Meprobamate

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 It was the best-selling minor tranquilizer for a time, but has largely been replaced by the benzodiazepines.

History
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 in New Jersey. Launched in 1955, it rapidly became a best seller and famous in the popular media as "Happy Pills".

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% of the cases relaxation brought about more favorable sleep habits. Hydrotherapy and all types of shock treatment were halted. Meprobamate was found to help in the treatment of alcoholics by 1956. Dr. Frank Berger, clinical director of Wallace Laboratories, described it as a relaxer of the central nervous system, whereas other 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.

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. 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.

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. 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.

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.

Pharmacology
Although it was marketed as being safer, meprobamate has most of the pharmacological effects and dangers of the barbiturates (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.

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 receptors which interrupt neuronal communication in the reticular formation and spinal cord, causing sedation and altered perception of pain.

Related drugs include carisoprodol (a prodrug of meprobamate) and tybamate.

Indications
Meprobamate is used for treatment of anxiety disorders or for short-term relief of anxiety.

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.

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.



Overdose
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.

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
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.

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.