Oxazepam

(ox-AZE-uh-pam)

Serax,  Apo-Oxazepam, Novoxapam, Oxpam, PMS-Oxazepam, Zapex

Class: Antianxiety/benzodiazepine

 Action Potentiates action of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter, resulting in increased neuronal inhibition and CNS depression, especially in limbic system and reticular formation.

 Indications Control of anxiety, anxiety associated with depression; control of anxiety, tension, agitation and irritability in elderly; treatment of alcoholics with acute tremulousness, inebriation or anxiety; treatment and prevention of alcohol withdrawal.

 Contraindications Hypersensitivity to benzodiazepines; psychoses.

 Route/Dosage

Mild-to-Moderate Anxiety

ADULTS: PO 10 to 15 mg tid to qid.

Severe Anxiety Syndromes, Anxiety Associated with Depression, Alcoholics

ADULTS: PO 15 to 30 mg tid to qid. ELDERLY: PO 10 mg tid; increase cautiously up to 15 tid to qid.

 Interactions

Alcohol, CNS depressants: Additive CNS depressant effects. Digoxin: Increased serum digoxin concentrations. Theophyllines: May antagonize sedative effects.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Cardiovascular collapse; hypotension. CNS: Drowsiness; confusion; dizziness; lethargy; fatigue; apathy; memory impairment; disorientation; anterograde amnesia; restlessness; headache; slurred speech; aphonia; stupor; coma; euphoria; irritability; vivid dreams; pyschomotor retardation; paradoxical reactions (eg, anger, hostility, mania, insomnia). DERM: Rash. EENT: Visual or auditory disturbances; depressed hearing. GI: Constipation; diarrhea; dry mouth; coated tongue; nausea; anorexia; vomiting. HEMA: Blood dyacrasias including agranulocytosis; anemia; thrombocytopenia; leukopenia; neutropenia; decreased Hct. HEPA: Hepatic dysfunction including hepatitis and jaundice; elevated LDH, ALT, AST, and alkaline phosphatase. OTHER: Dependence/withdrawal syndrome (eg, confusion, abnormal perception of movement, depersonalization, muscle twitching, psychosis, paranoid delusions, seizures).

 Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: Dosage and efficacy not established. Elderly/Debilitated patients: Initial dose should be small; increase gradually. Dependence: Prolonged use may lead to dependence. Withdrawal syndrome has occurred within 4 to 6 wk of treatment with therapeutic doses, especially if abruptly discontinued. Use caution and taper dosage. Long term use (> 4 mo): Effectiveness has not been assessed. Psychiatric disorders: Not intended for use in patients with primary depressive disorder, psychosis or disorders in which anxiety is not prominent. Suicide: Use drug with caution in patients with suicidal tendencies; do not allow access to large quantities of drug.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Administer with food if GI irritation occurs.
• Store at room temperature in tight container.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess BP while patient is lying down and standing. If systolic BP falls 20 mm Hg, withhold dose and notify physician.
• Assess patient’s level of anxiety and level of sedation before administration and periodically throughout therapy.
• Take safety precautions (eg, keep siderails up, assist with ambulation) to prevent falls caused by sedation.
• If drug is being given for alcohol withdrawal, assess tremulousness, anxiety level. Take seizure precautions.
• If serum bilirubin, ALT and AST levels rise, notify physician.
• If signs of drug dependence develop, notify physician. Do not discontinue therapy abruptly. Oxazepam is more commonly habit forming. Observe for excessive use and drug-seeking behavior.

OVERDOSAGE: SIGNS & SYMPTOMS   Slurred speech, sedation, respiratory depression, ataxia, hypotension

 Patient/Family Education

• Emphasize importance of not exceeding recommended dosage. If symptoms do not improve within 2 to 3 days of beginning therapy or if tolerance develops, notify physician.
• If patient has been taking drug for weeks to months, tell patient not to stop taking drug abruptly to avoid withdrawal symptoms.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient not to take otc medications without consulting physician.
• Instruct patient to use safety precautions if dizziness or sedation occurs.
• Advise patient to avoid intake of alcoholic beverages or other CNS depressants without consulting physician.
• Instruct patient to notify physician if dizziness or excessive drowsiness occurs.
• Advise patient that drug may cause drowsiness, and to avoid driving or performing other tasks requiring mental alertness after taking drug.

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