Esopam Special Precautions

Avoid use in older adults with a history of falls or fractures (unless safer alternatives are not available) as ataxia and impaired psychomotor performance may occur. Avoid concomitant use of 3 or more CNS-active agents in any combination due to increased risk of falls. Use caution if prescribed in older adults as SIADH or hyponatremia may occur or be exacerbated. Monitor sodium levels when starting or changing doses.
Use with caution in those with conditions or diseases that alter hemodynamic response.
Hyponatremia, usually the result of SIADH, has occurred, especially in volume-depleted and elderly patients or with concurrent diuretic therapy; discontinue if symptoms develop.
Use with caution in those with conditions or diseases that alter metabolism or hemodynamic responses.
Bleeding events (including life-threatening hemorrhages), have been reported with SSRIs and serotonin norepinephrine reuptake inhibitors; increased risk possible with concomitant use of NSAIDs, aspirin, warfarin, and other anticoagulants.
Dosage adjustment may be necessary in patients with hepatic impairment.
Convulsions have been reported with therapy; use with caution in patients with a history of seizure disorder.
Worsening of angle-closure glaucoma may occur in patients with anatomically narrow angle without a patent iridectomy.
Increased risk of suicidal thoughts and behaviors in pediatric patients and young adults (18 to 24 years old), especially in those with major depressive disorder. Monitoring recommended, especially during the initial few months of therapy and at dosage changes; consider changing therapy or discontinuation if occurs.
Antidepressant therapy may trigger a mixed/manic episode in patients with underlying bipolar disorder; screening recommended.
Life-threatening serotonin syndrome has been reported, often during concurrent use with other serotonergic drugs (ie, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, amphetamines, tryptophan, St John's wort) or drugs than impair the metabolism of serotonin (ie, MAOIs, linezolid, methylene blue); monitoring recommended and discontinue if suspected.
Use with caution in patients with severe renal impairment.
Serious withdrawal symptoms upon abrupt discontinuation have been reported; monitoring and gradual withdrawal are recommended when possible.