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Prazepam

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Prazepam chemical structure
Prazepam

7-chloro- 1-(cyclopropylmethyl)- 5-phenyl- 1,3-dihydro- 2H- 1,4-benzodiazepin- 2-one
IUPAC name
CAS number
2955-38-6
ATC code

N05BA11

PubChem
{{{PubChem}}}
DrugBank
none
Chemical formula {{{chemical_formula}}}
Molecular weight 324.8
Bioavailability  ?
Metabolism Hepatic
Elimination half-life 36-200 hours
Excretion Renal
Pregnancy category  ?
Legal status Schedule IV (US)
Routes of administration Oral

Prazepam is a benzodiazepine derivative drug. It possesses anxiolytic, anticonvulsant, sedative and skeletal muscle relaxant properties.[1] Prazepam is a prodrug for desmethyldiazepam which is an active metabolite of prazepam. Desmethyldiazepam is responsible for the therapeutic effects of prazepam.[2]

Prazepam is marketed for anxiolytic use under the trade names Centrac, Centrax, Demetrin, Lysanxia, Mono Demetrin, Pozapam, Prasepine, Prazene, Reapam and Trepidan.

IndicationsEdit

Prazepam is indicated for the short term treatment of anxiety. After short term therapy the dose is usually gradually tapered off to reduce or avoid any withdrawal or rebound effects.[3][4] Desmethyldiazepam, an active metabolite, has a very long half life of 29 to 224 hours which contributes to the therapeutic effects of prazepam.[5][6]

Side effectsEdit

Side effects of prazepam are less profound than with other benzodiazepines.[7] Excessive drowsiness and with longer term use drug dependence are the most common side effects of prazepam.[8][9] Side effects such as fatigue or "feeling spacey" can also occur but less commonly than with other benzodiazepines. Other side effects include feebleness, clumsiness, lethargic, clouded thinking and mentally slowness.[10][11][12]

Tolerance, dependence and withdrawalEdit

Tolerance and dependence can develop with long term use of prazepam and upon cessation or reduction in dosage a benzodiazepine withdrawal syndrome may occur with symptoms such as tremulousness, dysphoria, psychomotor agitation, tachycardia and sweating. In severe cases hallucinations, psychosis and seizures can occur. Withdrawal related psychosis is generally unresponsive to antipsychotic mediations. The risk and severity of the withdrawal syndrome increases the higher the dose and the longer prazepam is taken for.[13] Tolerance, dependence and withdrawal problems may be less severe than with other benzodiazepines such as diazepam.[14] It may be because tolerance is slower to develop with prazepam than with other benzodiazepines.[15] Abrupt or over-rapid discontinuation of prazepam after long term use even at low dosage may result in a protracted withdrawal syndrome.[16]

Benzodiazepines can induce serious problems of addiction which is one of the main reasons for their use being restricted to short term use. A survey in Senegal found that the majority of doctors believed that their training in this area was generally poor. Recommendations for national authorities to take urgent action regarding the rational use of benzodiazepines.[17] Another study in Dakar found that almost one fifth of doctors ignored prescribing guidelines regarding short term use of benzodiazepines and almost three quarters of doctors regarded their training and knowledge of benzodiazepines to be inadequate. More training regarding benzodiazepines has been recommended for doctors.[18]

Contraindications and special cautionEdit

Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol or drug-dependent individuals and individuals with comorbid psychiatric disorders.[19]

Mechanism of actionEdit

Prazepam exerts its therapeutic effects primarily via modulating the benzodiazepine receptor which in turn enhances GABA function in the brain.[20] Prazepam like other benzodiazepines has anticonvulsant properties but its anticonvulsant properties are not as potent as other benzodiazepines when tested in animal studies.[21][22][23][24]

PharmacokineticsEdit

Prazepam is metabolised into descyclopropylmethylprazepam (also known as desmethyldiazepam) and 3-hydroxyprazepam which is further metabolised into oxazepam.[25][26][27][28][29] Prazepam is a prodrug for descyclopropylmethylprazepam/desmethyldiazepam (also known as norprazepam or nordiazepam) which is responsible for most of the therapeutic activity of prazepam rather than prazepam itself.[13][20][30][31]

InteractionsEdit

Prazepam may interact with cimetidine.[32] Alcohol in combination with prazepam increases the adverse effects, particularly performance impairing side effects and drowsiness.[33]

Trade namesEdit

File:Prazepam DOJ.jpg

Prazepam is available under different trade names in the following countries; Austria: Demetrin, Belgium: Lysanxia, France: Lysanxia, Germany: Demetrin; Mono Demetrin, Greece: Centrac, Ireland: Centrax, Italy: Prazene; Trepidan, Netherlands: Reapam, Portugal: Demetrin, South Africa: Demetrin, Switzerland: Demetrin, Thailand: Pozapam; Prasepine.[34]

OverdoseEdit

The symptoms of an overdose of prazepam include sleepiness, agitation and ataxia. Hypotonia may also occur in severe cases. Overdoses in children typically result in more severe symptoms of overdose.[35]

Abuse potentialEdit

Prazepam like other benzodiazepines has abuse potential and can be habit forming. However, its abuse potential may be lower than other benzodiazepines because it has a slow onset of action.[13][36]

ToxicityEdit

Animal studies have found prazepam taken during pregnancy results in delayed growth and reproductive abnormalities.[37][38][39]

See alsoEdit

ReferencesEdit

  1. Shader RI, Greenblatt DJ (1979). Benzodiazepines: some aspects of their clinical pharmacology. Ciba Found. Symp. (74): 141–55.
  2. Jacqmin P, Ansseau M (1988). Comparison of sublingual and oral prazepam in normal subjects. II. Pharmacokinetic and pharmacodynamic data. Neuropsychobiology 19 (4): 186–91.
  3. Rickels K, Sablosky L, Silverman H, et al. (1977). Prazepam in anxiety: a controlled clinical trial. Compr Psychiatry 18 (3): 239–49.
  4. Ansseau M, Von Frenckell R (1991). [Value of prazepam drops in the brief treatment of anxiety disorders]. Encephale 17 (4): 291–4.
  5. Breimer DD, Jochemsen R, von Albert HH (1980). Pharmacokinetics of benzodiazepines. Short-acting versus long-acting. Arzneimittelforschung 30 (5a): 875–81.
  6. Allen MD, Greenblatt DJ, Harmatz JS, Shader RI (August 1980). Desmethyldiazepam kinetics in the elderly after oral prazepam. Clin. Pharmacol. Ther. 28 (2): 196–202.
  7. Greenblatt DJ, Harmatz JS, Dorsey C, Shader RI (September 1988). Comparative single-dose kinetics and dynamics of lorazepam, alprazolam, prazepam, and placebo. Clin. Pharmacol. Ther. 44 (3): 326–34.
  8. Danion JM, Brion S, Escande M, et al. (1984). [Treatment of anxiety with prazepam, 40 mg. A controlled study versus lorazepam]. Encephale 10 (3): 135–8.
  9. Dièye AM, Sy B, Diarra M, Faye B (March 2004). [Prescription and use of benzodiazepins in Saint-Louis in Senegal: patient survey]. Ann Pharm Fr 62 (2): 133–7.
  10. Shader RI, Pary RJ, Harmatz JS, Allison S, Locniskar A, Greenblatt DJ (October 1984). Plasma concentrations and clinical effects after single oral doses of prazepam, clorazepate, and diazepam. J Clin Psychiatry 45 (10): 411–3.
  11. Ansseau M, von Frenckell R, Jacqmin P (1987). Comparison of sublingual and oral prazepam in normal subjects. I. Clinical data. Neuropsychobiology 18 (2): 77–82.
  12. Chabannes JP, Lemoine P (1990). [Prazepam drops versus 10 mg prazepam tablets in anxious patients in ambulatory care]. Therapie 45 (6): 467–70.
  13. 13.0 13.1 13.2 Shader RI, Greenblatt DJ (1981). The use of benzodiazepines in clinical practice. Br J Clin Pharmacol 11 Suppl 1: 5S–9S.
  14. Dorman T (1983). A multi-centre comparison of prazepam and diazepam in the treatment of anxiety. Pharmatherapeutica 3 (6): 433–40.
  15. Saletu M, Saletu B, Grünberger J, Mader R, Karobath M (1983). Clinical symptomatology and computer analyzed EEG before, during and after anxiolytic therapy of alcohol withdrawal patients. Neuropsychobiology 9 (2-3): 119–34.
  16. Soyka M, Lehle R, Hippius H (September 1994). [Exacerbation of an affective psychosis after terminating a decade of benzodiazepine treatment. Which therapeutic procedure is sensible?]. Nervenarzt 65 (9): 628–32.
  17. Dièye AM, Sylla M, Ndiaye A, Ndiaye M, Sy GY, Faye B (June 2006). Benzodiazepines prescription in Dakar: a study about prescribing habits and knowledge in general practitioners, neurologists and psychiatrists. Fundam Clin Pharmacol 20 (3): 235–8.
  18. Dièye AM, Sy AN, Sy GY, et al. (2007). [Prescription of benzodiazepines by general practitioners in the private sector of Dakar: survey on knowledge and attitudes]. Therapie 62 (2): 163–8.
  19. (Nov 2009). Benzodiazepine dependence: focus on withdrawal syndrome.. Ann Pharm Fr 67 (6): 408-13.
  20. 20.0 20.1 Quast U (May 1981). [Molecular mechanism of action of benzodiazepines]. Fortschr. Med. 99 (20): 788–94.
  21. De Sarro G, Gitto R, Rizzo M, Zappia M, De Sarro A (September 1996). 1,4-Benzodiazepine derivatives as anticonvulsant agents in DBA/2 mice. Gen. Pharmacol. 27 (6): 935–41.
  22. De Sarro G, Chimirri A, Zappala M, Guisti P, Lipartiti M, De Sarro A (October 1996). Azirino[1, 2-d[1, 4]benzodiazepine derivatives and related 1,4-benzodiazepines as anticonvulsant agents in DBA/2 mice]. Gen. Pharmacol. 27 (7): 1155–62.
  23. De Sarro G, Chimirri A, McKernan R, Quirk K, Giusti P, De Sarro A (September 1997). Anticonvulsant activity of azirino[1,2-d[1,4]benzodiazepines and related 1,4-benzodiazepines in mice]. Pharmacol. Biochem. Behav. 58 (1): 281–9.
  24. Fukinaga M, Ishizawa K, Kamei C (November 1998). Anticonvulsant properties of 1,4-benzodiazepine derivatives in amygdaloid-kindled seizures and their chemical structure-related anticonvulsant action. Pharmacology 57 (5): 233–41.
  25. Viau JP, Epps JE, Di Carlo J (September 1973). Prazepam metabolism after chronic administration to humans. Xenobiotica 3 (9): 581–7.
  26. Valavani P, Atta-Politou J, Panderi I (April 2005). Development and validation of a liquid chromatographic/electrospray ionization mass spectrometric method for the quantitation of prazepam and its main metabolites in human plasma. J Mass Spectrom 40 (4): 516–26.
  27. Lu XL, Guengerich FP, Yang SK (1991). Stereoselective metabolism of prazepam and halazepam by human liver microsomes. Drug Metab. Dispos. 19 (3): 637–42.
  28. Greenblatt DJ, Shader RI (April 1978). Prazepam, a precursor of desmethyldiazepam. Lancet 1 (8066): 720.
  29. Nau H, Liddiard C, Jesdinsky D, Wittfoht W (September 1978). Quantitative analysis of prazepam and its metabolites by electron capture gas chromatography and selected ion monitoring. Application to diaplacetal passage and fetal hepatic metabolism in early human pregnancy. J. Chromatogr. 146 (2): 227–39.
  30. Kölle EU (June 1981). [Pharmacokinetics of oral prazepam]. Fortschr. Med. 99 (22): 874–9.
  31. Ochs HR, Greenblatt DJ, Verburg-Ochs B, Locniskar A (October 1984). Comparative single-dose kinetics of oxazolam, prazepam, and clorazepate: three precursors of desmethyldiazepam. J Clin Pharmacol 24 (10): 446–51.
  32. Ruffalo RL, Thompson JF, Segal J (September 1981). Cimetidine-benzodiazepine drug interaction. Am J Hosp Pharm 38 (9): 1365–6.
  33. Girre C, Hirschhorn M, Bertaux L, Palombo S, Fournier PE (1991). Comparison of performance of healthy volunteers given prazepam alone or combined with ethanol. Relation to drug plasma concentrations. Int Clin Psychopharmacol 6 (4): 227–38.
  34. Benzodiazepine Names. non-benzodiazepines.org.uk. URL accessed on 2009-05-31.
  35. Pulce C, Mollon P, Pham E, Frantz P, Descotes J (April 1992). Acute poisonings with ethyle loflazepate, flunitrazepam, prazepam and triazolam in children. Vet Hum Toxicol 34 (2): 141–3.
  36. Hakuba A, Matysiakiewicz J (1986). [The habit-forming effect of prazepam]. Psychiatr. Pol. 20 (3): 232–4.
  37. Fox KA, Guerriero FJ (July 1978). Effect of benzodiazepines on age of vaginal perforation and first estrus in mice. Res. Commun. Chem. Pathol. Pharmacol. 21 (1): 181–4.
  38. Guerriero FJ, Fox KA (April 1976). Benzodiazepines and reproduction of swiss-webster mice. Res. Commun. Chem. Pathol. Pharmacol. 13 (4): 601–10.
  39. Guerriero FJ, Fox KA (May 1975). Benzodiazepine-induced suppression of estrous cycles in C57BL/6J mice. Res. Commun. Chem. Pathol. Pharmacol. 11 (1): 155–8.

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