Chronic pulmonary insufficiency, muscle weakness, organic brain changes, impaired liver or kidney function, or in patients with history of alcohol or drug addiction. May affect performance of skilled tasks. May precipitate suicide or aggressive behaviour. Personality disorders. Hypotension occasionally occur with high dosage and parenteral administration. Elderly or debilitated patients. Pregnancy and lactation.
Adverse Drug Reactions
Hepatotoxicity. Drowsiness and lightheadedness, sedation, muscle weakness, and ataxia. Less frequently, vertigo, headache, confusion, depression, slurred speech or dysarthria, changes in libido, tremor, visual disturbances, urinary retention or incontinence, GI disturbances, changes in salivation, and amnesia.
Interactions
MAOIs. Enhanced sedation or resp and CV depression may occur if given with other drugs that have CNS depressant properties. Others: Fenoprofen, methadone, pethidine and opioid analgesics; disopyramide, lidocaine and quinidine; chloramphenicol, doxycycline; warfarin and coumarin; antidepressants eg, bupropion, fluoxetine, lithium and mianserin; valproate and progabide; vigabatrin, oxcarbazepine, carbamazepine, clonazepam, ethosuximide, lamotrigine, tiagabine and zonisamide, griseofulvin; teniposide; metronidazole; chlorpromazine; HIV-protease inhibitors; b-blockers; calcium-channel blockers eg, nifedipine and verapamil; digitoxin; ciclosporin; corticosteroids; furosemide; montelukast; oral contraceptives; theophylline; levothyroxine; influenza vaccination and vitamins. Alcohol. St. John's wort. Alcohol.
