How bromazepam works
In therapeutic doses, bromazepam primarily has anxiolytic and sedative properties. The effect is triggered by binding to an important binding site (receptor) for nerve cells, the so-called GABA receptor (gamma-aminobutyric acid receptor).
The nerve cells of the human brain communicate by means of messenger substances (neurotransmitters), which are released by one nerve cell and perceived by the next nerve cell via certain receptors. This results in very complex circuits, as one nerve cell is sometimes in contact with thousands of others and there are also different neurotransmitters.
Some excite the subsequent nerve cell and thus transmit a signal, others inhibit such signal transmission (inhibitory neurotransmitters). Adrenaline, for example, activates the nervous system and promotes motivation, whereas GABA has a dampening effect.
Benzodiazepines such as bromazepam act on the receptors for GABA and cause the receptor to react more sensitively to the neurotransmitter. This means that lower GABA levels lead more quickly to drowsiness or that constant GABA levels cause greater drowsiness of the nervous system.
Absorption, breakdown and excretion
This so-called “half-life” can increase with age – excretion is then slower. For this reason, a lower dosage is often necessary in old age.
When is bromazepam used?
Bromazepam is used to alleviate the symptoms of acute and chronic states of agitation, tension and anxiety. Due to its long duration of action, its use as a sleeping pill is only justified if a calming effect is also desired during the day.
Treatment should be as short-term as possible and should not last longer than four weeks, as bromazepam is highly addictive.
How bromazepam is used
Bromazepam is taken in the form of tablets. Treatment is usually started with a dosage of three milligrams daily as a single dose in the evening.
For particularly severe illnesses, the dose can be increased to a maximum of twelve milligrams of bromazepam daily, with the dose then being divided into several single doses throughout the day.
What are the side effects of bromazepam?
Side effects such as depression, memory loss, tiredness, drowsiness, dizziness, headaches, concentration problems, reduced responsiveness, fatigue and over-anxiety can occur very frequently (in more than one in ten people treated).
There is also a risk of “paradoxical” reactions occurring after taking bromazepam. After taking the drug, the patient exhibits agitated and aggressive behavior, irritability, restlessness, nervousness, anxiety and sleep disturbances.
Such paradoxical reactions are observed more frequently in children and older people.
What should be considered when taking bromazepam?
Contraindications
Bromazepam must not be taken if:
- Known dependence
- Myasthenia gravis (pathological muscle weakness)
- Severe respiratory weakness (respiratory insufficiency)
- Sleep apnea syndrome
- Severe liver dysfunction
Interactions
The simultaneous intake of other substances that act on the central nervous system can lead to increased respiratory suppression and sedation. These include active substances for schizophrenia and psychoses, tranquilizers, sleeping pills, antidepressants, anesthetics, anxiolytics, anti-seizure drugs, allergy medications (anti-allergics) and especially alcohol.
Other drugs that are broken down via the same liver enzyme systems (cytochrome P450) as bromazepam can delay its breakdown. This increases and prolongs the effect of bromazepam.
Ability to drive and operate heavy machinery
There is an increased risk of falling after taking bromazepam, especially in older patients. There is also an increased risk of accidents when operating heavy machinery and driving vehicles.
Age restriction
The use of bromazepam in children and adolescents is unusual and is only prescribed by a doctor after careful consideration of the risk-benefit ratio. The dose must be adjusted to the lower body weight.
In elderly patients and patients with liver dysfunction, the dosage must be reduced if necessary.
Pregnancy and breastfeeding
There is insufficient data on the use in pregnant women. However, animal studies have shown possible harm to the child, which is why bromazepam should not be used during pregnancy or only if absolutely necessary.
If bromazepam is taken shortly before birth, the child may show symptoms of benzodiazepine intoxication (“floppy-infant syndrome”) after birth. This is characterized by reduced muscle tone, low blood pressure, inability to drink, low body temperature and very weak breathing.
If there is an indication for long-term use during breastfeeding, the breastfed infant should be observed for side effects. If necessary, a switch to bottle feeding should be considered.
How to obtain medication with bromazepam
Medication containing bromazepam is only available on prescription in Germany, Austria and Switzerland, as its use requires strict medical supervision. They can therefore only be obtained from pharmacies with a doctor’s prescription.
How long has bromazepam been known?
The benzodiazepine bromazepam was patented in 1963 and underwent clinical development in the 1970s. It was launched on the German pharmaceutical market in 1977. Generics are now available.