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Prazepam is a benzodiazepine derivative drug developed by Warner-Lambert in the 1960s. It possesses anxiolytic, anticonvulsant, sedative and skeletal muscle relaxant properties. Prazepam is a prodrug for desmethyldiazepam which is responsible for the therapeutic effects of prazepam


Description

Prazepam

Prazepam is a benzodiazepine derivative drug developed by Warner-Lambert in the 1960s.[1] It possesses anxiolyticanticonvulsantsedative and skeletal muscle relaxant properties.[2] Prazepam is a prodrug for desmethyldiazepam which is responsible for the therapeutic effects of prazepam.[3]

Prazepam Indications

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.[4][5] Desmethyldiazepam, an active metabolite, has a very long half-life of 29 to 224 hours, which contributes to the therapeutic effects of prazepam.[6][7]

Prazepam Side effects

Side effects of prazepam are less profound than with other benzodiazepines.[8] Excessive drowsiness and with longer-term use, drug dependence, are the most common side effects of prazepam.[9][10] Side effects such as fatigue or “feeling spacey” can also occur but less commonly than with other benzodiazepines. Other side effects include feebleness, clumsiness or lethargy, clouded thinking and mental slowness.[11][12][13]

prazepam Tolerance, dependence and withdrawal

Tolerance and dependence can develop with long-term use of prazepam, and upon cessation or reduction in dosage, then a benzodiazepine withdrawal syndrome may occur with symptoms such as tremulousnessdysphoriapsychomotor agitationtachycardia and sweating. In severe cases, hallucinationspsychosis 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.[14] Tolerance, dependence and withdrawal problems may be less severe than with other benzodiazepines, such as diazepam.[15] It may be because tolerance is slower to develop with prazepam than with other benzodiazepines.[16] Abrupt or over-rapid discontinuation of prazepam after long-term use, even at low dosage, may result in a protracted withdrawal syndrome.[17]

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.[18] Another study in Dakar found that almost one-fifth of doctors ignored prescription 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.[19]

Contraindications and special caution

Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol or drug-dependent individuals and individuals with comorbid psychiatric disorders.[20]

Mechanism of action

Prazepam exerts its therapeutic effects primarily via modulating the benzodiazepine receptor which in turn enhances GABA function in the brain.[21] Prazepam like other benzodiazepines has anticonvulsant properties, but its anticonvulsant properties are not as potent as other benzodiazepines when tested in animal studies.[22][23][24][25]

Pharmacokinetics

Prazepam is metabolised into descyclopropylmethylprazepam (also known as desmethyldiazepam) and 3-hydroxyprazepam which is further metabolised into oxazepam.[26][27][28][29][30] Prazepam is a prodrug for descyclopropylmethylprazepam/desmethyldiazepam (also known as norprazepam or nordazepam) which is responsible for most of the therapeutic activity of prazepam rather than prazepam itself.[14][21][31][32]

An original electron-capture gas chromatographic assay was developed for simultaneous measurement of plasma levels of the benzodiazepine derivative prazepam and of its principal unconjugated metabolite, N-desmethyldiazepam. The assay was used to study the pharmacokinetics of the drug and its comparative bioavailability from tablets and from a specially prepared solution. Nine healthy adult volunteers were studied.

Each volunteer on one occasion took 30 mg of the drug in tablet form, and on another occasion 30 mg of the drug in solution. In all subjects, N-desmethyldiazepam appeared in plasma shortly after prazepam appeared and reached a peak within four hours of prazepam ingestion. Thereafter plasma N-desmethyldiazepam levels were much higher than plasma prazepam levels throughout. Prazepam became undetectable within six hours of intake, whereas its metabolite could still be measured in plasma fourteen days after dosage.

Thus much of the pharmacological action of prazepam may be mediated through its metabolite, N-desmethyldiazepam. In five of the nine subjects, areas under the plasma level curves for the metabolite were not markedly different for the tablet and solution formulations studied. In the other four subjects the area under the curve for the tablets was 50% to 80% of the area under the curve for the solution. The time to reach peak plasma level for the metabolite was shorter after the solution formulation (mean 2.0±SD 1.2 h) than after the tablet formulation (mean 4.2±SD 1.7 h).

Prazepam

PubChem CID 4890
Structure
Prazepam_small.png
Prazepam_3D_Structure.png
Chemical Safety
Irritant

 

Health Hazard
Molecular Formula C19H17ClN2O
Synonyms

prazepam

Demetrin

Lysanxia

Centrax

Trepidan

Molecular Weight 324.8 g/mol
Dates
  • Modify2020-12-19
  • Create2005-03-25

Prazepam is a DEA Schedule IV controlled substance. Substances in the DEA Schedule IV have a low potential for abuse relative to substances in Schedule III.

Prazepam is a benzodiazepine.

Prazepam is a benzodiazepine that is used in the treatment of anxiety disorders. It is a schedule IV drug in the U.S.

Predictive Pharmaco-EEG Trials in Normals

Digital computer period analysis of the R-EEG in normals after single doses of 3 mg, 5 mg and 10 mg lopirazepam, placebo and 10 mg prazepam demonstrated only some minor changes after administration of placebo. In contrast lopirazepam induced a pharmaco-EEG profile characterized by a dose-dependent increase of beta activity, average frequency and frequency deviation in both the primary wave and first derivative measurements, and a dose-dependent decrease in alpha activity and amplitude. The augmentation of beta activity was maximally pronounced in the 20-26 cps band. Slow activities indicating sleep-inducing properties were only significantly increased after the highest dosage (10 mg) lopirazepam, 10 mg prazepam induced the same type of changes and was most similar to 5 mg lopirazepam.

Statistical comparison of lopirazepam-induced changes at the hours 2, 4,6 and 8 after administration with alterations after placebo showed a significant augmentation of beta activity and average frequency already after the lowest dosage (3 mg) lasting up to the 4th hour post drug (Fig. 1). The 5 mg dosage produced the same type of changes up to the 6th hour, the 10 mg dosage up to the 8th hour after oral administration. 10 mg D-12524 produced also a significant augmentation of slow waves (delta and theta range) in the 4th and 6th hour post drug indicating hypnotic qualities of this dosage in normals at these times.

Benzodiazepines (Systemic)

This monograph includes information on the following:

1) Alprazolam
2) Bromazepam *
3) Chlordiazepoxide
4) Clobazam *
5) Clonazepam
6) Clorazepate
7) Diazepam
8) Estazolam 
9) Flurazepam
10) Halazepam 
11) Ketazolam * 
12) Lorazepam
13) Nitrazepam *
14) Oxazepam
15) Prazepam * 
16) Quazepam 
17) Temazepam
18) Triazolam

VA CLASSIFICATION
Alprazolam Oral
Primary: CN302

Bromazepam Oral
Primary: CN302

Chlordiazepoxide Oral
Primary: CN302

Chlordiazepoxide Parenteral
Primary: CN302

Clobazam Oral
Primary: CN400

Clonazepam Oral
Primary: CN302
Secondary: CN400

Clorazepate Oral
Primary: CN302
Secondary: CN400

Diazepam Oral
Primary: CN302
Secondary: CN400; MS200

Diazepam Parenteral
Primary: CN302
Secondary: CN400; MS200

Diazepam Rectal
Primary: CN400

Estazolam Oral
Primary: CN302

Flurazepam Oral
Primary: CN302

Halazepam Oral
Primary: CN302

Ketazolam Oral
Primary: CN302

Lorazepam Oral
Primary: CN302
Secondary: MS200

Lorazepam Parenteral
Primary: CN302
Secondary: CN400; MS200; GA609

Nitrazepam Oral
Primary: CN302
Secondary: CN400

Oxazepam Oral
Primary: CN302

Prazepam Oral
Primary: CN302

Quazepam Oral
Primary: CN302

Temazepam Oral
Primary: CN302

Triazolam Oral
Primary: CN302

Note: Controlled substance classification—

Note: Controlled substance classification

U.S.—Schedule IV (all of the benzodiazepines in this monograph)
Commonly used brand name(s): Alprazolam Intensol1; Alti-Alprazolam1; Alti-Bromazepam2; Alti-Clonazepam5; Alti-Triazolam18; Apo-Alpraz1; Apo-Chlordiazepoxide3; Apo-Clonazepam5; Apo-Clorazepate6; Apo-Diazepam7; Apo-Flurazepam9; Apo-Lorazepam12; Apo-Oxazepam14; Apo-Temazepam17; Apo-Triazo18; Ativan12; Clonapam5; Dalmane9; Diastat7; Diazemuls7; Diazepam Intensol7; Dizac7; Doral16; Frisium4; Gen-Alprazolam1; Gen-Bromazepam2; Gen-Clonazepam5; Gen-Triazolam18; Halcion18; Klonopin5; Lectopam2; Librium3; Lorazepam Intensol12; Mogadon13; Novo-Alprazol1; Novo-Clopate6; Novo-Dipam7; Novo-Flupam9; Novo-Lorazem12; Novo-Poxide3; Novo-Temazepam17; Novo-Triolam18; Novoxapam14; Nu-Alpraz1; Nu-Loraz12; PMS-Clonazepam5; PMS-Diazepam7; Paxipam10; ProSom8; Restoril17; Rivotril5; Serax14; Somnol9; Tranxene6; Tranxene T-Tab6; Tranxene-SD6; Tranxene-SD Half Strength6; Valium7; Vivol7; Xanax1; Xanax TS1.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

*Not commercially available in the U.S.

Not commercially available in Canada.

Category:

Note: All of the benzodiazepines have similar pharmacologic actions; however, clinical uses among specific agents may vary because of actual pharmacokinetic differences, availability of specific testing, and/or availability of clinical-use data.

Antianxiety agent—Alprazolam; Bromazepam; Chlordiazepoxide; Clorazepate; Diazepam; Halazepam; Ketazolam; Lorazepam; Oxazepam; Prazepam;

Sedative-hypnotic—Alprazolam; Bromazepam; Chlordiazepoxide; Clonazepam; Clorazepate; Diazepam; Estazolam; Flurazepam; Halazepam; Ketazolam; Lorazepam; Nitrazepam; Oxazepam; Prazepam; Quazepam; Temazepam; Triazolam;

Amnestic—Diazepam (parenteral only); Lorazepam (parenteral only);

Anticonvulsant—Clobazam; Clonazepam; Clorazepate; Diazepam; Lorazepam (parenteral only); Nitrazepam;

Antipanic agent—Alprazolam; Chlordiazepoxide (parenteral only); Clonazepam; Diazepam; Lorazepam;

Skeletal muscle relaxant adjunct—Diazepam; Lorazepam;

Antitremor agent—Alprazolam; Chlordiazepoxide (oral only); Diazepam (oral only); Lorazepam (oral only);

Antiemetic, in cancer chemotherapy—Lorazepam (parenteral only);

Indications

Note: Because ketazolam and prazepam are not commercially available in the U.S. or Canada, the bracketed information and the use of the superscript 1 in this monograph reflect the lack of labeled (approved) indications for these medications.

Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

Anxiety (treatment)—Alprazolam {61}2 {61}1 {61}0, bromazepam {55}9, chlordiazepoxide {55}8, clorazepate {55}7, diazepam {55}6 {55}5 {55}4 {55}3, halazepam {55}2, [ ketazolam {55}1]1 , lorazepam {55}0 {55}9, oxazepam {55}8, and [prazepam {55}7]1 are indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety. Chlordiazepoxide {55}6 {55}5, [oral diazepam]1 , and sublingual {55}4 or intramuscular lorazepam {55}3 are indicated for treatment of preoperative apprehension and anxiety.
—Benzodiazepines are not indicated for the treatment of anxiety or tension associated with the stress of everyday life {55}2 {55}1 {55}0 {55}9 {55}8. Effectiveness of these medications for long-term management of anxiety has not been assessed in systematic clinical studies {55}7 {55}6. The medication’s efficacy in an individual patient should be reassessed at periodic intervals {55}5.

Anxiety associated with mental depression (treatment adjunct)1—Alprazolam {55}4 {55}3, lorazepam (oral) {55}2, and oxazepam {55}1 are also indicated for the adjunctive management of anxiety associated with mental depression. Effectiveness of these medications for long-term use has not been assessed in systematic clinical studies {55}0 {55}9 {55}8. The medication’s efficacy in an individual patient should be reassessed at periodic intervals {55}7 {55}6 {55}5.

Alcohol withdrawal (treatment)—Chlordiazepoxide {55}4, clorazepate {55}3, diazepam {55}2 {55}1 {55}0, [ lorazepam]1 , and oxazepam {55}9 are indicated for the relief of acute alcohol withdrawal symptoms such as acute agitation, tremor, impending or acute delirium tremens, and hallucinosis.

Anesthesia, adjunct—Parenteral chlordiazepoxide {55}8 and parenteral diazepam {55}7 {55}6 {55}5 are indicated as premedication to relieve anxiety and tension in patients who are to undergo surgical procedures. Also, parenteral lorazepam is indicated in adults as preanesthetic medication to produce sedation, relief of anxiety, and anterograde amnesia {55}4.

Amnesia, in cardioversion or
Anxiety, in cardioversion (treatment)—Parenteral diazepam is indicated for intravenous administration prior to cardioversion to relieve anxiety and tension and to produce anterograde amnesia {55}3 {55}2 {55}1 {55}0.

Amnesia, in endoscopic procedures or
Anxiety, in endoscopic procedures (treatment adjunct)—Parenteral diazepam {61}9 {61}8 {61}7 {61}6 and [parenteral lorazepam]1 are indicated as adjuncts prior to endoscopic procedures if apprehension, anxiety, or acute stress reactions are present and to diminish patient’s recall of the procedure. Safety and efficacy have not been established for the use of diazepam prior to bronchoscopy or laryngoscopy {61}5.

[Sedation, conscious]1—Parenteral diazepam is used in dentistry to relieve anxiety and produce amnesia in prolonged or difficult dental procedures. It is used frequently with a local anesthetic. {61}4

Insomnia (treatment)—Estazolam {61}3, flurazepam {61}2 {61}1, nitrazepam {61}0, quazepam {55}9, temazepam {55}8, and triazolam {55}7 {55}6 are indicated for the short-term treatment of insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakenings. Lorazepam1 is indicated for insomnia due to anxiety or transient situational stress {55}5 {55}4. Other benzodiazepines, such as [alprazolam]1 , bromazepam1 , [ diazepam]1 {55}3, [ ketazolam]1 , [halazepam] , and [prazepam]1 , are also used in the treatment of insomnia. Failure of insomnia to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric or medical illness {55}2 {55}1 {55}0. Worsening of insomnia or the emergence of new abnormalities of thinking or behavior may be the consequence of an unrecognized psychiatric or physical disorder {33}9 {33}8 {33}7.
—[Short- and intermediate-acting benzodiazepine hypnotics may be useful in the prevention or treatment (short-term) {33}6 of transient insomnia associated with a sudden sleep schedule change, such as occurs in trans-meridian travel and shift-work rotation {33}5 {33}4 {33}3 .]1

Convulsions (treatment adjunct) or
Status epilepticus (treatment adjunct)—Diazepam injection {33}2, sterile emulsion1 {33}1, and [diazepam for rectal solution]1 {33}0 {35}9 {35}8 are indicated as adjuncts in status epilepticus and severe recurrent convulsive seizures. Lorazepam injection is indicated for the treatment of status epilepticus {35}7 {35}6 as part of a complex and sustained intervention that may include support of vital functions, administration of additional anticonvulsant medications, and/or correction of acute causes of status epilepticus {35}5. These medications are not recommended for maintenance anticonvulsant therapy; therefore, once seizures are controlled, appropriate maintenance anticonvulsant therapy should be instituted {35}4 {35}3.

Convulsive disorders (treatment adjunct)— Oral diazepam1is indicated as short-term (7 to 14 days) adjunctive therapy in convulsive disorders {35}2. It is not useful as sole therapy in convulsive disorders {35}1. [ Clonazepam may be effective as an adjunct in convulsive disorders such as eclamptic convulsions, infantile spasms {35}0 {61}9 , reading epilepsy {61}8 , and startle-induced seizures.]1 {61}7

Epilepsy (treatment adjunct)—Clobazam is indicated as an adjunct in the treatment of patients with epilepsy who are not adequately stabilized by their current anticonvulsant therapy {61}6.
—Diazepam rectal gel is indicated to control bouts of increased seizure activity in patients with refractory epilepsy who are on stable regimens of antiepileptic medications {61}5. Diazepam rectal gel may be administered in the home by a competent caregiver who has been instructed in its proper use and who can distinguish the characteristic seizure clusters that may be treated with diazepam rectal gel from the patient’s usual seizure activity {61}4.

Epilepsy, Lennox-Gastaut syndrome (treatment) or
Epilepsy, akinetic seizure pattern (treatment) or
Epilepsy, myoclonic seizure pattern (treatment)— Clonazepam is indicated for use alone or, more frequently, as an adjunct in the treatment of the Lennox-Gastaut syndrome (petit mal variant), akinetic seizures, and myoclonic seizures {61}3.
—Nitrazepam also is indicated for the treatment of myoclonic seizures {61}2.

[Epilepsy, myoclonic seizure pattern (treatment adjunct)]1—Oral diazepam is used as adjunctive therapy in myoclonus. It is not useful as sole therapy in this condition. {61}1

Epilepsy, absence seizure pattern (treatment)— Clonazepam may be useful in the treatment of absence (petit mal) seizures refractory to the succinimide anticonvulsants {61}0 or valproic acid.

Epilepsy, simple partial seizure pattern (treatment adjunct)1 or
Epilepsy, complex partial seizure pattern (treatment adjunct)1—Clorazepate is indicated as adjunctive therapy in the management of partial seizures {33}9.

[Epilepsy, simple partial seizure pattern (treatment)]1or
[Epilepsy, complex partial seizure pattern (treatment)]1—Clonazepam may be effective in refractory seizures such as complex partial (psychomotor, temporal lobe) or elementary partial (focal) seizures {33}8.

[Epilepsy, tonic-clonic seizure pattern (treatment)]1—Clonazepam may be effective in tonic-clonic (grand mal) seizures. However, when clonazepam is used in patients in whom several types of seizure disorders coexist, it may increase the incidence or, rarely, precipitate the onset of generalized tonic-clonic (grand mal) seizures; addition of another anticonvulsant and/or an increase in dosage may be required {33}7.

Panic disorders (treatment)—Alprazolam {33}6 {33}5 {33}4, [ chlordiazepoxide (parenteral)] {33}3, clonazepam1 {33}2, [ diazepam]1 {33}1 {33}0, and [lorazepam]1 {35}9 are used in the treatment of panic disorders.

[Agoraphobia]1—Alprazolam is used in the treatment of agoraphobia.{35}8{35}7{35}6

Spasm, skeletal muscle (treatment adjunct)—Diazepam {35}5 {35}4 {35}3 and [ lorazepam]1 {35}2 are indicated as adjunctive therapy for the relief of skeletal muscle spasm due to reflex spasm of local pathology (such as inflammation of the muscles or joints, or secondary to trauma); spasticity caused by upper motor neuron disorders (such as cerebral palsy and paraplegia); athetosis; stiff-man syndrome; and tetanus {35}1 {35}0 {61}9 {61}8. [Diazepam also is used to relieve spasms of facial muscles associated with problems of occlusion and temporomandibular joint disorders.]1

[Nausea and vomiting, cancer chemotherapy–induced (prophylaxis)]1—Lorazepam injection, alone or in combination with other agents, reduces the severity and duration of nausea and vomiting associated with emetogenic cancer chemotherapy {61}7 {61}6. In addition, lorazepam-induced amnesia can reduce anticipatory anxiety, nausea, and vomiting {61}5.

[Headache, tension (treatment)]—Chlordiazepoxide {61}4, diazepam1 , lorazepam1 , and possibly other benzodiazepines1 are used in the treatment of tension headache {61}3.

[Tremors (treatment)]1—Oral alprazolam {61}2, chlordiazepoxide, diazepam, and lorazepam {61}1 are also used in the treatment of familial, senile, or essential action tremors.

 

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