Side effects of prazepam are less profound than with other benzodiazepines. Excessive drowsiness and with longer-term use, drug dependence, are the most common side effects of prazepam. 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.
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. 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.
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 comorbidpsychiatric disorders.
Mechanism of action
Prazepam exerts its therapeutic effects primarily via modulating the benzodiazepine receptor which in turn enhances GABA function in the brain. Prazepam like other benzodiazepines has anticonvulsant properties, but its anticonvulsant properties are not as potent as other benzodiazepines when tested in animal studies.
Prazepam is metabolised into descyclopropylmethylprazepam (also known as desmethyldiazepam) and 3-hydroxyprazepam which is further metabolised into oxazepam. 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.
Prazepam may interact with cimetidine.Alcohol in combination with prazepam increases the adverse effects, particularly performance impairing side effects and drowsiness.
^Jacqmin P, Ansseau M (1988). "Comparison of sublingual and oral prazepam in normal subjects. II. Pharmacokinetic and pharmacodynamic data". Neuropsychobiology. 19 (4): 186–91. doi:10.1159/000118458. PMID2854609.
^Greenblatt DJ, Harmatz JS, Dorsey C, Shader RI (September 1988). "Comparative single-dose kinetics and dynamics of lorazepam, alprazolam, prazepam, and placebo". Clin. Pharmacol. Ther. 44 (3): 326–34. doi:10.1038/clpt.1988.158. PMID3138056. S2CID20150379.
^Danion JM, Brion S, Escande M, et al. (1984). "(title in French)" [Treatment of anxiety with prazepam, 40 mg. A controlled study versus lorazepam]. Encephale (in French). 10 (3): 135–138. PMID6389091.
^Shader RI, Pary RJ, Harmatz JS, Allison S, Locniskar A, Greenblatt DJ (October 1984). "Plasma concentrations and clinical effects after single oral doses of prazepam, clorazepate, and diazepam". J Clin Psychiatry. 45 (10): 411–3. PMID6148339.
^Ansseau M, von Frenckell R, Jacqmin P (1987). "Comparison of sublingual and oral prazepam in normal subjects. I. Clinical data". Neuropsychobiology. 18 (2): 77–82. doi:10.1159/000118397. PMID3330182.
^Chabannes JP, Lemoine P (1990). "(title in French)" [Prazepam drops versus 10 mg prazepam tablets in anxious patients in ambulatory care]. Thérapie (in French). 45 (6): 467–470. PMID2080484.
^Dorman T (1983). "A multi-centre comparison of prazepam and diazepam in the treatment of anxiety". Pharmatherapeutica. 3 (6): 433–40. PMID6353434.
^Saletu M, Saletu B, Grünberger J, Mader R, Karobath M (1983). "Clinical symptomatology and computer analyzed EEG before, during and after anxiolytic therapy of alcohol withdrawal patients". Neuropsychobiology. 9 (2–3): 119–34. doi:10.1159/000117949. PMID6353268.
^Soyka M, Lehle R, Hippius H (September 1994). "(title in German)" [Exacerbation of an affective psychosis after terminating a decade of benzodiazepine treatment. Which therapeutic procedure is sensible?]. Nervenarzt (in German). 65 (9): 628–32. PMID7991010.
^Dièye AM, Sylla M, Ndiaye A, Ndiaye M, Sy GY, Faye B (June 2006). "Benzodiazepines prescription in Dakar: a study about prescribing habits and knowledge in general practitioners, neurologists and psychiatrists". Fundam Clin Pharmacol. 20 (3): 235–8. doi:10.1111/j.1472-8206.2006.00400.x. PMID16671957. S2CID20619323.
^Dièye AM, Sy AN, Sy GY, et al. (2007). "(title in French)" [Prescription of benzodiazepines by general practitioners in the private sector of Dakar: survey on knowledge and attitudes]. Thérapie (in French). 62 (2): 163–168. doi:10.2515/therapie:2007018. PMID17582318.
^Authier, N.; Balayssac, D.; Sautereau, M.; Zangarelli, A.; Courty, P.; Somogyi, AA.; Vennat, B.; Llorca, PM.; Eschalier, A. (Nov 2009). "Benzodiazepine dependence: focus on withdrawal syndrome". Ann Pharm Fr. 67 (6): 408–13. doi:10.1016/j.pharma.2009.07.001. PMID19900604.
^ abQuast U (May 1981). "(title in German)" [Molecular mechanism of action of benzodiazepines]. Fortschr. Med. (in German). 99 (20): 788–94. PMID6114911.
^De Sarro G, Gitto R, Rizzo M, Zappia M, De Sarro A (September 1996). "1,4-Benzodiazepine derivatives as anticonvulsant agents in DBA/2 mice". Gen. Pharmacol. 27 (6): 935–41. doi:10.1016/0306-3623(95)02147-7. PMID8909973.
^De Sarro G, Chimirri A, Zappala M, Guisti P, Lipartiti M, De Sarro A (October 1996). "Azirino[1, 2-d][1, 4]benzodiazepine derivatives and related 1,4-benzodiazepines as anticonvulsant agents in DBA/2 mice". Gen. Pharmacol. 27 (7): 1155–1162. doi:10.1016/S0306-3623(96)00049-3. PMID8981061.
^De Sarro G, Chimirri A, McKernan R, Quirk K, Giusti P, De Sarro A (September 1997). "Anticonvulsant activity of azirino[1,2-d][1,4]benzodiazepines and related 1,4-benzodiazepines in mice". Pharmacol. Biochem. Behav. 58 (1): 281–289. doi:10.1016/S0091-3057(96)00565-5. PMID9264104. S2CID24492818.
^Valavani P, Atta-Politou J, Panderi I (April 2005). "Development and validation of a liquid chromatographic/electrospray ionization mass spectrometric method for the quantitation of prazepam and its main metabolites in human plasma". J Mass Spectrom. 40 (4): 516–26. Bibcode:2005JMSp...40..516V. doi:10.1002/jms.824. PMID15712230.
^Nau H, Liddiard C, Jesdinsky D, Wittfoht W (September 1978). "Quantitative analysis of prazepam and its metabolites by electron capture gas chromatography and selected ion monitoring. Application to diaplacetal passage and fetal hepatic metabolism in early human pregnancy". J. Chromatogr. 146 (2): 227–239. doi:10.1016/S0378-4347(00)81889-7. PMID701422.
^Kölle EU (June 1981). "(title in German)" [Pharmacokinetics of oral prazepam]. Fortschr. Med. (in German). 99 (22): 874–879. PMID6790396.
^Ruffalo RL, Thompson JF, Segal J (September 1981). "Cimetidine-benzodiazepine drug interaction". Am J Hosp Pharm. 38 (9): 1365–1366. PMID6116430.
^Girre C, Hirschhorn M, Bertaux L, Palombo S, Fournier PE (1991). "Comparison of performance of healthy volunteers given prazepam alone or combined with ethanol. Relation to drug plasma concentrations". Int Clin Psychopharmacol. 6 (4): 227–238. doi:10.1097/00004850-199100640-00004. PMID1816280.
^Pulce C, Mollon P, Pham E, Frantz P, Descotes J (April 1992). "Acute poisonings with ethyle loflazepate, flunitrazepam, prazepam and triazolam in children". Vet Hum Toxicol. 34 (2): 141–143. PMID1354907.
^Hakuba A, Matysiakiewicz J (1986). "Uzalezniajace właściwości prazepamu" [The habit-forming effect of prazepam]. Psychiatr. Pol. (in Polish). 20 (3): 232–234. PMID3797537.
^Fox KA, Guerriero FJ (July 1978). "Effect of benzodiazepines on age of vaginal perforation and first estrus in mice". Res. Commun. Chem. Pathol. Pharmacol. 21 (1): 181–184. PMID28555.
^Guerriero FJ, Fox KA (April 1976). "Benzodiazepines and reproduction of swiss-webster mice". Res. Commun. Chem. Pathol. Pharmacol. 13 (4): 601–10. PMID4863.
^Guerriero FJ, Fox KA (May 1975). "Benzodiazepine-induced suppression of estrous cycles in C57BL/6J mice". Res. Commun. Chem. Pathol. Pharmacol. 11 (1): 155–158. PMID239442.