Bipolar disorder increased brain levels of γ-aminobutyric
Classification: Adult: As valpromide: 600-1800 mg/day in 2 divided acid (GABA).
Antipsychotics/ anticonvulsants doses. Usual dose: 1200 mg/day. Initiate at required dose
or dosage may be increased every 2-3 days to reach
Contraindications: optimal dose in 2 wk w/ simultaneous and progressive
Preexisting or family history of hepatic dose reduction of concurrent psychotropic drugs.
dysfunction, active liver disease,
porphyria; mitochondrial and urea cycle Oral
disorders. Patient with known Complex partial seizures
mitochondrial disorders caused by Adult: As monotherapy, conversion to monotherapy or
mutations in mitochondrial DNA adjunctive therapy. Given as valproic acid or valproate
polymerase gamma (e.g. Alpers- semisodium: ≥10 yr Initially 10-15 mg/kg/day in 2-4
Huttenlocher Syndrome). Hepatic divided doses, increased by 5-10 mg/kg/wk. Max: 60
impairment. Children <2 years. mg/kg/day. Given as sodium valproate: 600 mg/day in 2
Pregnancy. divided doses, increased by 150-300 mg every 3 days.
Usual range: 1-2 g/day (20-30 mg/kg/day). Max: 2.5
g/day.
Child: As monotherapy, conversion to monotherapy or
adjunctive therapy. Given as sodium valproate: >20 kg:
400 mg/day in 2 divided doses, increased gradually until
control is achieved. Usual range: 20-30 mg/kg/day. Max:
35 mg/kg/day. <20 kg: 20 mg/kg/day in 2 divided doses,
increased to 40 mg/kg/day.
Elderly: Initiate at lower dose and increase slowly.

 Asenapine - sold under the trade names Saphris and Sycrest among others, is an atypical antipsychotic medication used to treat
schizophrenia and acute mania associated with bipolar disorder. It was chemically derived via altering the chemical structure
of the tetracyclic antidepressant, mianserin.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Asenapine Sublingual Asenapine, a dibenzo-oxepino pyrrole
Schizophrenia derivative, is a 2nd generation or atypical
Brand Name: Adult: Initially, 5 mg bid, may increase to 10 mg bid after antipsychotic w/ mixed antagonistic
sycrest 1 wk if tolerated. activity. It has high affinity for serotonin
(5-HT1A-B, 2A-C, 5-7), dopamine (D1-4),
Indication : Sublingual adrenergic (α1-2), and histamine (H1)
Treatment for Schizophrenia and Acute Acute mixed or manic episodes in bipolar disorder receptors; and moderate affinity for H2
mixed or manic episodes in bipolar disorder Adult: As monotherapy or adjunct to lithium or valproate: receptor.
Initially, 5 mg bid, may increase to 10 mg bid depending
Classification: on clinical response and tolerability.
Antipsychotics

Contraindications:
Hypersensitivity to asenapine.
Dementia-related psychosis. Severe
(Child-Pugh Class C) hepatic
impairment.
4. Antipsychotic agents - also known as neuroleptics or major tranquilizers, are a class of medication primarily used to manage
psychosis, principally in schizophrenia and bipolar disorder. Antipsychotics are usually effective in relieving symptoms of psychosis
in the short term.
 Aripiprazole - sold under the brand name Abilify among others, is an atypical antipsychotic. It is primarily used in the
treatment of schizophrenia and bipolar disorder. Other uses include as an add-on treatment in major depressive disorder, tic
disorders and irritability associated with autism.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Intramuscular Aripiprazole is a quinolinone derivative
Aripiprazole Rapid control of agitation and disturbed behaviour in antipsychotic agent which acts as a partial
schizophrenia or mania agonist at D2 and 5-HT1A receptors and as
Brand Name: Adult: Initially, 9.75 mg as a single dose by deep inj an antagonist at 5-HT2A receptors.
abdin followed by a further dose after 2 hr if necessary. Dose
range: 5.25-15 mg as a single dose. Max: 30 mg daily
Indication : (combined oral and parenteral dose). Patients could only
Treatment for Rapid control of agitation receive up to 3 inj daily.
and disturbed behaviour in schizophrenia Elderly: Reduce initial dose.
or mania, Schizophrenia and Acute manic
episodes of bipolar disorder Oral
Schizophrenia
Classification: Adult: Initially, 10 mg or 15 mg once daily.
Antipsychotics Maintenance: 15 mg once daily. Adjust dose at intervals
of at least 2 wk. Max: 30 mg once daily.
Contraindications: Child: ≥15 yr Initially, 2 mg for 2 days, titrated to 5 mg
Contraindicated for patients who have : for 2 additional days to achieve the recommended dose,
 diabetes 10 mg daily. Subsequent increases should be
 overweight administered in 5 mg increments. Max: 30 mg daily.
 very low levels of granulocytes Elderly: Reduce initial dose.
 a type of white blood cell
 low levels of white blood cells Oral
 low levels of a type of white Acute manic episodes of bipolar disorder
blood cell called neutrophils Adult: Initially, 15 mg once daily, increased to 30 mg
 confusion once daily according to response.
 suicidal thoughts Child: ≥13 yr Initially, 2 mg for 2 days, titrated to 5 mg
 Alzheimer's disease for 2 additional days to achieve the recommended dose,
10 mg daily. Subsequent increases should be
 a type of movement disorder
administered in 5 mg increments. Max: 30 mg daily.
called parkinsonism
Elderly: Reduce initial dose.
 tardive dyskinesia
 a disorder characterized by
involuntary movements of the
face, mouth and tongue
 neuroleptic malignant syndrome
 a reaction characterized by fever
muscle rigidity and confusion
 a low seizure threshold
 a low supply of oxygen rich
blood to the heart
 chronic heart failure
 a disorder of the blood vessels of
the brain
 orthostatic hypotension
 a form of low blood pressure
 low blood pressure
 seizures
 weight gain
 susceptible to breathing fluid into
lungs
 problems with food passing
through the esophagus
 metabolic syndrome x
 dementia in an elderly person
CYP2D6 poor metabolizer

 Asenapine - sold under the trade names Saphris and Sycrest among others, is an atypical antipsychotic medication used to treat
schizophrenia and acute mania associated with bipolar disorder. It was chemically derived via altering the chemical structure
of the tetracyclic antidepressant, mianserin.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Asenapine Sublingual Asenapine, a dibenzo-oxepino pyrrole
Schizophrenia derivative, is a 2nd generation or atypical
Brand Name: Adult: Initially, 5 mg bid, may increase to 10 mg bid after antipsychotic w/ mixed antagonistic
sycrest 1 wk if tolerated. activity. It has high affinity for serotonin
(5-HT1A-B, 2A-C, 5-7), dopamine (D1-4),
Indication : Sublingual adrenergic (α1-2), and histamine (H1)
Treatment for Schizophrenia and Acute Acute mixed or manic episodes in bipolar disorder receptors; and moderate affinity for H2
mixed or manic episodes in bipolar disorder Adult: As monotherapy or adjunct to lithium or valproate: receptor.
Initially, 5 mg bid, may increase to 10 mg bid depending
Classification: on clinical response and tolerability.
Antipsychotics

Contraindications:
Hypersensitivity to asenapine.
Dementia-related psychosis. Severe
(Child-Pugh Class C) hepatic
impairment.
 Clozapine – sold under the brand name Clozaril among others, is an atypical antipsychotic medication. It is mainly used for
schizophrenia that does not improve following the use of other antipsychotic medications. In those with schizophrenia and
schizoaffective disorder it may decrease the rate of suicidal behavior
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Clozapine Oral Clozapine is a dibenzodiazepine
Schizophrenia derivative. It has a weak dopamine
Brand Name: Adult: In patients unresponsive to, or intolerant to other receptor-blocking activity at D1, D2, D3
nirva antipsychotics: 12.5 mg 1-2 times on day 1, followed by 25 and D5 but has high affinity to D4. It
mg 1-2 times on day 2. Thereafter, may increase dose in also possesses α-adrenergic blocking,
Indication : increments of 25-50 mg daily within 14-21 days up to 300 antimuscarinic, antihistaminic,
Treatment for Schizophrenia, Psychoses mg daily in divided doses. Subsequent increments of 50-100 antiserotonergic and sedative properties.
in Parkinson's disease, and Suicidal mg 1-2 times a week if required. Usual dose: 200-450 mg
behaviour in schizophrenia daily. Max: 900 mg daily. Gradually reduce to a suitable
maintenance dose once desired therapeutic response is
Classification: achieved.
Antipsychotics Elderly: 12.5 mg on day 1, increased subsequently in
increments of up to 25 mg daily.
Contraindications:
History of toxic or idiosyncratic Oral
agranulocytosis/granulocytopenia, Psychoses in Parkinson's disease
neutropenia, impaired bone marrow Adult: 12.5 mg at bedtime, increased in increments of 12.5
function, uncontrolled epilepsy, mg up to twice weekly up to max 50 mg, according to
circulatory collapse, CNS depression of response. Usual dose: 25-37.5 mg at bedtime. Max: 100 mg
any cause, severe cardiac disorder, daily.
circulatory collapse, paralytic ileus,
alcoholic or toxic psychosis, drug Oral
intoxication. Severe renal and hepatic Suicidal behaviour in schizophrenia
(including active or progressive liver Adult: Initially, 12.5 mg 1-2 times daily, increased in
disease, hepatic failure) impairment. increments of 25-50 mg daily if tolerated, up to target dose
Concomitant use with long-acting depot of 300-450 mg daily within 2 weeks. Subsequent increments
antipsychotics, alcohol. of up to 100 mg 1-2 times a week. Max: 900 mg daily.

 Olanzapine - sold under the trade name Zyprexa among others, is an atypical antipsychotic primarily used to treat
schizophrenia and bipolar disorder. For schizophrenia, it can be used for both new onset disease and long term maintenance. It
is taken by mouth or by injection into a muscle.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Olanzapine Intramuscular Olanzapine is an atypical antipsychotic w/
Rapid control of agitation and disturbed behaviour in affinity for serotonin 5-HT2A/2C,
Brand Name: schizophrenia or mania dopamine D1-4, histamine H1 and
zyprexa Adult: Initially, 5-10 mg followed by 5-10 mg as required adrenergic α1 receptors. Efficacy is
2 hr later. Max: 20 mg/day (combined oral and parenteral thought to be mediated through combined
Indication : dose). Patients could only receive up to 3 inj in any 24-hr antagonism of dopamine and serotonin
Treatment for Rapid control of agitation period. May give inj for up to 3 days but should transfer type 2 receptor sites.
and disturbed behaviour in schizophrenia or to oral therapy as soon as possible.
mania, Acute mixed or manic episodes in
bipolar disorder, Schizophrenia Oral
Acute mixed or manic episodes in bipolar disorder
Adult: Initially, 10 or 15 mg daily as monotherapy or 10
Classification: mg daily as part of combination therapy. Adjust dose in
Antipsychotics increments or decrements of 5 mg at intervals of not less
than 24 hr to a dose of 5-20 mg daily.
Contraindications:
Patient w/ angle-closure glaucoma. Oral
Schizophrenia
Adult: Initially, 10 mg daily as a single dose. Adjust dose
according to response at intervals of not less than 24 hr
w/in the range of 5-20 mg daily.
 Risperidone - sold under the brand name Risperdal among others, is an atypical antipsychotic. It is used to treat schizophrenia,
bipolar disorder, and irritability associated with autism. It is taken either by mouth or by injection into a muscle. The injectable
version is long-acting and lasts for about two weeks.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Oral Risperidone is a benzisoxazole atypical
Risperidone Schizophrenia antipsychotic w/ mixed serotonin
Adult: Initially, 2 mg daily, may increase to 4 mg on the dopamine antagonist activity that binds to
Brand Name: 2nd day, adjust further if needed. Doses may be given in 5-HT2-receptors in the CNS and in the
risgen, aspidon 1-2 divided doses. Maintenance: 4-6 mg daily. Max: 16 periphery w/ a very high affinity; binds to
mg daily. dopamine-D2 receptors w/ less affinity.
Indication : Elderly: Initially, 0.5 mg bid gradually increased in
Treatment for Schizophrenia, Acute increments of 0.5 mg bid to 1-2 mg bid.
manic episodes of bipolar disorder,
Moderate dementia in Alzheimer's disease, Oral
Severe dementia in Alzheimer's disease, Acute manic episodes of bipolar disorder
Conduct disorder Adult: Initially, 2 mg once daily. May increase in
increments of 1 mg daily at intervals of at least 24 hr.
Classification: Max: 6 mg daily.
Antipsychotics Elderly: Initially, 0.5 mg bid gradually increased in
increments of 0.5 mg bid to 1-2 mg bid.
Contraindications:
contraindicated in patients with a known Oral
hypersensitivity to risperidone or Moderate dementia in Alzheimer's disease, Severe
paliperidone, or to any of the excipients dementia in Alzheimer's disease
in the risperidone formulation. There is Adult: Initially, 0.25 mg bid. Adjust in increments of 0.25
a risk of serious hypersensitivity mg bid on alternate days. Usual dose: 0.5 mg bid (up to 1
reactions or anaphylaxis. mg bid, if needed). Max duration: 6 wk.

Oral
Conduct disorder
Child: 5-18 yr ≥50 kg: Initially, 0.5 mg once daily. Adjust
in increments of 0.5 mg once daily on alternate days.
Usual dose: 1 mg once daily; some may require up to 1.5
mg once daily. <50 kg: Initially, 0.25 mg once daily.
Adjust in increments of 0.25 mg once daily on alternate
days. Usual dose: 0.5 mg once daily; some may require up
to 0.75 mg once daily.
5. Anti-parkinsonism Agents - Agents used in the treatment of Parkinson's disease. The most commonly used drugs act on the
dopaminergic system in the striatum and basal ganglia or are centrally acting muscarinic antagonists.
 Procyclidine Hydrochloride - May be used as monotherapy for mild to moderate symptoms or in combination with other
antiparkinsonian agents for severe symptoms.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Oral Exhibits atropine-like action and exerts
Procyclidine Hydrochloride Initially, 2.5 mg 3 times daily after meals.a As tolerated, antispasmodic effects on parasympathetic-
gradually increase to 5 mg 3 times daily or the minimum innervated peripheral structures including
Brand Name: dosage needed to control symptoms.a If needed, smooth muscle.
kemadrin administer an additional 5-mg dose at bedtime.

Indication :
Treatment for Parkinson's disease

Classification:
Antiparkinsonian Drugs

Contraindications:
known hypersensitivity to procyclidine
or any ingredient in the formulation.
 Amantadine - sold under the brand name Gocovri among others, is a medication used to treat dyskinesia associated with
parkinsonism and influenza caused by type A influenzavirus, though its use for the latter is no longer recommended due to
drug resistance.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Oral Amantadine is a weak dopamine agonist
Amantadine Parkinson's disease possessing antimuscarinic properties. It
Adult: Initially, 100 mg daily, increased to 100 mg bid alters dopamine release and re-uptake. It
Brand Name: after a wk or more. Max dose: 400 mg daily. also noncompetitively antagonises N-
pk-merz Elderly: >65 yr Lowest effective dose. methyl-D-aspartate. As an antiviral drug, it
inhibits replication of influenza type A
Indication : Oral
virus.
Treatment for Parkinson's disease, Prophylaxis of influenza A
Prophylaxis of influenza A, Influenza Adult: 100 mg daily for up to 6 wk; when used w/
A, Herpes zoster (shingles), Drug- influenza vaccination: only up to 3 wk after vaccination.
induced extrapyramidal symptoms Child: 10-15 yr 100 mg daily.
Elderly: >65 yr <100 mg daily or 100 mg given at
Classification: intervals >1 day.
Antivirals / Antiparkinsonian Drugs
Oral
Influenza A
Contraindications: Adult: 100 mg daily for 5 days.
Hypersensitivity to amantadine. History Child: 10-15 yr 100 mg daily.
of epilepsy or other seizure disorders, Elderly: >65 yr <100 mg daily or 100 mg given at
history of gastric ulceration. Severe intervals >1 day.
renal impairment (CrCl <15 mL/min).
Lactation.
Oral
Herpes zoster (shingles)
Adult: 100 mg bid for 14 days, may continue for another
14 days if pain persists.
Oral
Drug-induced extrapyramidal symptoms
Adult: 200 mg daily in 2 divided doses, increased up to
300 mg daily if needed.
 Benzatropine - is a medication used to treat a type of movement disorder due to antipsychotics known as dystonia and
parkinsonism. It is not useful for tardive dyskinesia. It is taken by mouth or by injection into a vein or muscle.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Oral Benzatropine is a centrally-acting
Benzatropine Drug-induced extrapyramidal symptoms anticholinergic agent w/ antihistamine
Adult: 1-4 mg once daily or bid. Stop therapy after 1-2 wk activity. It decreases imbalance between
Brand Name: to assess whether it is still needed. the neurotransmitters acetylcholine and
benztropine dopamine by antagonising the effect of
Oral acetylcholine, thus improving the
Indication : Adjunct in parkinsonism
symptoms of early Parkinson's disease.
Treatment for Drug-induced Adult: Arteriosclerotic and idiopathic parkinsonism:
extrapyramidal symptoms, Adjunct in Initially, 0.5-1 mg at bedtime, some may initiate 4-6 mg
parkinsonism, Drug-induced extrapyramidal daily. Postencephalitic parkinsonism: Initially, 2 mg daily
symptoms, Adjunct in parkinsonism and as a single or in divided doses; may initiate 0.5 mg at
Acute dystonia bedtime in highly-sensitive patient. Gradually increase
dose by 0.5 mg every 5-6 days if necessary. Maintenance:
Classification: May be given as a single dose at bedtime or in 2-4 divided
Antiparkinsonian Drugs doses. Max: 6 mg daily.

Contraindications: Parenteral
Childn <3 yr. Drug-induced extrapyramidal symptoms
Adult: 1-4 mg once daily or bid by IM or IV inj. Stop
therapy after 1-2 wk to assess whether it is still needed.

Parenteral
Adjunct in parkinsonism
Adult: Arteriosclerotic and idiopathic parkinsonism:
Initially, 0.5-1 mg at bedtime by IM or IV inj, some may
initiate 4-6 mg daily. Postencephalitic parkinsonism:
Initially, 2 mg daily as a single or in divided doses by IM
or IV inj; may initiate 0.5 mg at bedtime in highly-
sensitive patient. Gradually increase dose by 0.5 mg every
5-6 days if necessary. Maintenance: May be given as a
single dose at bedtime or in 2-4 divided doses. Max: 6 mg
daily.

Parenteral
Acute dystonia
Adult: 1-2 mg by IM or IV inj. May be followed by 1-2
mg once daily to bid orally for up to 7-28 days to prevent
recurrence.
 Biperiden - sold under the brandname Akineton among others, is a medication used to treat Parkinson disease and certain drug-
induced movement disorders. It is not recommended for tardive dyskinesias. It is taken by mouth, injection into a vein, or
muscle.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Oral Biperiden is an anticholinergic agent w/
Biperiden Drug-induced extrapyramidal symptoms marked effect on the CNS which is
Adult: As biperiden HCl: 2 mg 1-3 times daily. important for its therapeutic application
Brand Name: Elderly: Lower initial dose and increase gradually to the and has weak peripheral vegetative effects.
apiden lowest effective dose. The mechanism of action is considered to
relate to competitive antagonism of
Indication : Oral
acetylcholine at cholinergic receptors in the
Treatment for drug-induced Parkinsonism
extrapyramidal symptoms, Parkinsonism, corpus striatum, which then restores the
Adult: As biperiden HCl: Initially, 2 mg 3-4 times daily,
Drug-induced extrapyramidal symptoms, may increase according to response. Max: 16 mg/day. balance.
Parkinsonism Elderly: Lower initial dose and increase gradually to the
lowest effective dose.
Classification:
Antiparkinsonian Drugs Parenteral
Drug-induced extrapyramidal symptoms, Parkinsonism
Adult: As biperiden lactate: Up to 10-20 mg daily by IM
Contraindications: or slow IV inj.
Untreated narrow-angle glaucoma, Elderly: Lower initial dose and increase gradually to the
mechanical stenoses in the GI tract, lowest effective dose.
paralytic ileus, megacolon, prostatic
adenoma and diseases that can lead to
perilous tachycardia.
 Akidin - biperiden hydrochloride is an anticholinergic antiparkinson agent used to treat the stiffness, tremors, spasms, and poor
muscle control of Parkinson's disease.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Initial dose is 2 mg three to four times a day, increased Biperiden is readily absorbed from the
Akidin according to the patient's needs up to a maximum of 16 gastrointestinal tract. It undergoes
mg in 24 hours. extensive first-pass metabolism, hence its
Brand Name: bioavailability is only 30%. Its elimination
biperiden hydrochloride half-life is about 20 hours.
Indication :
Treatment for stiffness, tremors, spasms,
and poor muscle control of Parkinson's
disease.

Classification:
Antiparkinsonian Drugs

Contraindications:
this product is contraindicated in
patients with prostatic enlargement, in
whom it may lead to urinary retention,
those with paralytic ileus or pyloric
stenosis and ulcerative colitis. It should
not be given to patients with angle-
closure glaucoma and myasthenia
gravis, except to reduce adverse
muscarinic effects of an
anticholinesterase.
6. Sedative Hypnotics - chemical substance used to reduce tension and anxiety and induce calm (sedative effect) or to induce sleep
(hypnotic effect). Most such drugs exert a quieting or calming effect at low doses and a sleep-inducing effect in larger doses.

 Dormid - to provide sedation for minor surgical procedures eg, dental treatment & endoscopy. Induction of general anesthesia

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Intravenously; an initial dose of 2 mg over 30 seconds Midazolam is a drug acting on psychic
Dormid has been suggested, with further incremental doses of 0.5 function, behavior, or experience which
to 1 mg at intervals of 2 minutes if required until the alters the mental state by affecting the
Brand Name: desired end-points is reached. neurophysiological and biochemical
midazolam HCl The dosage of Midazolam should be determined by the activity of the functional units of the CNS,
response of the individual patient. The usual dose of or in the pharmacological sense, as
Indication : Midazolam for induction of anaesthesia is about 200 mcg
narcotics.
a short-acting benzodiazepine with anti- per kg by slow I.V. injection in premedicated patients and
convulsant, anxiolytic, sedative, muscle at least 300 mcg per kg in those who not received a
relaxant, and amnestic properties. It is premedicant. A dose of 150 mcg per kg has been
mainly used in premedication to provide recommended for the induction of anaesthesia in children
sedation for minor surgical or over 7 years of age.
investigation procedures such as dental
treatment and endoscopy and for
induction of general anaesthesia. It is
also used to provide continuous sedation
in patients in intensive care. Midazolam
has no part to play in the treatment of
conversion and dissociative disorders
but it is used to confirm the diagnosis of
hysterical paralysis. Midazolam is used
in patients with advanced cancer and
interactable dyspnoea to relieve air
hunger and to sedate dying patients who
have unrelieved distress. The
conventional use of benzodiazepines in
pain management is as muscle relaxants
to relieve pain associated with skeletal
muscle spasm.

Classification:
Hypnotics & Sedatives

Contraindications:
Midazolam should not be administered
to patients with Myasthenia gravis,
hypersensitivity to benzodiazepines;
patient in shock or coma, or in acute
alcoholic intoxication with depression
of vital signs. Benzodiazepines are
contraindicated in patients with acute
narrow angle glaucoma.
 Diazepam - first marketed as Valium, is a medicine of the benzodiazepine family that typically produces a calming effect.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Oral Diazepam is a long-acting benzodiazepine
Diazepam Insomnia associated with anxiety that exerts anxiolytic, sedative,
Adult: 5-15 mg at bedtime. anticonvulsant, muscle relaxant and
Brand Name: Elderly: Reduce to half of the dose. amnestic effect. It binds to stereospecific
anxiol benzodiazepine receptors on the
Oral postsynaptic gamma-aminobutyric acid
Indication : Adjunct in seizures
(GABA) neuron in different regions of the
Treatment for Adult: 2-60 mg daily in divided doses.
central nervous system, e.g. brain and
Insomnia associated with anxiety, Elderly: Reduce to half of the dose.
Adjunct in seizures, Premedication spinal cord thereby, increasing the
before anaesthesia, Sedation in minor Oral inhibitory effects of GABA which is
surgical and medical procedures Premedication before anaesthesia, Sedation in minor involved in sleep induction, control of
surgical and medical procedures hypnosis, memory, anxiety, epilepsy and
Classification: Adult: 5-20 mg. neuronal excitability.
Anxiolytics / Anticonvulsants / Child: 2-10 mg.
Hypnotics & Sedatives Elderly: Reduce to half of the dose.

Contraindications:
Acute or chronic severe respiratory
insufficiency, respiratory depression,
myasthenia gravis, sleep apnoea, severe
hepatic insufficiency, acute narrow-
angle glaucoma, phobic or obsessional
states, chronic psychosis, hyperkinesis,
acute porphyria. Avoid alcohol. Infants
<6 months.

 Tranxene - sold under the brand name Tranxene among others, is a benzodiazepine medication. It possesses anxiolytic,
anticonvulsant, sedative, hypnotic, and skeletal muscle relaxant properties.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Oral Clorazepate binds to stereospecific
Tranxene Alcohol withdrawal syndrome, Epilepsy benzodiazepine receptors on the
Adult: 90 mg daily in divided doses. postsynaptic GABA neuron within the
Brand Name: Child: 9-12 yr old: 60 mg in divided doses. central nervous system, limbic system,
clorazepate dipotassium Elderly: and debilitated patients: Initiate at lower dose and reticular formation resulting to an increase
adjust slowly. in chloride ion permeability which further
Indication :
leads to hyperpolarisation and stabilisation.
Treatment for Alcohol withdrawal Oral
syndrome, Epilepsy, Anxiety Anxiety
Adult: Initially, 30 mg daily in divided doses, then may
Classification: gradually adjust dose to 15-60 mg daily , according to
Anticonvulsants / Hypnotics & patient's response.
Sedatives Elderly: Initially, 7.5-15 mg daily.

Contraindications:
Hypersensitivity (cross-sensitivity with
other benzodiazepines may occur);
narrow-angle glaucoma. Patients with
depressive or psychotic disorders. child
<9 yr. Pregnancy; lactation.
 Phenobarbital - also known as phenobarbitone or phenobarb, is a medication recommended by the World Health Organization
for the treatment of certain types of epilepsy in developing countries.
Generic Name Route/ Dosage Mechanism of Action
(Brand Name)
Generic Name: Intravenous Phenobarbital is a long-acting barbiturate.
Phenobarbital Preoperative sedation It depresses the sensory cortex, reduces
Child: 1-3 mg/kg pre-op. motor activity, changes cerebellar function
Brand Name: and produces drowsiness, sedation and
rhea phenobarbital Oral hypnosis. Its anticonvulsant property is
Emergency management of acute seizures, Status exhibited at high doses..
Indication : epilepticus
Treatment for Preoperative sedation, Adult: 100-300 mg daily at bedtime.
Emergency management of acute Child: 3-5 mg/kg or 125 mg/m2 daily.
seizures, Status epilepticus, Hypnotic Elderly: Reduce dose.

Classification: Oral
Anticonvulsants / Hypnotics & Hypnotic
Sedatives Adult: 100-320 mg. Do not admin for >2 wk for the
treatment of insomnia.
Contraindications: Elderly: Reduce dose.
Severe resp depression, acute
intermittent porphyria. Severe renal and Intramuscular
hepatic impairment. Intra-arterial and Preoperative sedation
SC admin. Adult: As phenobarbital Na: 100-200 mg 60-90 min pre-
op.
Child: As phenobarbital Na: 16-100 mg 60-90 min pre-op.
Elderly: Reduce dose.
 Dactive - or the short-term treatment of insomnia characterized by difficulties with sleep initiation.

Generic Name Route/ Dosage Mechanism of Action


(Brand Name)
Generic Name: Oral Zolpidem is an imidazopyridine which
Dactive 10 mg once daily immediately before bedtime. The total selectively binds the omega-1 receptor
Zolpidem tartrate dose should not exceed 10 mg per day. subtype (also known as the
Brand Name: benzodiazepine-1 subtype) which is the
zolpidem tartrate alpha unit of the GABA-A receptor
complex. Whereas benzodiazepines non-
Indication :
selectively bind all three omega receptor
indicated for the short-term treatment of
subtypes, Zolpidem preferentially binds the
insomnia characterized by difficulties
with sleep initiation. omega-1 subtype. The modulation of the
chloride anion channel via this receptor
Classification: leads to the specific sedative effects
Hypnotics & Sedatives demonstrated by zolpidem. These effects
are reversed by the benzodiazepine
Contraindications: antagonist flumazenil.
Zolpidem tartrate is contraindicated in
patients with known hypersensitivity to
Zolpidem tartrate or to any of the
inactive ingredients in the formulation.
Observed reactions include anaphylaxis
and angioedema.

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