'''Meprobamate''' (marketed under the brand names '''Miltown'''® by Wallace Laboratories, '''Equanil'''® by Wyeth, and '''Meprospan®''') is a [[carbamate]] derivative which is used as an [[anxiolytic]] drug. It was the best-selling minor tranquilizer for a time, but has largely been replaced by the [[benzodiazepine]]s.
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There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
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|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
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==History==
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Meprobamate was first synthesized by Bernie Ludwig at Carter Products in May 1950. Wallace Laboratories bought the license and named it Miltown after the village [[Milltown, New Jersey|Milltown]] in [[New Jersey]]. Launched in 1955, it rapidly became a best seller and famous in the popular media as "Happy Pills".{{Fact|date=September 2007}}
A December [[1955]] study of 101 patients at the Mississippi State Hospital in Whitfield, Mississippi, found Meprobamate useful in the alleviation of ''mental symptoms''. 3% of the patients made a complete recovery, 29% were greatly improved, and 50% were somewhat better. 18% realized little change. Self-destructive patients became cooperative and calmer, and experienced a resumption of logical thinking. In 50%
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of the cases relaxation brought about more favorable sleep habits. [[Hydrotherapy]] and all types of [[shock treatment]] were halted.<ref>''New Hope Arises On Cancer Serum'', New York Times, December 28, 1955, Page 21.</ref> Meprobamate was found to help in the treatment of alcoholics by [[1956]].<ref>''Alcohol Peril Found In Drugs'', [[New York Times]], April 1, 1956, Page 28.</ref>
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Dr. Frank Berger, clinical director of Wallace Laboratories, described it as a relaxer of the [[central nervous system]], whereas other
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[[tranquilizers]] suppressed it. A [[University of Michigan]] study found that Meprobamate affected driving skills. Patients reported being able to relax more even though they continued to feel tense. The disclosures came at a special scientific meeting at the Barbizon Plaza Hotel in [[New York City]]. [[Aldous Huxley]] addressed an evening session. He predicted the development of many
chemicals ''capable of changing the quality of human consciousness'', in the next few years.<ref>''Behavior Drugs Now Envisioned'', New York Times,
October 19, 1956, Page 29.</ref>
Miltown was sometimes referred to incorrectly as [[Chlorpromazine]]. One such instance of this was a review by author [[Frank Slaughter]] of the book, ''A Man Against Insanity'', by [[Paul de Kruif]].<ref>''Letters To The Editor: Drugs'', New York Times, April 7, 1957, Page 263.</ref>
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In January [[1960]] Carter Products, Inc., makers of Miltown and American Home Products Corporation, which marketed Equinal, were charged with having conspired to monopolize the market in mild tranquilizers. It was revealed that in [[1948]] the sale of Meprobamate earned $40,000,000 for the defendants. Of this amount American Home Products accounted for approximately 2/3 and Carter about 1/3. The U.S. Government sought an
order mandating that Carter make its Meprobamate patent available at no charge to any company desiring to use it.<ref>''Trust Suit Names 2 Drug Concerns'', New York Times, January 28, 1960, Page 1.</ref>
In April [[1965]] Meprobamate was removed from the list of tranquilizers when experts ruled that the drug was a [[sedative]] instead. U.S. Pharmacopoeia published the ruling. At the same time the [[Medical Letter]] disclosed that Meprobamate could be addictive ''at dosage levels not much above recommended.''<ref>''Miltown Off List Of Tranquilizers'', New York Times, April 22, 1965, Page 34.</ref> In December [[1967]] Meprobamate was placed under abuse control amendments to the [[Food, Drug and Cosmetic Act]]. Records on production and distribution were required to be kept. Limits were placed on prescription duration and refills.<ref>''Tranquilizer Is Put Under U.S. Curbs; Side-Effects Noted'', New York Times, December 6, 1967, Page 35.</ref>
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
Production continued throughout the 1960s but by 1970 it was listed as a controlled substance after it was discovered to cause physical and psychological dependence.
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==Pharmacology==
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Although it was marketed as being safer, meprobamate has most of the pharmacological effects and dangers of the [[barbiturate]]s (though it is less sedating at effective doses). It is reported to have some anticonvulsant properties against absence seizures, but can exacerbate generalized tonic-clonic seizures.
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Meprobamate's mechanism of action is not known. It has been shown in animal studies to have effects at multiple sites in the central nervous system, including the [[thalamus]] and [[limbic system]]. Meprobamate binds to [[GABA A receptor]]s which interrupt neuronal communication in the [[reticular formation]] and [[spinal cord]], causing sedation and altered perception of pain.
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Related drugs include [[carisoprodol]] (a [[prodrug]] of meprobamate) and tybamate.
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==Indications==
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Meprobamate is used for treatment of anxiety disorders or for short-term relief of anxiety.
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It has also been used [[off-label]] as a [[sedative]]. However, it is currently only licensed as an anxiolytic, and is not used as often as the benzodiazepines for this purpose.
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|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Meprobamate is available in 200mg and 400mg tablets for oral administration. Meprobamate is also a component of the combination drug [[Equagesic]] (discontinued in the UK in 2002) acting as a [[muscle relaxant]].
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==Overdose==
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Symptoms of meprobamate overdose include: coma, drowsiness, loss of muscle control, severely impaired breathing, shock, sluggishness, and unresponsiveness. Death has been reported with ingestion of as little as 12g of meprobamate and survival with as much as 40g.
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==Legal Issues==
Meprobamate is a [[Schedule IV]] drug under the [[Convention on Psychotropic Substances]].
Meprobamate may cause GI concretions in overdose; therefore, charcoal should be considered even after 4 hours or if levels are rising.
==Trivia==
{{Trivia|date=September 2007}}
Meprobamate was the first drug ever used to lower high blood pressure or [[hypertension]]; however, it was later replaced by better drugs like [[metoprolol]] which do not make the patient sleepy.
Outed CIA Russian spy Aldrich H. Ames was reported in the Feb. 27, 1994 edition of The Washington Post as saying that taking 400mg of Meprobamate was an effective method for 'cheating' a polygraph (lie detector) test.<ref>http://www.csicop.org/klassfiles/SUN-50.html</ref>
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[[Maude]] Findlay, played by [[Bea Arthur]] in the 1970's sitcom ''Maude'' announced that she had taken two Miltown before giving a dinner party during an episode in the first season of the program.
==References==
<references/>
* Barondes, Samuel H. ''Better Than Prozac''. New York: Oxford University Press, 2003. ISBN 0-19-515130-5.
* ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac'' by Edward Shorte. John Wiley and Sons.
* [http://www.incb.org/pdf/e/list/green.pdf List of psychotropic substances under international control].
* [http://ctd.mdibl.org/voc.go?voc=chem&termUI=Meprobamate The Comparative Toxicogenomics Database: Meprobamate].
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Black Box Warning
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See full prescribing information for complete Boxed Warning.
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Overview
Meprobamate is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .
Adult Indications and Dosage
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Off-Label Use and Dosage (Adult)
Guideline-Supported Use
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There is limited information regarding Off-Label Guideline-Supported Use of Meprobamate in adult patients.
Non–Guideline-Supported Use
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There is limited information regarding Off-Label Non–Guideline-Supported Use of Meprobamate in adult patients.
Pediatric Indications and Dosage
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There is limited information regarding FDA-Labeled Use of Meprobamate in pediatric patients.
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There is limited information regarding Off-Label Non–Guideline-Supported Use of Meprobamate in pediatric patients.
Contraindications
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See full prescribing information for complete Boxed Warning.
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Content
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Clinical Trials Experience
There is limited information regarding Clinical Trial Experience of Meprobamate in the drug label.
Body as a Whole
Cardiovascular
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Endocrine
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Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
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Miscellaneous
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Meprobamate in the drug label.
