Dipan
Generic Name
dipan-1-mg-tablet
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| dipan 1 mg tablet | ৳ 8.40 | ৳ 84.00 |
Description
Overview of the medicine
Dipan (Lorazepam) 1 mg tablet is a short-acting benzodiazepine primarily used for the management of anxiety disorders, insomnia, and as a premedication for surgical procedures. It acts on the central nervous system to produce a calming effect.
Uses & Indications
Dosage
Adults
Anxiety: 1-4 mg daily in divided doses. Insomnia: 1-2 mg at bedtime. Premedication: 2-4 mg the night before surgery or 1-2 hours before surgery.
Elderly
Initially 0.5-1 mg daily in divided doses, adjusted as needed and tolerated. Lower doses are generally recommended due to increased sensitivity.
Renal_impairment
No specific dose adjustment is usually required, but use with caution and monitor patient response. Lower doses may be considered if impairment is severe.
How to Take
Take the tablet orally with or without food. Swallow whole with a glass of water. Do not chew or crush.
Mechanism of Action
Lorazepam enhances the effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, at the GABA-A receptors in the brain. This potentiation of GABA's inhibitory effects leads to central nervous system depression, resulting in anxiolytic, sedative, hypnotic, anticonvulsant, and muscle relaxant properties.
Pharmacokinetics
Onset
Anxiolytic and sedative effects usually begin within 15-30 minutes after oral administration.
Excretion
Excreted mainly in the urine as lorazepam glucuronide.
Half life
The elimination half-life of lorazepam is approximately 10-20 hours. Its active conjugate, lorazepam glucuronide, has a half-life of about 18 hours.
Absorption
Rapidly and completely absorbed from the gastrointestinal tract after oral administration. Peak plasma concentrations are achieved within 2 hours.
Metabolism
Primarily metabolized in the liver by glucuronidation into inactive metabolites (lorazepam glucuronide). It does not undergo oxidative metabolism by cytochrome P450 enzymes.
Side Effects
Contraindications
- Hypersensitivity to lorazepam or any component of the formulation, or to other benzodiazepines.
- Acute narrow-angle glaucoma.
- Severe respiratory insufficiency or sleep apnea syndrome.
- Myasthenia gravis.
- Concurrent use with opioids unless benefits outweigh risks and patients are closely monitored.
Drug Interactions
Valproate
May increase lorazepam plasma concentrations and prolong its half-life, necessitating a reduction in lorazepam dosage.
Probenecid
May decrease lorazepam clearance, leading to increased plasma concentrations and prolonged effects. A 50% reduction in lorazepam dose may be needed.
Aminophylline/Theophylline
May antagonize the sedative effects of lorazepam.
CNS Depressants (e.g., alcohol, opioids, barbiturates, antidepressants, antihistamines)
Increased CNS depression, potentially leading to profound sedation, respiratory depression, hypotension, and coma. Avoid concomitant use or reduce dosage of one or both agents.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include drowsiness, confusion, lethargy, ataxia, hypotonia, hypotension, respiratory depression, and rarely, coma. Management involves supportive care, maintaining a patent airway, and monitoring vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used to reverse the sedative effects, but it carries risks, especially in patients dependent on benzodiazepines.
Pregnancy & Lactation
Pregnancy Category D: Lorazepam may cause fetal harm when administered to a pregnant woman, including an increased risk of congenital malformations and neonatal withdrawal symptoms. Avoid during pregnancy, especially in the first trimester. Lactation: Lorazepam is excreted into breast milk. Nursing should be avoided while using this medication due to the potential for sedation and feeding difficulties in the infant.
Side Effects
Contraindications
- Hypersensitivity to lorazepam or any component of the formulation, or to other benzodiazepines.
- Acute narrow-angle glaucoma.
- Severe respiratory insufficiency or sleep apnea syndrome.
- Myasthenia gravis.
- Concurrent use with opioids unless benefits outweigh risks and patients are closely monitored.
Drug Interactions
Valproate
May increase lorazepam plasma concentrations and prolong its half-life, necessitating a reduction in lorazepam dosage.
Probenecid
May decrease lorazepam clearance, leading to increased plasma concentrations and prolonged effects. A 50% reduction in lorazepam dose may be needed.
Aminophylline/Theophylline
May antagonize the sedative effects of lorazepam.
CNS Depressants (e.g., alcohol, opioids, barbiturates, antidepressants, antihistamines)
Increased CNS depression, potentially leading to profound sedation, respiratory depression, hypotension, and coma. Avoid concomitant use or reduce dosage of one or both agents.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include drowsiness, confusion, lethargy, ataxia, hypotonia, hypotension, respiratory depression, and rarely, coma. Management involves supportive care, maintaining a patent airway, and monitoring vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used to reverse the sedative effects, but it carries risks, especially in patients dependent on benzodiazepines.
Pregnancy & Lactation
Pregnancy Category D: Lorazepam may cause fetal harm when administered to a pregnant woman, including an increased risk of congenital malformations and neonatal withdrawal symptoms. Avoid during pregnancy, especially in the first trimester. Lactation: Lorazepam is excreted into breast milk. Nursing should be avoided while using this medication due to the potential for sedation and feeding difficulties in the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2 to 3 years from the date of manufacture, specific expiry date is printed on the packaging.
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Lorazepam has undergone extensive clinical trials since its development, establishing its efficacy and safety for various indications including anxiety, insomnia, and seizure management. Ongoing research may explore new formulations or extended uses.
Lab Monitoring
- Liver function tests (LFTs) should be periodically monitored, especially during prolonged therapy, as benzodiazepines can rarely cause elevated liver enzymes.
- Complete blood count (CBC) may be considered during long-term therapy, although blood dyscrasias are rare.
Doctor Notes
- Counsel patients thoroughly regarding the risks of dependence, tolerance, and withdrawal. Emphasize the importance of gradual dose reduction.
- Be vigilant for signs of respiratory depression, especially in elderly patients or those concomitantly using other CNS depressants.
- Assess for comorbid psychiatric conditions like depression, as benzodiazepines may worsen depressive symptoms in some patients.
Patient Guidelines
- Do not stop taking Dipan abruptly, as this can lead to withdrawal symptoms. Your doctor will gradually reduce the dose.
- Avoid consuming alcohol or other CNS depressants while on this medication.
- Be aware that Dipan can cause drowsiness and impair your ability to drive or operate machinery. Avoid such activities until you know how the medicine affects you.
- Inform your doctor about all other medications, including over-the-counter drugs, herbal supplements, and recreational drugs, to avoid potential interactions.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Dipan causes sedation, dizziness, and impaired coordination. It significantly impairs the ability to drive or operate heavy machinery. Patients should be warned not to engage in such activities until they are certain that Dipan does not adversely affect their performance.
Lifestyle Advice
- Practice good sleep hygiene, such as maintaining a regular sleep schedule and creating a comfortable sleep environment, to support the treatment of insomnia.
- Manage stress through relaxation techniques, meditation, or light exercise to complement anxiety management.
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