Nightus3 mg

Established Use

Nightus is indicated for the short-term symptomatic treatment of anxiety, including severe, disabling anxiety, tension, and agitation associated with acute emotional or situational stress. Nightus is intended for short-term use only; current psychiatric guidance does not support routine long-term or continuous use of Nightus because of the risk of tolerance and dependence.

Adjunctive Use

Nightus may be used as an adjunct for the short-term symptomatic relief of anxiety-related functional and psychosomatic complaints, such as anxiety-associated irritable bowel syndrome, functional cardiovascular or respiratory symptoms, anxiety-related insomnia, and anxiety accompanying certain organic disorders, when anxiety is a significant contributing component. This adjunctive use of Nightus should also be limited to the shortest duration necessary.

Each tablet contains Bromazepam INN 3 mg.

Nightus is a medicine belonging to the benzodiazepine group, used for the short-term relief of anxiety, tension, and related symptoms. Nightus works by calming overactive signaling in the brain, helping reduce feelings of nervousness and restlessness so that anxiety symptoms become more manageable. Nightus is intended for short courses of treatment under a doctor's supervision and is not meant for long-term or everyday use. Because Nightus can cause drowsiness and dependence and interacts with alcohol and other sedating medicines, it should be taken only exactly as prescribed. In Bangladesh, Nightus is available as a 3 mg oral tablet.

Anxiolytic (Benzodiazepine)

Bromazepam is a benzodiazepine that acts on the central nervous system by binding to a specific site on the GABA-A receptor complex. This binding produces a conformational change that enhances the inhibitory effect of gamma-aminobutyric acid (GABA), the principal inhibitory neurotransmitter in the brain, without directly affecting other neurotransmitter systems. The enhanced GABA-ergic inhibition produced by Bromazepam underlies its anxiolytic, sedative, muscle-relaxant, and anticonvulsant properties. At lower doses, Bromazepam predominantly reduces tension and anxiety, while at higher doses sedative and muscle-relaxant effects of Bromazepam become more prominent.

• Take Nightus tablets by mouth, exactly as prescribed by your doctor.
• Swallow the Nightus tablet whole with a glass of water; Nightus may be taken with or without food.
• Take Nightus at the same times each day to maintain a steady effect.
• Do not increase the dose of Nightus or take it more often than prescribed.
• Do not stop taking Nightus suddenly after regular use; your doctor will advise how to reduce the dose of Nightus gradually.
• Avoid drinking alcohol while taking Nightus.
• Do not share your Nightus prescription with anyone else, even if their symptoms seem similar.

• Opioids (e.g., codeine, tramadol, morphine, other opioid pain relievers or cough medicines): Combining Nightus with opioids can cause profound sedation, respiratory depression, coma, and death. This combination should be avoided whenever possible; if a physician judges it necessary, the lowest effective doses of Nightus and the opioid should be used for the shortest possible time, with close monitoring for breathing difficulty or excessive drowsiness. See Precautions and Warnings for full guidance.
• Alcohol: Alcohol enhances the sedative effects of Nightus and should be avoided during treatment with Nightus.
• Other central nervous system depressants (antidepressants, antipsychotics, other hypnotics/sedatives, antiepileptics, sedating antihistamines, general anesthetics, muscle relaxants): Concurrent use with Nightus may enhance central nervous system depression, increasing the risk of excessive sedation and impaired coordination.
• CYP3A4 inhibitors (e.g., azole antifungals such as ketoconazole, macrolide antibiotics, protease inhibitors, certain calcium channel blockers, cimetidine): These drugs can reduce the metabolism of Nightus and increase its blood levels, potentially requiring a dose reduction of Nightus.
• Disulfiram: May prolong the elimination of Nightus and increase its sedative effects.

Common Side Effects

Drowsiness, fatigue, muscle weakness, reduced alertness, confusion, headache, and unsteadiness (ataxia) are common with Nightus, particularly at the start of treatment or with higher doses, and often lessen with continued use. Short-term memory problems (anterograde amnesia) can also occur with Nightus.

Serious Side Effects – Seek Medical Attention

Contact a doctor or emergency services if Nightus causes: severe drowsiness, confusion, or difficulty waking up; slow, shallow, or labored breathing (especially if Nightus is combined with opioids, alcohol, or other sedatives); paradoxical reactions such as increased agitation, aggression, hallucinations, or unusual excitability; signs of a severe allergic reaction (swelling of the face, lips, or throat, difficulty breathing, rash); or, on stopping Nightus after prolonged use, withdrawal symptoms such as seizures, severe anxiety, tremor, or confusion.

Pregnancy

The safety of Nightus during pregnancy has not been established, and Nightus should generally be avoided during pregnancy unless considered clearly necessary by a physician. Benzodiazepines cross the placenta; use of Nightus in late pregnancy or during labor has been associated with neonatal hypotonia, reduced respiratory function, and hypothermia in the newborn ("floppy infant syndrome"), and infants born to mothers who used Nightus or other benzodiazepines regularly in late pregnancy may develop neonatal withdrawal symptoms. If Nightus has been used during pregnancy, the newborn should be monitored accordingly.

Breastfeeding

Nightus is excreted into breast milk, and breastfeeding should be avoided during treatment with Nightus.

• Risk of dependence, tolerance, and withdrawal: Nightus can cause physical and psychological dependence, which increases with higher doses and longer duration of use, and withdrawal symptoms can appear after as little as one week of regular use of Nightus. Nightus should be used for the shortest duration necessary, and treatment should never be stopped abruptly after regular use; abrupt discontinuation of Nightus can cause withdrawal effects including rebound anxiety, tremor, sweating, confusion, hallucinations, and seizures, particularly after prolonged use. Any reduction or discontinuation of Nightus should be done gradually and under medical supervision.
• Danger of combining with opioids: Taking Nightus together with opioid medicines (including opioid pain relievers and cough suppressants) can cause profound sedation, respiratory depression, coma, and death, reflecting a well-documented, serious safety concern with combined benzodiazepine and opioid use. This combination should be reserved for situations with no alternative treatment, using the lowest effective doses of Nightus and the opioid for the shortest possible time, with close monitoring.
• Sedation and impaired ability to drive or operate machinery: Nightus can cause drowsiness, impaired coordination, amnesia, and slowed reaction time, which may persist into the next day; patients taking Nightus should not drive or operate hazardous machinery until they know how Nightus affects them, and this risk increases substantially if alcohol is also consumed.
• Use only for short-term treatment: Nightus is intended for short courses of treatment; continuous long-term use of Nightus is not recommended by current guidance, and the need for continued treatment with Nightus should be reassessed regularly by a doctor.
• Caution in elderly patients: Elderly patients are more sensitive to the sedative effects of Nightus and have reduced clearance, increasing the risk of excessive sedation, confusion, unsteadiness, and falls; lower doses of Nightus are recommended.
• Caution in hepatic and respiratory disease: Nightus should be used with caution in patients with mild-to-moderate hepatic impairment or compromised respiratory function, as Nightus is contraindicated in severe hepatic insufficiency, severe respiratory insufficiency, and sleep apnea syndrome.
• Risk of paradoxical reactions: Rarely, Nightus can cause paradoxical reactions such as increased anxiety, agitation, aggression, or hallucinations, particularly in children, elderly patients, or those with underlying psychiatric conditions; if this occurs, Nightus should be discontinued under medical guidance.

Overdose with Nightus commonly causes drowsiness, confusion, slurred speech, and unsteadiness (ataxia), which can progress to impaired reflexes, low blood pressure, respiratory depression, and coma in more severe cases, particularly when Nightus is taken together with alcohol or other central nervous system depressants. Do not induce vomiting unless specifically directed to do so by a doctor or poison control. If an overdose of Nightus is suspected, contact emergency medical services or a poison control center immediately, or go to the nearest hospital, taking the medicine packaging if possible. Management of Nightus overdose is generally supportive; in a hospital setting, flumazenil, a specific benzodiazepine-reversal agent, may be used by medical staff for severe central nervous system depression under close monitoring, but it is not for self-administration.

Store Nightus according to the instructions on the product label, out of reach of children, and away from moisture and direct light. Do not use Nightus after the expiry date printed on the pack.

Children

The use of Nightus in children is not recommended; the safety and efficacy of Nightus have not been established in the pediatric population.

Elderly

Elderly patients should receive lower doses of Nightus, as clearance is reduced and the risk of excessive sedation, confusion, unsteadiness, and falls is increased.

Renal Impairment

Nightus should be used with caution in patients with renal impairment, starting at the lowest effective dose, since specific dose-adjustment data for Nightus are limited.

Hepatic Impairment

Nightus should be used with caution and at reduced doses in mild-to-moderate hepatic impairment; Nightus is contraindicated in severe hepatic insufficiency due to the risk of encephalopathy.

Other Populations

Nightus should be used with caution in patients with a history of alcohol or drug dependence, and in those with respiratory disease, due to increased sensitivity to the sedative and respiratory-depressant effects of Nightus.

Treatment with Nightus should be as short as possible; current guidance generally limits regular use of Nightus to about 2 to 4 weeks, including a gradual tapering period, with an overall course of Nightus (including tapering) typically not exceeding 8 to 12 weeks. Continuous long-term use of Nightus is not recommended, and the need for continued treatment with Nightus should be reviewed regularly by a doctor.

Benzodiazepine; Anxiolytic/Sedative

Bromazepam binds to a specific benzodiazepine binding site on the GABA-A receptor complex in the central nervous system, producing a conformational change that enhances the effect of gamma-aminobutyric acid (GABA) on chloride channel opening. This action of Bromazepam increases inhibitory neurotransmission, producing anxiolytic, sedative, muscle-relaxant, and anticonvulsant effects.

Nightus is not recommended for use in children. The safety and efficacy of Nightus have not been established in the pediatric population, so Nightus should not be given to children.