substance abuse
Carisoprodol (Soma) Contraindications and Precautions
Carisoprodol is contraindicated in acute intermittent porphyria because it can potentiate the disease.
Carisoprodol is contraindicated in patients with a known carbamate hypersensitivity because carisoprodol is metabolized to meprobamate.
Carisoprodol is metabolized in the liver and should be used with caution in patients with hepatic disease. Hepatic dysfunction can reduce the excretion rate and possibly lead to toxicity. Carisoprodol is excreted in the urine and should be used with caution in patients with renal disease. Renal impairment or renal failure can reduce the excretion rate of metabolites such as meprobamate (minor active metabolite). Carisoprodol is poorly tolerated in the elderly due to anticholinergic and sedative effects. Efficacy is questionable at doses tolerated by the elderly. It is recommended that carisoprodol be avoided in patients 65 years of age and older.
Carisoprodol should be used with caution in patients with CNS depression. Carisoprodol is a centrally acting agent and can exacerbate CNS depression. Carisoprodol may impair mental or physical abilities required for driving or operating machinery. There may be an additive effect and an increase in CNS depression if carisoprodol is combined with ethanol or other CNS depressants. Use caution with simultaneous administration.
Carisoprodol should be used with caution in patients with a history of substance abuse or dependency. Psychological dependence and drug abuse have been reported with carisoprodol. Withdrawal reactions after abrupt discontinuation of carisoprodol have occurred but appear to be mild and less severe than benzodiazepine withdrawal. Avoid abrupt discontinuation of aspirin with carisoprodol. Abrupt interruption of therapy with carisoprodol at doses five times those recommended produced mild withdrawal symptoms. Although carisoprodol is not officially categorized as a controlled substance, the possibility of dependence and withdrawal exists.
Carisoprodol is considered to be in FDA pregnancy category C. Carisoprodol has not been studied in either animals or humans during gestation. It is unknown if carisoprodol would have effects on reproductive capacity. Carisoprodol crosses the placenta and is not recommended for use during pregnancy. Effects on the fetus are unknown. Carisoprodol should be used only when the benefits outweigh the risks.
Carisoprodol is distributed into breast milk in concentrations 2 - 4 times higher than those of maternal plasma. Carisoprodol should be avoided in breast-feeding mothers. If carisoprodol administration cannot be avoided in a lactating mother, a decision regarding whether to continue breast-feeding should be made. Breast-feeding infants should be monitored for sedation, GI upset, or other changes in behavior or activities.
Carisoprodol is contraindicated in children under the age of 12 years because safe use has not been established in pediatric patients. No pediatric specific problems have been documented.
[ Last revised: 4/1/2003 12:45:00 PM ]
References
. Beers MH. Explicit criteria for determining potential inappropriate medication use by the elderly: an update. Arch Intern Med 1997;157:1531 - 6.
. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716 - 24.
. Reeves RR, Pinkofsky HB, Carter OS. Carisoprodol: a drug of continuing abuse. J Am Osteopath Assoc 1997;97:723 - 4.
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