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Concurrent use with strong CYP3A4 inhibitor: 1 mg before bedtime; if needed, dose may be increased to 2 mg. Our patient's renal function remained stable throughout the hospital course, which caused us to look further for an explanation for the propylene glycol-induced lactic acidosis.

Dosage adjustment in hepatic impairment: Mild-to-moderate: Use with caution; dosage adjustment unnecessary Severe: Maximum dose: 2 mg Supplied: 1 mg, 2 mg, 3 mg tablet. Based on the Naranjo probability scale, propylene glycol was determined to be the probable cause of lactic acidosis.

Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron at several sites within the central nervous system, including the limbic system, reticular formation.

Enhancement of the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions.

Buspirone has moderate affinity for brain D2-dopamine receptors.

Some studies do suggest that buspirone may have indirect effects on other neurotransmitter systems.

Ethanol withdrawal: Initial: 30 mg, then 15 mg 2-4 times/day on first day; maximum daily dose: 90 mg; gradually decrease dose over subsequent days SUPPLIED: Tablet, as dipotassium: 3.75 mg, 7.5 mg, 15 mg Tranxene®-SD™: 22.5 mg [once daily] Tranxene®-SD™ Half Strength: 11.25 mg [once daily] Tranxene® T-Tab®: 3.75 mg, 7.5 mg, 15 mg Dosing (Adults): Seizure disorders: Initial daily dose not to exceed 1.5 mg given in 3 divided doses; may increase by 0.5-1 mg every third day until seizures are controlled or adverse effects seen (maximum: 20 mg/day) Usual maintenance dose: 0.05-0.2 mg/kg; do not exceed 20 mg/day Panic disorder: 0.25 mg twice daily; increase in increments of 0.125-0.25 mg twice daily every 3 days; target dose: 1 mg/day (maximum: 4 mg/day) Discontinuation of treatment: To discontinue, treatment should be withdrawn gradually.

Buspirone differs from typical benzodiazepine anxiolytics in that it does not exert anticonvulsant or muscle relaxant effects.

It also lacks the prominent sedative effect that is associated with more typical anxiolytics.

V.: 0.02-0.04 mg/kg; repeat every 5 minutes as needed to desired effect or up to 0.1-0.2 mg/kg Conscious sedation: I. Maintenance: 0.05-0.3 mg/kg as needed, or continuous infusion 0.25-1.5 mcg/kg/minute. DOSING: ELDERLY — The dose of midazolam needs to be individualized based on the patient's age, underlying diseases, and concurrent medications. A total dose PHARMACODYNAMICS / KINETICS Onset of action: I. The clinical trials performed in support of efficacy were 2 weeks in duration with the final formal assessment of sleep latency performed at the end of treatment.

Decrease dose (by ~30%) if narcotics or other CNS depressants are administered concomitantly. DOSAGE AND ADMINISTRATION While the recommended usual adult dose is 15 mg before retiring, 7.5 mg may be sufficient for some patients, and others may need 30 mg.

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Prolonged infusions have been associated with toxicity from propylene glycol and/or polyethylene glycol. Since this case occurred, our intensive care unit has instituted recommendations for the prevention of lorazepam-associated propylene glycol toxicity.