Adult: 7.5-15 mg at bedtime. Elderly: Dosage adjustment may be required.
Renal Impairment
Dosage adjustment may be required.
Hepatic Impairment
Dosage adjustment may be required.
Contraindications
Severe respiratory failure. Children <15 years.
Special Precautions
Patient with respiratory disease, myasthenia gravis, depression, history of alcohol or substance use disorder, psychiatric or personality disorders, insomnia, and those who are at risk of falls. Debilitated patients. Avoid abrupt withdrawal. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Anterograde amnesia, paradoxical reactions (e.g. hyperactive or aggressive behaviour), sleep-related activities (e.g. sleep-driving; cooking and eating food, and making phone calls while asleep). Musculoskeletal and connective tissue disorders: Muscle hypotonia. Nervous system disorders: Drowsiness, seizures. Psychiatric disorders: Confusion, excitability, intoxicated feeling, irritability. Skin and subcutaneous tissue disorders: Maculopapular rash.
Patient Counseling Information
This drug may cause CNS depression (e.g. drowsiness), if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor mental status, blood pressure, heart rate; respiratory, liver and renal functions (periodically with long-term therapy).
Drug Interactions
Potentiates the effects of CNS depressants including sedatives (e.g. tranquilisers, sleeping pills, opioid-containing cough or pain medications, antidepressants, neuroleptics), buprenorphine.
Food Interaction
Increased risk of drowsiness with alcohol; avoid concomitant use.
Action
Description: Nordazepam is a long-acting benzodiazepine. It enhances the activity of GABA, a major inhibitory neurotransmitter in the brain, by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron at several sites within the CNS. This results in increased neuronal membrane permeability to chloride ions, leading to hyperpolarisation (a less excitable state) and stabilisation. Pharmacokinetics: Absorption: Time to peak plasma concentration: 1.5 hours. Distribution: Enters breast milk. Plasma protein binding: 97%. Metabolism: Metabolised in the liver via hydroxylation to form oxazepam. Excretion: Mainly via urine. Elimination half-life: Approx 65 hours.
Chemical Structure
Nordazepam Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2997, Nordazepam. https://pubchem.ncbi.nlm.nih.gov/compound/Nordazepam. Accessed Feb. 23, 2022.
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