Clorazepate Dipotassium(klor az’ e pate)
Apo-Clorazepate (CAN), Tranxene-T-tab
PREGNANCY CATEGORY D
CONTROLLED SUBSTANCE C-IV
Drug Classes
Antiepileptic
Anxiolytic
Benzodiazepine
Therapeutic Actions
Exact mechanisms not understood; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those necessary to cause sedation, ataxia.
Indications
Management of anxiety disorders or for short-term relief of symptoms of anxiety
Symptomatic relief of acute alcohol withdrawal
Adjunctive therapy for partial seizures
Contraindications and Cautions
Contraindicated with hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; pregnancy (risk of congenital malformations, neonatal withdrawal syndrome); labor and delivery (“floppy infant” syndrome); lactation (infants tend to become lethargic and lose weight).
Use cautiously with impaired liver or renal function, debilitation; elderly patients.
Available Forms
Tablets—3.75, 7.5, 15 mg
Dosages
Individualize dosage; increase dosage gradually to avoid adverse effects. Drug is available only in oral forms.
Adults
Anxiety: Usual dose is 30 mg/day PO in divided doses tid; adjust gradually within the range of 15–60 mg/day; also may be given as a single daily dose at bedtime with a maximum starting dose of 15 mg. For maintenance, give the 22.5-mg PO tablet in a single daily dose as an alternate form for patients stabilized on 7.5 mg PO tid; do not use to initiate therapy.
Adjunct to antiepileptic medication: Maximum initial dose is 7.5 mg PO tid. Increase dosage by no more than 7.5 mg every wk, do not exceed 90 mg/day.
Acute alcohol withdrawal: Day 1: 30 mg PO initially, then 30–60 mg in divided doses. Day 2: 45–90 mg PO in divided doses. Day 3: 22.5–45 mg PO in divided doses. Day 4: 15–30 mg PO in divided doses. Thereafter, gradually reduce dose to 7.5–15 mg/day PO, and stop as soon as condition is stable.
Pediatric patients
Adjunct to antiepileptic medication: Older than 12 yr: Use adult dosage.
9–12 yr: Maximum initial dose is 7.5 mg PO bid; increase dosage by no more than 7.5 mg every wk, and do not exceed 60 mg/day.
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