📋 Indications & Clinical Dosage
*Short-term use in anxiety:*
Adult: 1-4 mg daily in divided doses, for debilitated patients, use elderly dose
Elderly: 0.5-2 mg daily in divided doses.
*Short-term use in insomnia associated with anxiety:*
Adult: 1-2 mg daily, to be taken at bedtime.
*Conscious sedation for procedures:*
Adult: 2-3 mg, to be taken the night before operation; 2-4 mg, to be taken 1-2 hours before operation.
*Premedication:*
Adult: 2-3 mg, to be taken the night before operation; 2-4 mg, to be taken 1-2 hours before operation.
⛔ Contraindications
Chronic psychosis, CNS depression, respiratory depression, compromised airway, hyperkinesis, not for use alone to treat depression (or anxiety associated with depression), obsessional states, phobic states, acute pulmonary insufficiency, severe hepatic impairment.
⚠️ Precautions & Warnings
Personality disorder (dependent, avoidant, obsessive-compulsive) may increase risk of dependence, muscle weakness, organic brain changes, parenteral administration, narrow-angle glaucoma, renal impairment, Mild to moderate hepatic impairment, elderly or debilitated patients. Avoid long term use. Withdraw gradually.
🔄 Drug Interactions
Alcohol, CNS depressants including valproate, clozapine, haloperidol, theophylline, aminophylline, CYP3A4 inhibitors or inducers (e.g. cimetidine, rifampicin), probenecid.
⚠️ Adverse Reactions / Side Effects
Amnesia, ataxia (especially in the elderly),confusion, dependence, drowsiness, lightheadedness, muscle weakness, paradoxical increase in aggression, dizziness, dysarthria, GI disturbances, gynaecomastia, headache, hypotension, incontinence, salivation changes, slurred speech, tremor, urinary retention, vertigo, visual disturbances. Rare: Apnoea, blood disorders, respiratory depression, jaundice, skin reactions
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Avoid unless potential benefit outweighs risk
Lactation / Breastfeeding:
Contraindicated, avoid
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.