Dosage and administration
Recommended dosage is 1-2 pills 1-3 times a day. If taken occasionally, the dosage is 1-2 pills. Maximum daily dose is 300mg. Geriatric patients and patients with renal insufficiency should take twice less.
- Decreased appetite
- Dry mouth
- May provoke seizures in patients with epilepsy
- Skin rash
- Muscle tension
- Hypersensitivity to Tofisopam or other benzodiazepines
- Conditions accompanied by severe depression, psychomotor agitation, and aggression
- Respiratory failure
- Pregnancy and lactation
- Sleep apnea
- Treatment with tacrolimus, sirolimus and/or cyclosporine
This drug should be taken with caution in patients with acute respiratory distress syndrome, angle-closure glaucoma, epilepsy and organic brain syndrome.
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Grandaxin ® (Tofisopam) is a non-sedating anxiolytic drug with unique pharmacological action.
Tofisopam was first synthesized in 1966 in Hungary, and is successfully used for anxiety management since 1970’s.
As of today, Grandaxin is used in 15 countries across the world, including Russia, Japan, Hungary and the Czech Republic. Although this drug is not approved for use in the North America, its R-enantiomer is in stage II clinical trials for the treatment of irritable bowel syndrome.
Grandaxin is a benzodiazepine tranquilizer; however, its pharmacological action differs from that of typical benzodiazepine derivatives. Tofisopam belongs to the 2,3-benzodiazepines family, a unique class of psychoactive substances also known as homophthalazines. Unlike 1,4- benzodiazepine derivatives (e.g Diazepam), Tofisopam does not have sedative and anticonvulsant properties and is not habit-forming.
Grandaxin does not impair cognitive functions; moreover, it has a mild stimulant action and is able to potentiate the effect of dopaminergic stimulants.
Tofisopam has a complicated mechanism of action. It does not bind to benzodiazepine receptors and has a limited affinity to the peripheral benzodiazepine receptors, but shown to improve the binding of 1,4-benzodiazepines to their receptors.
The drug acts as a PDE inhibitor with highest affinity to PDE-4A1, PDE-10A1, PDE-3 and PDE-2A3 which can be responsible for its moderate antipsychotic action.
Several studies suggest that the behavioral effects of Grandaxin are likely to be mediated through its effect on dopaminergic and opioid neurotransmission. Tofisopam appears to increase the sensitivity of dopamine receptors and modulate opioid signal transduction in the brain without the danger of addiction.
Tofisopam may increase the plasma concentration of the drugs metabolized by CYP3A4. Does potentiate the effects of CNS depressants (e.g analgesics, anesthetics, antidepressants, H1-antihistamines, sedatives and antipsychotics).
Hepatic enzyme inducers (alcohol, nicotine, barbiturates, anticonvulsants) may enhance the metabolism of Tofisopam, thus decreasing its efficacy.
Some antifungal drugs (Ketoconazole, Itraconazole) may inhibit the metabolism of Tofisopam and increase its concentration in blood plasma.
Some antihypertensive drugs (Clonidine, calcium channel blockers) may potentiate the effect of Tofisopam. Beta-blockers may inhibit the metabolism of the drug without affecting its efficacy significantly.
Tofisopam may increase plasma levels of Digoxin.
Benzodiazepines may affect the anticoagulant effect of warfarin.
Long-term treatment with disulfiram may inhibit the metabolism of Tofisopam.
Antacids may affect the absorption of Tofisopam. Omeprazole and Cimetidine does inhibit the metabolism of Tofisopam.
Oral contraceptives may inhibit the metabolism of Tofisopam.
Tofisopam does decrease the depressant effect of alcohol on the central nervous system.
- Varady et al (1975) The clinical evaluation of Grandaxin used in the treatment of outpatients (a multicentric study) https://www.ncbi.nlm.nih.gov/pubmed/7855
- Sladka et al (1978) Placebo controlled study with tofisopam in anxious neurosis https://www.ncbi.nlm.nih.gov/pubmed/32724
- A Bond, M Lader (1982) A comparison of the psychotropic profiles of tofisopam and diazepam https://www.ncbi.nlm.nih.gov/pubmed/6124424
- C Banki (1983) Comparative study with Grandaxin and diazepam in alcohol withdrawal syndrome and gerontopsychiatric diseases https://www.ncbi.nlm.nih.gov/pubmed/6152821
- Szego et al (1993) Excerpts from the clinical-pharmacologic and clinical studies of Grandaxin https://www.ncbi.nlm.nih.gov/pubmed/8100114
- Klebovich et al (1993) Pharmacokinetics and metabolism of tofizopam (Grandaxin) https://www.ncbi.nlm.nih.gov/m/pubmed/8100113/
- Kalashnikov et al (2002) Immunomodulating effects of tofizopam (Grandaxin) and diazepam in vitro https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781640/
- Baek et al (2002) Analysis of tofisopam in human serum by column-switching semi-micro high-performance liquid chromatography and evaluation of tofisopam bioequivalency https://www.ncbi.nlm.nih.gov/pubmed/11933029
- Eros et al (2002) A population-based case-control teratologic study of nitrazepam, medazepam, tofisopam, alprazolum and clonazepam treatment during pregnancy https://www.ncbi.nlm.nih.gov/pubmed/11858890
- Kato et al (2003) A case in which tofisopam was effective for treatment of paroxysmal supraventricular tachycardia https://www.ncbi.nlm.nih.gov/pubmed/12772593
- Arushanian et al (2004) Peculiarities in the effect of tofisopam and valerian extract on short-term memory and anxiety states in healthy humanshttps://www.ncbi.nlm.nih.gov/pubmed/15707009
- E Plotnikova, E Beloborodova (2005) Use of grandaxin in hypermotor dysfunction of the biliary ducts in young people https://www.ncbi.nlm.nih.gov/pubmed/17378391
- Rundfeldt et al (2010) The atypical anxiolytic drug, tofisopam, selectively blocks phosphodiesterase isoenzymes and is active in the mouse model of negative symptoms of psychosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993883/