Europe Cleans the Medicine Cabinet

The European Medications Agency is banning meprobamate and meprobamate-containing medications from the sale in Europe, after concluding that the risks from the medication exceed the therapeutic benefit. The removal comes six months after a decision by the same agency to suspend authorization for all marketing for the medication.  I have not read of any similar action by the FDA, the US agency responsible for medication approvals.

Meprobamate is a 1960’s-era medication, indicated for treating anxiety and muscle tension.  The medication was a blockbuster hit when first introduced, used to treat a range of symptoms and disorders under the brand name Miltown.  I don’t know offhand if that drug is still produced under that name, or whether all meprobamate is now sold as generic in this country.  Meprobamate was also a part of several combination medications used to treat pain and muscle tension.

Miltown, as well as Valium (diazepam) and Quaalude (methaqualone), were largely prescribed to calm the nerves of the middle class, as they freaked out to news reports of the younger generation who used the same drugs to turn on, tune in, and drop out (a phrase coined by Timothy Leary at the 1967 Human Be-In.  Man, I’m so bummed that I missed that groovy scene…   Meprobamate has some unique problems that allowed benzodiazepines to become more popular.  Meprobamate was first thought to be non-addictive, but clinical experience proved that was not the case (sound familiar?). Meprobamate is lethal in overdose, and the toxic dose varies considerably from one person to another.  After long-term use, sudden cessation of meprobamate can cause grand mal seizures and death.

Miltown is stashed in many of the medicine cabinets of today’s grandmothers and great-grandmothers.  I have not prescribed meprobamate, but I have prescribed a similar medication, carisoprodol (brand name Soma) that is largely converted to meprobamate in the human body.  Meprobamate, like Soma, reduces muscle tension, anxiety, and pain through mechanisms that are not entirely understood, but that likely involve the GABA receptor complex—the same receptors where alcohol, benzodiazepines and barbiturates have their effects.

Methaqualone, by the way, was another popular anxiety treatment in the late 1960’s and early 1970’s, with effects similar to meprobamate and benzodiazepines.  Methaqualone fell out of favor after becoming a schedule II drug in 1973 in response to widespread abuse, and was banned in the mid-1980’s.   Quaaludes had a unique ability to introduce human faces to pavement.  When I was in college, people could tell whether Quaaludes were around because of the number of people using crutches when the drug was available.

Out of the big three classes of sedatives in the 1960’s, only benzodiazepines continue to be prescribed in large amounts.   Benzodiazepines remain popular even as they now contribute to the cause of death in most drug overdoses in the US.  While useful for short-term crises, I’m convinced that society would be better off if benzodiazepines were dumped in the same ash-bin of history as Quaaludes and Miltown.

Thoughts?

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