Tranquilizers

Tranquilizers (from Lat. tranquilo-are — to make calm, serene) are psychotropic drugs that eliminate fear, anxiety, affective tension in neurosis and neurosis-like states. Synonyms of the term are the expressions “anxiolytic agents” (from the English anxiety — fear), “anti—anxiety agents” (antianxiety agents), “ataractics” (from the Greek ataraxia – calmness, equanimity), “antiphobic agents”, “general soothing agents”. Most tranquilizers have practically no antipsychotic effect and the ability to eliminate psychotic fear and anxiety. There are, however, powerful tranquilizers with transitional to antipsychotic properties (for example, phenazepam). Tranquilizers do not have a pronounced antidepressant effect, but there are some exceptions in this regard. The main properties of this group of drugs are:

anxiolytic, eliminating anxiety, fear, tension. To a certain extent, tranquilizers can significantly alleviate the emotional state of psychiatric patients, since their depression, fears, anxiety are not always directly related to the primary damage of neuropsychiatric processes, but arise as a reaction to the situation or consciousness of the disease;

soothing and hypnotic only in this sense, that is, facilitating the onset of sleep, therefore they are not prescribed if the patient performs work that requires a quick mental and motor reaction. Tranquilizers do not have a direct hypnotic effect, although many of them significantly improve the quality of sleep, in particular, relieve patients from painful dreams. The only exceptions are, perhaps, only such drugs as natrazepam, flunitracepam and triazolam;

central muscle relaxant, reducing the tonic tension of the striated musculature;

anticonvulsant; tranquilizers can also be effective in mental seizures;

the ability to potentiate the effects of alcohol, sedatives, sleeping pills, narcotic and analgesic agents;

the ability to cause addictive phenomena and side effects, in particular an increase in intraocular pressure;

stress-protective effect, that is, resistance to the influence of stress;

to a lesser extent, the antidepressant effect; first of all, we do not mean endogenous depressions, but situational and arising as a reaction to the effects of traumatic factors.

The mechanisms of action of tranquilizers are not fully known to this day. It has been established that tranquilizers have a very weak effect on the noradrenergic, dopaminergic and serotonergic systems of the brain. At the same time, it was found that benzodiazepine tranquilizers actively affect GABAergic structures and potentiate the central inhibitory effect of gamma-aminobutyric acid. Specific “benzodiazepine” receptors (and their subgroups) have been identified in CNS cells, for which benzodiazepines are exogenous ligands (from Latin ligo — binding). Derivatives of diphenylmethane (amisyl, etc.) actively affect the cholinergic systems of the brain, which is why such drugs are called central cholinolytics. Propanediol derivatives have no pronounced effect on benzodiazepine and cholinergic receptors.
Attention! Do not start pharmacological treatment without consulting a psychiatrist
Benzodiazepine derivatives

This is a group of drugs whose representatives differ significantly in the profile of psychotropic activity from each other. Thus, the pronounced anxiolytic effect is especially characteristic of phenazepam, diazepam, nosepam, lorzepam, alprazolam (described in the section “Other antidepressants”). Sedative-hypnotic effect is more represented in nitrazepam, alprazolam, flunitrazepam, triazolam. The anticonvulsant effect is especially pronounced in clonazepam, to a lesser extent in phenazepam, sibazone and nitrazepam. The muscle relaxant effect is more characteristic of phenazepam, sibazone, lorazepam. The “daytime” tranquilizers have an anti-anxiety effect. Benzodiazepines are usually well tolerated.

1. Chlozepid (Chlozepidum). Synonyms: Librium, Napoton, Chlordiazepoxide, Elenium, Ansiacal, Droxol, Labiton and many others have not yet lost their significance in the treatment of neurotic conditions with fears, anxiety, affective tension, irritability, impressionability, obsessions, as well as shallow hypochondriac depression, epilepsy, alcohol withdrawal.

It is prescribed orally up to 3-4 times a day, regardless of food intake. Treatment of adults begins with 5-10 mg per day. If necessary, the daily dose is gradually increased (5-10 mg each) to 30-50 mg. The dose is also reduced gradually, since there is a possibility of developing withdrawal syndrome. Weakened and elderly patients are prescribed smaller doses (up to 20 mg / day). Children, depending on their age, are prescribed 2.5–5 mg at a time.

Side effects: dry mouth, drowsiness, light dizziness, uncertainty of gait, itching, nausea, constipation, dysmenorrhea, increased appetite, decreased libido, headache, arterial hypotension, impaired concentration, slowing mental and motor reactions, memory loss, excitement, aggressiveness, fear, muscle weakness. In some cases, excitement occurs at the beginning of treatment. Hallucinations, ataxia, and changes in the peripheral blood pattern are also described. Sometimes paradoxical reactions occur. The drug potentiates the effect of hypnotics and analgesics, in the first 3-5 days of continuous treatment it has a moderate hypnotic effect.

Contraindications to the appointment: hypersensitivity, acute liver and kidney diseases, myasthenia gravis, the first trimester of pregnancy, drug and alcohol dependence. The drug is not combined with MAO inhibitors and phenothiazine derivatives. It is not recommended to drink alcohol during the treatment period. Persons whose work requires a quick mental and physical reaction should not take chlosepid on the eve of the working day.

These complications and contraindications to the use of chlosepide are characteristic of other benzodiazepine derivatives.

Product form: tablets of 5 mg in a package of 50 pieces.

2. Sibazon (Sibazonum). Synonyms: Apourin, Bensedin, Valium, Oxazepam, Relanium, Relium, Seduxen, Apozepam, Bensedin, Diazepam, Saromet, Serensin, Vatran, etc. One of the main benzodiazepine tranquilizers. It is indicated for use in the treatment of various neuropsychiatric diseases: neuroses, psychopathies, as well as neurosis-like and psychopath-like conditions (with schizophrenia, organic brain lesions, including cerebrovascular pathology and somatic pathology), accompanied by symptoms of emotional tension, anxiety, fear, irritability, senestipochondriac, obsessive-phobic disorder, sleep disorders. It is also used for the relief of psychomotor agitation, anxiety agitation in these diseases, epileptic status, treatment of convulsive paroxysms and mental equivalents in epilepsy, spastic states, withdrawal syndrome in alcoholism (together with other drugs). In children’s neuropsychiatric practice, it is used in the treatment of neurotic and neurosis-like conditions with these symptoms, as well as headaches, enuresis, mood and behavior disorders. In somatic medicine, it is used in the treatment of itchy dermatoses, gastric ulcer, cardiac arrhythmia, in preparation for operations.

It is assigned inside, in / m and in / V. For adults, when ingested, the drug is prescribed starting from 2.5–5 mg / day 1-2 times, regardless of food intake. If necessary, the single dose is gradually increased to 5-10 mg, and in some cases — up to 20 mg. The daily dose for inpatient treatment can reach 45 mg, for outpatient treatment — 25 mg. The maximum daily dose is 60 mg (in 2-3 doses). Dose reduction is also gradual. Weakened and elderly patients are prescribed 2.5 mg 1-2 times a day. Single and daily doses for children aged 1 to 3 years are 1 mg and 2 mg, respectively, from 3 to 7 years — 2 mg and 6 mg, from 7 years and older — 3-5 mg and 8-10 mg. For older children, if necessary, the daily dose can be increased to 14-16 mg. The duration of the course of treatment should not exceed 2 months (the risk of developing addiction to the drug!).

Intravenous (drip or jet) and intravenous sibazone are administered to adults in the treatment of diseases that are accompanied by agitation, convulsions; in the relief of epileptic status, acute anxiety-depressive and anxiety-phobic states of various genesis, including abstinence and psychosis with alcoholism. The average single dose is 10 mg (2 ml of 0.5% solution), the daily dose is 30 mg, and the maximum is 30 mg and 70 mg, respectively. Sedative effect is observed a few minutes after intravenous and 30-40 minutes after intravenous administration of the drug. The actual therapeutic effect is revealed after 3-10 days.

The epileptic status is stopped in / in (slow!) infusion of 10-40 mg of sibazone. Its repeated administration is done in / in or in / m every 3-4 hours. This technique is especially effective if the status of generalized seizures begins to be stopped in the first 3 hours after its onset.

Possible complications, contraindications to the appointment of sibazone are basically the same as in the treatment with chlozepid. With intravenous and intravenous administration, the drug should not be mixed with others (in order to avoid precipitation).

Release forms: tablets of 5 mg in a pack of 20 pieces; tablets for children of 1 mg and 2 mg in a pack of 20 pieces; 0.5% solution in ampoules (Solutio Sibazoni pro injectionibus) of 2 ml in a pack of 10 ampoules. Sibazone is an integral part of the sleeping drug Reladorm.

3. Phenazepam (Phenazepamum). By the strength of the tranquilizing effect, it surpasses other tranquilizers, also has a pronounced anticonvulsant, muscle relaxant and hypnotic effect. In terms of anti-anxiety activity, it is not inferior to some neuroleptics. When used together with sleeping pills and narcotic drugs, their mutual potentiation occurs. It is indicated for use in the treatment of neuroses, neurosis-like, psychopathic, psychopathic and reactive states, in which anxiety, fear, affective tension, emotional excitability, as well as obsessive-phobic, hypochondriacal phenomena and panic attacks are presented. It is used in the treatment of alcohol withdrawal, epilepsy, sleep deficiency.

It is prescribed orally regardless of food intake 2-3 times a day. The daily dose for adults in the hospital can reach 3-5 mg, in outpatient practice — 1.5 mg. In the treatment of epilepsy, it is prescribed at a dose of 2 to 10 mg / day, as a sleeping pill — up to 2.5 mg per reception (20-30 minutes before bedtime). The relief of alcohol withdrawal requires the appointment of 2.5 to 5 mg / day. The maximum daily dose should not exceed 10 mg.

Possible side effects and contraindications to use are the same as in the treatment with chlozepid and sibazone. More often, however, ataxia, drowsiness, muscle weakness, dizziness are observed.

Product form: tablets of 0.5 mg and 1 mg in a package of 50 pieces; tablets of 2.5 mg in a package of 20 pieces.

4. Nozepam (Nozepamum). Synonyms: Apo-Oxazepam, Medazepam, Rudotel, Tazepam, Oxazepam, Oxazepam, Rondar, Serax, etc. In its properties, it is similar to chlosepid and diazepam, but inferior to them in strength of action. It is somewhat less toxic than they are, in some cases it is better tolerated, especially by elderly and somatically weakened patients. Indications for use, side effects, contraindications to use are similar to those in the treatment of chlozepid.

It is prescribed orally regardless of food intake 2-3 times a day. The initial single dose for adults is 5-10 mg, the average therapeutic dose for one dose is 20-30 mg.

Product form: tablets of 10 mg in a package of 50 pieces.

5. Lorazepam. Synonyms: Apo-lorazepam, Ativan, Lorafen, Merlit, Trapex, etc. Similar to triazolam (see below). It has a pronounced tranquilizing activity, can be used in the treatment of mental disorders (panic attacks, reactive psychoses, subpsychotic phenomena). Indications for use, side effects, contraindications to the appointment are similar to those in the treatment of chlozepid.

It is prescribed orally regardless of food intake 2-3 times a day. In neurotic conditions, it is prescribed at a dose of 1.25–5 mg / day, in the treatment of psychoses — up to 15 mg / day.

Product form: tablets of 2.5 mg in a package of 50 pieces.

6. Bromazepam. Synonyms: Bromazep, Lexotan, Bartul, Deptran, Pascalium and many others. Anxiolytic with sedative-hypnotic, anticonvulsant and muscle relaxant effects. According to the action, indications for use, side effects and contraindications to the appointment, it is close to other benzodiazepines. With a single dose, it has a short-lived effect.

It is prescribed orally regardless of food intake 2-3 times a day at a dose of up to 36 mg / day (in a hospital setting), in outpatient practice — 1.5–3 mg at a time.

Product form: tablets of 1.5 mg, 3 mg and 6 mg.

7. Mezapam (Mezapamum). Synonyms: Nobrium, Rudotel, Anxitol, Imazepam, Merlit, Stratium and many others. The peculiarities of the drug’s action are the lesser severity of the muscle relaxant and general depressing effect, the presence of some stimulating radical. It is considered a “daytime” tranquilizer, suitable for the treatment of children, elderly and somatically weakened patients. Indications, contraindications to use, side effects are generally similar to those in the treatment of other benzodiazepines, excluding acute states of fear and anxiety, reactive psychoses, epileptic status.

It is prescribed orally 2-3 times a day, regardless of food intake. The average daily dose for adults is 30-40 mg, the highest is 60-70 mg. Elderly and adolescents are prescribed up to 20-30 mg / day, children aged 1-2 years — 2-2.5 mg / day, from 3 to 6 years — 3-6 mg / day, from 7 to 10 years — 6-24 mg / day.

Release forms: tablets of 10 mg; granules (20 pieces, contain 40 mg of mezapam) for the preparation of a suspension for children in cans labeled 100 ml. The suspension is prepared on freshly boiled chilled water.

8. Gidazepam (Gidazepamum). It interacts with benzodiazepine receptors in the limbic system, in the insertion neurons of the lateral horns of the spinal cord. It has an anxiolytic, anticonvulsant and weak muscle relaxant effect. It refers to “daytime” tranquilizers, it does not have a hypnotic effect. Unlike many tranquilizers, it has a psychoactivating effect. Indications and contraindications for use, side effects are generally the same as in the treatment with chlozepid. Gidazepam is also prescribed for the treatment of migraines.

It is prescribed orally regardless of food intake 3 times a day, starting from 6-15 mg / day. The dose is gradually increased to 60-200 mg / day. In migraine and logoneurosis, the therapeutic dose is 40-60 mg / day. The duration of the course of therapy is from several days to 3-4 months.

9. Clobazam. Synonyms: Frisium, Clarmyl, Frizin, Sentil, Urbanil, etc. Anxiolytic with anticonvulsant effect. It is indicated for the treatment of painful conditions with acute and chronic feelings of fear, as well as as an additional remedy — epilepsy, dysphoria, aggressiveness.

It is prescribed orally regardless of food intake 2-3 times a day. The dose for adults with neurotic conditions is 10-20 mg / day, with a feeling of fear — from 20 to 30 mg / day. Children under the age of 3 years are not prescribed the drug, older than 3 years, as well as elderly patients are recommended reduced doses. In the treatment of epilepsy, the initial dose of the drug is 5-15 mg / day, it can be increased to 80 mg / day (the maximum daily dose). The increase and decrease in doses should be gradual; as with treatment with other tranquilizers, withdrawal syndrome may occur.

Side effects, contraindications to use are the same as in the treatment of other benzodiazepines. When treated with high doses and for a long time, there may be articulation disorders, diplopia, nystagmus, in elderly patients — impaired consciousness.

Product form: tablets of 5 mg and 10 mg.

10. Alprazolam.

11. Tetrazepam. Synonyms: Myolastan, Myolastan. An anxiolytic with a pronounced muscle relaxant effect. It is indicated for the treatment of mainly muscle contractures, tendovaginitis, myositis, accompanied by muscle pain.

It is prescribed orally regardless of food intake 2-3 times a day in doses for adults from 50 to 150 mg / day.

Side effects, contraindications to use are the same as in the treatment of other benzodiazepines.

Product form: 50 mg tablets in a pack of 20 pieces.

12. Signopam. Synonyms: Temazepam, Euhuphos, Levanxene, Normison, Planum, Texapan, Veroqual, etc. Anxiolytic with mild antidepressant effect. It is indicated for the treatment of neuroses and neurosis-like conditions, especially accompanied by depressed mood and hypochondriacal phenomena; shallow depression, increased neuropsychiatric excitability with thyrotoxicosis. It has a pronounced anticonvulsant, as well as anti-dysphoric effect.

It is prescribed orally, regardless of food intake, 10 mg 2-3 times a day (for adults). The dose can be increased to 40 mg / day (in 2-3 doses). The increase and decrease in doses is gradual, over 7-10 days.

Side effects: there may be (rarely) drowsiness, fatigue, dizziness, allergic skin reactions, decreased libido, dysmenorrhea, in some cases — disorientation. It is forbidden to drink alcohol, driving a vehicle.

Contraindications to use: hypersensitivity, drug and alcohol dependence.

13. Tranxene. Synonyms: Anxidin, Belseren, Tranex, Tranxilen. Anxiolytic with sedative, muscle relaxant and anticonvulsant effect. It can be used to relieve psychomotor agitation with parenteral administration. It is assigned inside, in / m and in / V. The average therapeutic dose when taking the drug by adults orally is 10-30 mg / day. The dose can be increased to 50-100 mg / day. Elderly and senile patients are prescribed the drug in reduced doses. To relieve psychomotor agitation, attacks of aggressiveness, the drug is administered intravenously or intravenously at a dose of 20 to 200 mg / day.

Side effects: drowsiness, muscle weakness, anterograde amnesia, euphoria, paradoxical mental reactions (increased fear, aggressiveness, etc.). With a sharp decrease in dosages, withdrawal syndrome may develop.

Contraindications to use: hypersensitivity, respiratory and heart failure, pregnancy, breastfeeding, childhood.

14. Nitrazepam. Synonyms: Berlidorm, Neozepam, Radedorm, Eunoctin, Apodorm, Benzalin, HinpaxInsomin, Magadon, Nitrodiazepam, Senerex and many others. Increases the sensitivity of benzodiazepine receptors to the mediator, enhances the inhibitory effect of GABA in the central nervous system, reduces the excitability of cells in the cortex and subcortical areas of the brain, inhibits cells of the reticular formation. It has a tranquilizing, muscle relaxant, anticonvulsant effect, inhibits conditioned reflexes, suppresses polysynaptic spinal reflexes. A distinctive feature is its hypnotic, hypnotic effect, it lengthens sleep and improves its quality. It is indicated for the treatment of various sleep disorders, neuroses and psychopathies with the phenomena of anxiety, fear, affective tension. In combination with other drugs, it is used in the treatment of schizophrenia, affective and schizoaffective psychoses, some organic and toxic damage to the central nervous system, in particular disorders of cerebral circulation and chronic alcoholism. In combination with anticonvulsants, it is used in the treatment of epilepsy.

It is prescribed inside regardless of the meal. As a hypnotic, it is used once half an hour before bedtime at a dose of 5-10 mg for adults, 2.5—5 mg for elderly patients. For this purpose, the drug is also prescribed to children in a lower dose: at the age of 1 year — 1.25–2.5 mg; from 1 year to 5 years — 2.5–5 mg; from 6 to 14 years — 5 mg. The maximum single dose as a sleeping pill for adults is 20 mg.

As a tranquilizer and anticonvulsant, nitrazepam is used 2-3 times a day for 5-10 mg (adults). If necessary, the dose for the treatment of epilepsy can be increased. The highest daily dose of the drug is 30 mg. The course of treatment is on average 4-6 weeks.

Side effects: daytime drowsiness, feeling of lethargy, ataxia, impaired coordination of movements, headache, deafness, dizziness, less often — nausea, tachycardia, hyperhidrosis, skin allergic reactions. In most cases, these phenomena are observed in elderly and somatically weakened patients. The dose of the drug should be reduced or the treatment should be discontinued.

Contraindications to use: the first trimester of pregnancy, myasthenia gravis, liver and kidney diseases with impaired functions, the work of patients if they require a quick mental and physical reaction. The use of alcoholic beverages is prohibited. It should be borne in mind the possibility of enhancing the action of analgesics and other neurotropic drugs.

Product form: tablets of 5 mg in a pack of 20 pieces.

15. Flunitrazepam. Synonyms: Rohypnol, Dububene, Hypnodorm, Narcozep, Primum, Sedex, etc. Close to nitrazepam. It has a sedative, hypnotic, anticonvulsant effect. It is indicated for the treatment of insomnia. In anesthesiological practice, it is used for premedication and immersion in anesthesia.

It is prescribed orally half an hour before bedtime at a dose of 1-2 mg for adults, 0.5 mg for elderly patients; children under the age of 14 are prescribed extremely rarely and only 0.5–1 mg. Parenterally used for premedication (in / m 1-2 mg), for injection into anesthesia — in / in 1 mg (administered slowly).

Side effects and contraindications to use are the same as in the treatment with nitrazepam. There is a possibility of developing withdrawal syndrome.

Forms of release: tablets of 2 mg in a package of 10, 30 and 100 pieces; in ampoules of 2 mg of the drug and with the application of ampoules with 1 ml of sterile water for injection, in a package of 25 ampoules (it is impossible to inject the drug without a solvent).

16. Triazolam. Synonyms: Somneton, Chalcion, Apo-Triazo, Clorazolam, Nuctan, Somneton, Songar, etc. Similar in structure to alprazolam. A short-acting hypnotist, other aspects of the action have not been studied enough.

It is prescribed orally 20-30 minutes before bedtime at a dose of 0.25–0.5 mg (for adults).

Product form: tablets of 0.25 mg (blue) and 0.5 mg (white). Foreign analogues of triazolam: Flurazepam (Flurazepam), synonyms — Benozil,

Fluzepam, Waldorm, etc.; Lorazepam (Lorazepam), synonyms — Almazin, Ansilor, Ativan, Durazolam, Sedatival, etc.; Tomazepam (Tomazepam), synonyms — Cerepax, Levaxol, Temazepam, Temazin, etc.

17. Zopiclone. Synonyms: Piclodorm, Relaxon, Somnol. Activates GABAergic mechanisms of synaptic transmission in the brain. It has a sedative and hypnotic effect. It is prescribed mainly for the treatment of deficiency and deterioration of sleep quality of various origins, including depression, as well as for the treatment of nocturnal asthma (in combination with theophylline).

It is prescribed orally half an hour before bedtime once per 7.5 mg tablet (for adults), for elderly patients — 2 tablets. The course of treatment is no more than 1 month. The maximum dose is 15 mg.

Side effects: lethargy, drowsiness, a feeling of bitter and metallic taste in the mouth, nausea, irritability, depressed mood, withdrawal syndrome, skin allergic reactions, impaired consciousness. The drug reduces the concentration of trimipramine in the blood, reduces its effect. Enhances the effect of sedatives and alcohol.

Contraindications to use: hypersensitivity, severe respiratory failure, pregnancy, breastfeeding, age up to 15 years.

Product form: 7.5 mg tablets.

18. Estazolam. Excites benzodiazepine receptors, enhances GABAergic transmission and its inhibitory effect. Anxiolytic with sedative, hypnotic and central muscle relaxant effect. It is indicated for the treatment of neuroses and neurosis-like states with depressive-phobic symptoms, anxiety, affective tension, sleep disorders, as well as epilepsy (as an adjunct).

It is prescribed orally regardless of food intake several times a day. The average therapeutic dose for adults is 4-6 mg / day. Tablets should be swallowed whole, washed down with a small amount of water. As a sleeping pill, 2-4 mg is prescribed (1 mg for elderly patients) half an hour before bedtime. The increase and decrease in dosages is gradual, with prolonged treatment there may be a withdrawal syndrome with anxiety, anxiety, fears. Alcohol consumption is prohibited.

Side effects: daytime drowsiness, fatigue, weakness, irritability, headache, dizziness, ataxia, disorientation, impaired memory and thinking, addiction, addiction. The drug enhances the effect of sedatives. It should be prescribed with caution to persons whose work requires a quick physical and mental reaction. A paradoxical reaction to the drug is possible.

Contraindications to use: hypersensitivity, myasthenia gravis, ataxia, severe respiratory failure, impaired consciousness, angle-closure glaucoma, dependence on alcohol and drugs, pregnancy, breast-feeding, age up to 18 years.

Product form: tablets of 1 mg.

19. Clonazepam (Clonazepame). Synonyms: Antelepsin, Rivotril, Clonopin, Ictorivil, Rivatril, etc. It interacts with benzodiazepine receptors, has a GABAergic effect in the limbic system, reticular formation, insertion neurons of the spinal cord. Reduces the excitability of subcortical structures of the brain and disrupts their interaction with the cerebral cortex. Anxiolytic with anticonvulsant, antiepileptic and sedative activity, has a hypnotic and central muscle relaxant effect. It is used mainly for the treatment of epilepsy with large, temporal, focal and small seizures, paroxysmal fear syndromes, phobias (in patients over 18 years old) and manic states, especially in epilepsy; psychomotor agitation in reactive psychoses, as well as insomnia and muscle hypertension.

It is prescribed orally regardless of food intake 3 times a day. The initial dose for adults is 4.5 mg / day. The dose can be gradually, every 3 days, 0.5–1 mg increased to 4-8 mg / day. The maximum dose is 20 mg / day. With paroxysmal fear syndrome in adults, 1 mg / day is prescribed, up to a maximum of 4 mg / day. The dose for children is 0.01–0.03 mg / kg / day for 3 doses. Children under the age of 1 year are given 0.1–1 mg / day, from 1 year to 5 years — 1.5–3 mg / day, from 6 to 16 years — 3-6 mg / day. The maximum dose for children is 0.05 mg / kg / day for 3 doses.

Side effects: drowsiness, dizziness, ataxia, choreic hyperkinesis, dysarthria, weakness, fatigue, nervousness, insomnia, visual impairment, memory and speech disorders, emotional lability, hypersalivation or xerostomia, constipation, abdominal pain, muscle pain, dysmenorrhea, increased urination or urinary retention, decreased appetite and libido, depression, disorientation, paradoxical reactions to the drug, skin allergic reactions, alopecia, hirsutism, erythro-, leukemia and thrombocytopenia, increased concentration of transaminases and alkaline phosphatase in the blood, withdrawal syndrome, addiction, addiction, etc. The drug enhances the effect of barbiturates, neuroleptics, antidepressants, anticonvulsants, narcotic analgesics, alcohol and drugs that lower the tone of skeletal muscles. When drinking alcohol, cases of pathological intoxication have been noted.

Contraindications to use: hypersensitivity, impaired liver and kidney function, myasthenia gravis, pregnancy, impaired consciousness, central respiratory failure, respiratory failure, glaucoma.

Product form: tablets of 0.5 mg and 2 mg.