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Meprobamate: Drug information

Meprobamate: Drug information
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For additional information see "Meprobamate: Patient drug information"

For abbreviations, symbols, and age group definitions show table
Pharmacologic Category
  • Antianxiety Agent, Miscellaneous
Dosing: Adult
Anxiety

Anxiety: Oral: 1,200 to 1,600 mg/day in 3 to 4 divided doses; maximum: 2,400 mg/day

Discontinuation: In patients with excessive dosage continued for weeks or months, meprobamate should be tapered off gradually over 1 to 2 weeks to avoid withdrawal symptoms such as anxiety, anorexia, or insomnia.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in manufacturer’s labeling; however, the following adjustments have been recommended (Ref):

CrCl 10 to 50 mL/minute: Administer every 9 to 12 hours

CrCl <10 mL/minute: Administer every 12 to 18 hours

Hemodialysis: No dosage adjustment necessary

Peritoneal dialysis: Administer every 12 to 18 hours

Continuous renal replacement therapy (CRRT): Administer every 9 to 12 hours

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in manufacturer’s labeling; use with caution.

Dosing: Older Adult

Avoid use (Ref).

Dosing: Pediatric
Anxiety

Anxiety: Oral:

Children ≥6 years: 200 to 600 mg/day in 2 to 3 divided doses

Discontinuation: In patients with excessive dosage continued for weeks or months, meprobamate should be tapered off gradually over 1 to 2 weeks to avoid withdrawal symptoms such as anxiety, anorexia, or insomnia.

Adolescents: Refer to adult dosing.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling; based on experience in adult patients, dosing adjustment suggested.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in manufacturer’s labeling; use with caution.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.

Cardiovascular: Abnormal electroencephalogram, cardiac arrhythmia, peripheral edema, palpitations, severe hypotension, syncope, tachycardia

Central nervous system: Ataxia, chills, dizziness, drowsiness, euphoria, headache, overstimulation, paradoxical excitation, paresthesia, slurred speech, vertigo

Dermatologic: Dermatitis, erythema multiforme, skin rash, Stevens-Johnson syndrome

Endocrine & metabolic: Exacerbation of porphyria

Gastrointestinal: Diarrhea, nausea, proctitis, stomatitis, vomiting

Genitourinary: Anuria, oliguria

Hematologic & oncologic: Agranulocytosis, aplastic anemia, bruise, eosinophilia, immune thrombocytopenia, leukopenia, petechia, purpura

Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reaction

Neuromuscular & skeletal: Weakness

Ophthalmic: Accommodation disturbance

Respiratory: Bronchospasm

Miscellaneous: Fever

Contraindications

Hypersensitivity to meprobamate, related compounds (including carisoprodol), or any component of the formulation; acute intermittent porphyria

Warnings/Precautions

Concerns related to adverse effects:

• Allergic reactions: May occur in patients with history of dermatological condition (usually by fourth dose).

• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving). Effects may be potentiated when used with other sedative drugs or ethanol.

Disease-related concerns:

• Depression: Use with caution in patients with depression or suicidal tendencies.

• Drug abuse: Use with caution in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Tolerance, psychological and physical dependence may occur with prolonged use.

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Renal impairment: Use with caution in patients with renal impairment.

• Seizure disorder: Use with caution in patients with a history of seizure disorder.

Other warnings/precautions:

• Withdrawal: Abrupt discontinuation may precipitate withdrawal. In patients with excessive dosage continued for weeks or months, meprobamate should be tapered off gradually over 1 to 2 weeks to avoid withdrawal symptoms such as anxiety, anorexia, or insomnia.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 200 mg, 400 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Meprobamate Oral)

200 mg (per each): $6.88

400 mg (per each): $8.25

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Controlled Substance

C-IV

Use: Labeled Indications

Anxiety: Management of anxiety disorders

Limitations of use: Meprobamate is not a preferred treatment option for anxiety disorders per the American Psychiatric Association, World Federation of Societies of Biological Psychiatry, and British Association for Psychopharmacology guidelines (APA [Stein 2009]; BAP [Baldwin 2014]; WFSBP [Bandelow 2023]).

Medication Safety Issues
Sound-alike/look-alike issues:

Meprobamate may be confused with meperidine

Equanil may be confused with Elavil

Older Adult: High-Risk Medication:

Beers Criteria: Meprobamate is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older (independent of diagnosis or condition) due to high rate of physical dependence in addition to being very sedating (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Alcohol (Ethyl): CNS Depressants may increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification

Brexanolone: CNS Depressants may increase CNS depressant effects of Brexanolone. Risk C: Monitor

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification

BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification

Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

CNS Depressants: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Dantrolene: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Doxylamine: CNS Depressants may increase CNS depressant effects of Doxylamine. Risk C: Monitor

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification

HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification

Methoxyflurane: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: CNS Depressants may increase CNS depressant effects of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification

OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Perampanel: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor

Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Suvorexant: CNS Depressants may increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Yohimbine: May decrease therapeutic effects of Antianxiety Agents. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Pregnancy Considerations

Meprobamate crosses the placenta and is found in cord blood in concentrations similar to those in the maternal plasma. Maternal use may be associated with congenital malformations; avoid use during pregnancy.

Breastfeeding Considerations

Breast milk concentrations are higher than maternal plasma concentrations.

Monitoring Parameters

Anxiety symptoms, mental status, abuse/overuse

Reference Range

Serum levels reported at usual doses are expected to range between 10 to 20 mcg/mL (SI: 45.8 to 91.6 micromole/L) (Gaillard 1997). Adverse events such as vertigo, gait abnormalities, stupor, slurred speech, and light coma have been reported with serum levels of 30 to 100 mcg/mL (SI: 137.4 to 458 micromole/L). Serum levels of 100 to 200 mcg/mL (SI: 458 to 916 micromole/L) increase the risk for coma, hypotension, respiratory depression, shock, pulmonary edema, and heart failure (Daval 2006).

Mechanism of Action

Affects the thalamus and limbic system; also appears to inhibit multineuronal spinal reflexes

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Sedation: ~1 hour

Metabolism: Hepatic

Half-life elimination: 10 hours

Excretion: Urine (8% to 20% as unchanged drug); feces (10% as metabolites)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Equanil | Mepavlon;
  • (AT) Austria: Epikur | Meprobamat | Microbamat | Miltaun;
  • (BE) Belgium: Pertranquil | Procalmadiol | Reposo-Mono;
  • (CH) Switzerland: Meprodil;
  • (CZ) Czech Republic: Meprobamat;
  • (DE) Germany: Meprobamat | Meprobamat berco | Visano N;
  • (ES) Spain: Dapaz;
  • (FI) Finland: Equanil | Miltown | Nervonus;
  • (FR) France: Equanil;
  • (GB) United Kingdom: Equanil | Mepavlon | Meprobamate kent | Miltown | Tised;
  • (HR) Croatia: Meprobamat Pliva;
  • (HU) Hungary: Andaxin;
  • (ID) Indonesia: Medicar;
  • (IL) Israel: Mepro;
  • (IQ) Iraq: Tranquin;
  • (IT) Italy: Quanil;
  • (JP) Japan: Atraxin | Equanil | Meprobamate towa;
  • (KR) Korea, Republic of: Equanil;
  • (LU) Luxembourg: Pertranquil | Probamyl | Relax | Reposo-Mono;
  • (LV) Latvia: Meprobamat;
  • (MA) Morocco: Apo-mepromate | Equanil;
  • (NL) Netherlands: Meprobamaat | Meprobamatum;
  • (NO) Norway: Meprodil;
  • (NZ) New Zealand: Equanil;
  • (PL) Poland: Equanil;
  • (PR) Puerto Rico: Equanil;
  • (RU) Russian Federation: Apo meprobamat;
  • (SE) Sweden: Restenil;
  • (SI) Slovenia: Meprobamat | Miltaun;
  • (TH) Thailand: Meprobar | Miltown;
  • (TN) Tunisia: Equanil;
  • (TR) Turkey: Equanil | Meprol | Miltown | Sintown | Trankilin;
  • (TW) Taiwan: Koligin | Meprozin;
  • (UY) Uruguay: Ecuanil;
  • (ZA) South Africa: Equanil
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