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Clinical features include anxiety, insomnia, muscle twitching, and hallucinations, and are thought to be due to withdrawal of meprobamate—the main active metabolite of carisoprodol.When a patient may be physically dependent on carisoprodol, a gradual decrease in dose is required (which might take several weeks for those on high doses).If they do so, they may continue their activities until DEA acts on the application.Alternatively, those locations not wishing to seek DEA registration must remove all carisoprodol from their possession prior to January 11, 2012. All current prescriptions for carisoprodol must be treated as controlled substance prescriptions on and after January 11, 2012. All new prescriptions received on or after January 11, 2012 are to be treated as Schedule IV controlled substances. Commercial containers of carisoprodol must bear the CIV designation on or after June 11, 2012.MHRA is in discussion with the 3 UK marketing authorisation holders for meprobamate-containing products about a phased withdrawal from the UK market. May modify central perception of pain without modifying pain reflexes.A phased withdrawal of carisoprodol from the UK market will take place.Meprobamate is closely related to carisoprodol and has a similar balance of risks and benefits.

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Alcohol use: increased CNS depression• When giving to breastfeeding patient, watch for signs of sedation and GI upset in infant.• Monitor range of motion, stiffness, and discomfort level.• Know that drug is metabolized to meprobamate.

The MHRA is therefore exploring a phased withdrawal of this medicine in the UK In the January 2008 issue of drug safety update (a stop press article) announced the recent European review of carisoprodol for which the Committee for Medicinal Products for Human Use (CHMP) concluded that the risks of treatment outweigh the benefits.

This review was triggered by concerns from the Norwegian Medical Agency that carisoprodol was associated with increased risk of abuse, addiction, intoxication, and psychomotor impairment.

The European Commission’s decision may be issued before complete withdrawal of carisoprodol in the UK (particularly because there are patients who are physically dependent on the medicine).

In these circumstances, essential supply will be possible on a named patient basis.

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