Bromazepam is similar in side effects to other benzodiazepines. The most common side effects reported are drowsiness, sedation,
ataxia, memory impairment, and dizziness. Impairments to memory functions are common with bromazepam and include a reduced
working memory and reduced ability to process environmental information. A 1975 experiment on healthy, male college students exploring the effects of four different drugs on learning capacity observed that taking bromazepam alone at 6 mg 3 times daily for 2 weeks impaired learning capacities significantly. In combination with
alcohol, impairments in learning capacity became even more pronounced. Various studies report impaired memory, visual information processing and sensory data and impaired psychomotor performance; deterioration of cognition including attention capacity and impaired co-ordinative skills; impaired reactive and attention performance, which can impair driving skills;
drowsiness and decrease in
libido. Unsteadiness after taking bromazepam is, however, less pronounced than other benzodiazepines such as
lorazepam. On occasion, benzodiazepines can induce extreme alterations in memory such as
anterograde amnesia and
amnesic automatism, which may have medico-legal consequences. Such reactions occur usually only at the higher dose end of the prescribing spectrum. Very rarely,
dystonia can develop. Up to 30% treated on a long-term basis develop a form of
dependence, i.e. these patients cannot stop the medication without experiencing physical or psychological
benzodiazepine withdrawal symptoms.
Leukopenia and liver damage of the cholestatic type with or without
jaundice have additionally been seen; the original manufacturer
Roche recommends regular laboratory examinations to be performed routinely. Ambulatory patients should be warned that bromazepam may impair the ability to drive vehicles and to operate machinery. The impairment is worsened by consumption of alcohol, because both act as central nervous system depressants. During the course of therapy, tolerance to the
sedative effect usually develops.
Frequency and seriousness of adverse effects As with all medication, the frequency and seriousness of side-effects varies greatly depending on quantities consumed. In a study about bromazepam's negative effects on psychomotor skills and driving ability, it was noted that 3 mg doses caused minimal impairment. It also appeared that impairment may be tied to methods of testing more so than on the product's intrinsic activity. Moreover, side effects other than drowsiness, dizziness and ataxia seem to be rare and not experienced by more than a few percent of users. The use of other, comparable medication seems to display an identically moderate side effect profile.
Tolerance, dependence and withdrawal Prolonged use of bromazepam can cause tolerance and may lead to both physical and psychological dependence on the drug, and as a result, it is a medication which is controlled by international law. It is nonetheless important to note that dependence, long-term use and misuse occur in a minority of cases and are not representative of most patients' experience with this type of medication. It shares with other benzodiazepines the risk of abuse, misuse,
psychological dependence or
physical dependence. A withdrawal study demonstrated both psychological dependence and physical dependence on bromazepam including marked
rebound anxiety after 4 weeks chronic use. Those whose dose was gradually reduced experienced no withdrawal. Patients treated with bromazepam for generalised anxiety disorder were found to experience withdrawal symptoms such as a worsening of anxiety, as well as the development of physical withdrawal symptoms when abruptly withdrawn bromazepam. Abrupt or over rapid withdrawal from bromazepam after chronic use even at therapeutic prescribed doses can lead to a severe withdrawal syndrome including
status epilepticus and a condition resembling
delerium tremens. Animal studies have shown that chronic administration of
diazepam (or bromazepam) causes a
decrease in spontaneous locomotor activity, decreased turnover of
noradrenaline and dopamine and
serotonin, increased activity of tyrosine hydroxylase and increased levels of the catecholamines. During withdrawal of bromazepam or diazepam a fall in tryptophan, serotonin levels occurs as part of the
benzodiazepine withdrawal syndrome. Changes in the levels of these chemicals in the brain can cause headaches, anxiety, tension, depression, insomnia, restlessness, confusion, irritability, sweating,
dysphoria, dizziness,
derealization, depersonalization, numbness/tingling of extremities, hypersensitivity to light, sound, and smell, perceptual distortions, nausea, vomiting, diarrhea, appetite loss, hallucinations, delirium, seizures, tremor, stomach cramps,
myalgia, agitation, palpitations,
tachycardia, panic attacks, short-term memory loss, and hyperthermia.
Overdose Bromazepam is commonly involved in drug overdoses. A severe bromazepam
benzodiazepine overdose may result in an alpha pattern coma type. The toxicity of bromazepam in overdosage increases when combined with other CNS depressant drugs such as
alcohol or sedative hypnotic drugs. Similarly to other benzodiazepines however, being a positive modulator of certain neuroreceptors and not an
agonist, the product has reduced overdose potential compared to older products of the
barbiturate class. Its consumption alone is very seldom fatal in healthy adults. Bromazepam was in 2005 the most common benzodiazepine involved in intentional overdoses in
France. Bromazepam has also been responsible for accidental poisonings in companion animals. A review of benzodiazepine poisonings in cats and dogs from 1991 to 1994 found bromazepam to be responsible for significantly more poisonings than any other benzodiazepine. ==Contraindications==