Serax


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Serax

 [ser´aks]
trademark for preparations of oxazepam, an antianxiety agent.

oxazepam

(ox-az-e-pam) ,

Novoxapam

(trade name),

Oxpam

(trade name),

Serax

(trade name)

Classification

Therapeutic: antianxiety agents
Pharmacologic: benzodiazepines
Pregnancy Category: D

Indications

Management of anxiety, anxiety associated with depression.Symptomatic treatment of alcohol withdrawal.

Action

Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

Therapeutic effects

Decreased anxiety.
Diminished symptoms of alcohol withdrawal.

Pharmacokinetics

Absorption: Well absorbed following oral administration. Absorption is slower than with other benzodiazepines.
Distribution: Widely distributed. Crosses the blood-brain barrier. May cross the placenta and enter breast milk.
Metabolism and Excretion: Metabolized by the liver to inactive compounds.
Protein Binding: 97%.
Half-life: 5–15 hr.

Time/action profile (sedation)

ROUTEONSETPEAKDURATION
PO45–90 minunknown6–12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Cross-sensitivity with other benzodiazepines may exist;Comatose patients or those with pre-existing CNS depression;Uncontrolled severe pain;Angle-closure glaucoma;Some products contain tartrazine and should be avoided in patients with known intolerance; Obstetric / Lactation: Pregnancy or lactation.
Use Cautiously in: Hepatic dysfunction (may be preferred over some benzodiazepines due to short half-life);History of suicide attempt or substance use disorder;Debilitated patients (initial dosage ↓ recommended);Severe chronic obstructive pulmonary disease;Myasthenia gravis; Pediatric: Children <6 yr (safety not established); Geriatric: Appears on Beers list (associated with ↑ risk of falls; ↓ dose required); ↑sensitivity to benzodiazepines.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • drowsiness (most frequent)
  • confusion
  • hangover
  • headache
  • impaired memory
  • mental depression
  • paradoxical excitation
  • slurred speech

Ear, Eye, Nose, Throat

  • blurred vision

Respiratory

  • respiratory depression

Cardiovascular

  • tachycardia

Gastrointestinal

  • constipation
  • diarrhea
  • drug-induced hepatitis
  • nausea
  • vomiting
  • weight gain (unusual)

Genitourinary

  • urinary problems

Dermatologic

  • rashes

Hematologic

  • leukopenia

Miscellaneous

  • physical dependence
  • psychological dependence
  • tolerance

Interactions

Drug-Drug interaction

Additive CNS depression with other CNS depressants, including alcohol, antihistamines, antidepressants, opioid analgesics, and other sedative/hypnotics (including other benzodiazepines ).May ↓ the therapeutic effectiveness of levodopa.Hormonal contraceptives or phenytoin may ↓ effectiveness.Theophylline may ↓ sedative effects.Concomitant use of kava-kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.

Route/Dosage

Oral (Adults) Antianxiety agent—10–30 mg 3–4 times daily. Sedative/hypnotic/management of alcohol withdrawal—15–30 mg 3–4 times daily.
Oral (Geriatric Patients) 5 mg 1–2 times daily initially or 10 mg 3 times daily; may be ↑ as needed.

Availability (generic available)

Capsules: 10 mg, 15 mg, 30 mg
Tablets: 10 mg, 15 mg, 30 mg

Nursing implications

Nursing assessment

  • Assess patient for anxiety and orientation, mood and behavior.
  • Assess level of sedation (ataxia, dizziness, slurred speech) periodically throughout therapy.
  • Assess regularly for continued need for treatment.
  • Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict the amount of drug available to patient.
  • Geriatric: Assess CNS effects and risk of falls. Institute falls prevention strategies.
  • Lab Test Considerations: Monitor CBC and liver function tests periodically during prolonged therapy.
    • May cause decreased thyroidal uptake of sodium iodide 123I and 131I.

Potential Nursing Diagnoses

Anxiety (Indications)
Ineffective coping (Indications)
Risk for injury (Side Effects)

Implementation

  • Medication should be tapered at the completion of therapy (taper by 0.5 mg q 3 days). Sudden cessation of medication may lead to withdrawal (insomnia, irritability, nervousness, tremors).
  • Oral: Administer with food if GI irritation becomes a problem.

Patient/Family Teaching

  • Instruct patient to take oxazepam exactly as directed. Missed doses should be taken within 1 hr; if remembered later, omit and return to regular dosing schedule. Do not double or increase doses. If dose is less effective after a few weeks, notify health care professional.
  • Inform patient that oxazepam is usually prescribed for short-term use. Encourage patient to participate in psychotherapy to address source of anxiety and improve coping skills.
  • Encourage patient to participate in psychotherapy to address source of anxiety and improve coping skills.
  • Teach other methods to decrease anxiety, such as increased exercise, support group, relaxation techniques.
  • May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to avoid the use of alcohol and to consult health care professional prior to the use of OTC preparations that contain antihistamines or alcohol.
  • Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
  • Advise patient to inform health care professional if pregnancy is planned or suspected.
  • Emphasize the importance of follow-up exams to monitor effectiveness of medication.
  • Geriatric: Instruct patient and family how to reduce falls risk at home.

Evaluation/Desired Outcomes

  • Decreased sense of anxiety.
    • Increased ability to cope.
  • Prevention or relief of acute agitation, tremor, and hallucinations during alcohol withdrawal.

Serax®

Oxazepam, see there.
References in periodicals archive ?
Terrazzo-like flower pots inscribed with Maison de Provence from Zodax, based in Van Nuys, Cal., and white milk-glass candle cups and vases from Serax in Belgium are located upstairs.
Drugs indicative of psychological treatment include Nortriptyline, Amitriptyline, Lorazepam, Temazepam, Prozac, Trazodone, Oxazepam, Serax, Xanax, Ambian (sleep medication), and many others.
Geriatricians therefore recommend that, if a sleeping pill is really necessary, older women should be given the kind that doesn't accumulate in the body--such as oxazepam (Serax) and lorazepam (Ativan).
Serax was tried, but it made me so depressed I couldn't function and cried constantly.
insomnia, and loss of memory: Ativan Nembutal Lanoxin Butalan Noludar Procan Centrax Restoril Aldomet Dalmane Serax Catapres Luminal Tranxene Benadryl Halcion Valium Compazine Librium Xanax Zantac Limbitrol Haldol
The brand names of some common benzodiazepine drugs include Ativan, Dalmane, Diastat or Valium, Doral, Halcion, Klonopin, Librium, Paxipam, ProSom, Restoril, Serax, Tranxene-SD, and Xanax.
A patient may tell me they have a prescription for Serax, and the urine is positive for Xanax.
Antianxiety and Hypnotic Agents -- Librium, Valium, Dalmane, Miltown/Equanil, Tranxene, Paxipam, Centrax, Klonopin, Ativan, ProSom, Doral, Serax, Xanax, Halcion, chloral hydrate, Doriden, Noludar, Placidyl, Seconal, Nembutal, Amytal, Tuinal, Butisol, phenobarbital