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Advisory – Updates to safety labelling for benzodiazepines and benzodiazepine-like drugs

October 30, 2020
By Health Canada;Government of Canada;
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OTTAWA, ON, Oct. 30, 2020 /CNW/ –

Summary

Product: Benzodiazepines and benzodiazepine-like prescription drugs used to treat sleep and anxiety disorders, certain seizure disorders, and to help relax muscles or relieve muscle spasms.

Issue: Health Canada is working with Market Authorization Holders to update the safety labelling for these drugs to provide patients and healthcare professionals with prominent and consistent messaging about the severe and potentially life-threatening risks associated with these drugs.

What to do: Patients should discuss any questions or concerns about this safety information with their healthcare professional.

Benzodiazepines and benzodiazepine-like prescription drugs (commonly referred to as “Z-drugs)—commonly used to treat sleep and anxiety disorders, certain seizure disorders, and to help relax muscles or relieve muscle pain—can lead to problematic use and substance use disorder. To help mitigate these risks, Health Canada is asking manufacturers to update their safety warnings to include more prominent and consistent messaging for patients and healthcare professionals.

The update requested by Health Canada includes language around the risks of:

  • problematic use and substance use disorder;
  • severe withdrawal symptoms;
  • harm when taken with opioids, which may cause deep drowsiness, respiratory depression, coma and death; and
  • falls and fractures in specified populations.

The update includes labelling to reflect that problematic use of these medications can result in overdose or death, especially when combined with other medicines.

The update also contains information to address the risk of severe and life-threatening withdrawal symptoms that can result from abrupt discontinuation or rapid dose reduction.

The Government of Canada is committed to a broad range of activities to help address Canada’s opioid crisis in the areas of prevention, treatment, harm reduction, and enforcement. As part of this commitment, Health Canada is working to strengthen the labelling of benzodiazepines and benzodiazepine-like drugs to better reflect the serious risks when used with opioid drugs.

Impacted Products

Product Name

Active Ingredient(s)

Formulation

DIN

Company

RIVOTRIL 0.5 TAB

RIVOTRIL 2.0 TAB

Clonazepam

Tablet

00382825, 00382841

Hoffman-La Roche Limited

DIASTAT

Diazepam

Gel

02238162

Valeant Pharmaceuticals North America Llc.

DIAZEPAM 2MG TABLETS, DIAZEPAM 5MG TABLETS, DIAZEPAM 10MG TABLETS

Diazepam

Tablet

02232737,
02232749,
02232751

Laboratoires Confab Inc.

DIAZEPAM INJECTION USP

Diazepam

Solution

00399728

Sandoz Canada Inc.

VALIUM 5.0 TAB

Diazepam

Tablet

00013285

Hoffman-La Roche Limited

BIO-DIAZEPAM

Diazepam

Tablet

02247173,
02247174,
02247176

Biomed Pharma

ATIVAN

Lorazepam

Tablet

02041413, 02041421, 02041448, 02041456, 02041464, 02041472

Pfizer Canada Ulc.

LORAZEPAM INJECTION USP

Lorazepam

Solution

02438704

Sandoz Canada Inc.

 

XANAX, XANAX TAB 0.5MG, XANAX TAB 1MG, XANAX TS

Alprazoalm

Tablet

00548359, 00548367, 00723770,  00813958

Upjohn Canada Ulc.

CHLORDIAZEPOXIDE

Chlordiazepoxide hydrochloride

 

Capsule

00522724, 00522988, 00522996

AA Pharma Inc.

CHLORAX

Chlordiazepoxide hydrochloride – clinidium bromide

Capsule

00618454

AA Pharma Inc.

LIBRAX

Chlordiazepoxide hydrochloride – clinidium bromide

Capsule

00115630

Bausch Health Canada Inc.

APO-CLOBAZAM

Clobazam

Tablet

02244638

Apotex Inc.

FLURAZEPAM

Flurazepam HCl

Capsule

00521698, 00521701

AA Pharma Inc.

FLURAZEPAM 15MG CAP, FLURAZEPAM 30MG CAP

Flurazepam HCl

Capsule

02232656,
02232657

Laboratoires Confab Inc.

SOM-PAM

Flurazepam HCl

Capsule

00414220, 00414239

Biomed Pharma

OXAZEPAM 10MG TAB, OXAZEPAM 15 MG TAB, OXAZEPAM 30MG TAB

Oxazepam

Tablet

02232721,
02232727,
02232732

Laboratoires Confab Inc.

OXPAM

Oxazepam

Tablet

00414247, 00414255,
00414263

Biomed Pharma

MOGADON

Nitrazepam

Tablet

00511528, 00511536

AA Pharma Inc.

TRIAZOLAM

Triazolam

Tablet

00808571

AA Pharma Inc.

RESTORIL

Temazepam

Capsule

00604453, 00604461

AA Pharma Inc.

IMOVANE

Zopiclone

Tablet

02216167,
01926799

Sanofi-Aventis Canada Inc.

SUBLINOX

Zolpidem Tartrate

Tablet

02370433, 02391678

Bausch Health Canada Inc.

ZOLPIDEM TARTRATE ODT

Zolpidem Tartrate

Tablet

02439646,
02439638

Valeant Canada LP/Valeant Canada S.E.C.

STARNOC

Zaleplon

Capsule

02297124,02297132

Pfizer Canada Ulc.

LUNESTA

Eszopiclone

Tablet

02453207, 02453215, 02453223

Sunovion Pharmaceuticals Canada Inc.

TEVA-BROMAZEPAM

Bromazepam

Tablet

02230584, 02230585

Teva Canada Limited

CLORAZEPATE

Clorazepate dipotassium

Capsule

00860689, 00860700,
00860697

AA Pharma Inc.

PMS-FLURAZEPAM CAP 15MG

Flurazepam HCl

Capsule

00667102

Pharmascience Inc

MIDAZOLAM INJECTION

Midazolam

Solution

02240285, 02240286

Sandoz Canada Incorporated

MIDAZOLAM INJECTION SDZ

Midazolam

Solution

02382873, 02382903

Sandoz Canada Incorporated

What Health Canada is doing:
Health Canada is issuing specific instructions to all Market Authorization Holders (MAH) of the impacted products to request these updates.

Information for patients:

  • Consult with your doctor or pharmacist if you have any questions or concerns regarding treatment with benzodiazepines or benzodiazepine-like drugs (commonly referred to as “Z-drugs”).
  • Report any health product adverse events or health product complaint to Health Canada.
  • Use benzodiazepines and all medicines exactly as prescribed by your healthcare professional.
  • Store medications securely by keeping products in their original containers; in a cool, dry area, away from the sun; and out of the reach of children.
  • Visit Health Canada’s website for information on benzodiazepines.

Information for healthcare professionals:

  • Assess a patient’s condition, other medicines taken and the risk of problematic use and substance use disorder prior to prescribing.
  • Reserve concomitant prescribing of benzodiazepines and opioids to patients for whom alternative treatment options are not possible.
  • Limit dosages and durations to the minimum required.
  • Monitor patients for signs and symptoms of respiratory depression and sedation.
  • Avoid abrupt discontinuation or rapid dose reduction. Gradually taper to reduce the dose or to discontinue the medication.

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