Benzodiazepines

Alprazolam

Brand Name (Manufacturer)

Xanax (Upjohn)

Type of Drug

Psychoactive-antianxiety agent

Used For

Alprazolam is used primarily for short-term relief of anxiety. It is also effective for treating anxiety associated with depression and for the treatment of panic disorders.

General Information

Alprazolam belongs to a class of psychoactive drugs called benzodiazepines. Benzodiazepines are the most commonly used antianxiety drugs because they are fairly safe; they rapidly reduce the symptoms of anxiety, and they don't have to be taken on an ongoing basis in order to be effective. All benzodiazepines cause dose-related suppression of the central nervous system, varying from slight impairment to hypnosis.

Alprazolam is available in tablets for oral administration.

Treatment

In general, the minimum effective dose of the drug should be used. For treatment of symptoms of anxiety, 0.25 to 0.5 mg taken three to four times a day is the usual starting dosage. The dose may be increased, if necessary, at intervals of three to four days. The maximum daily dose is 4 mg.

When discontinuing the drug, it is recommended that the daily dose be decreased by no more than 0.5 mg every three days to avoid withdrawal symptoms. Some people may require an even slower dose reduction.

Treatment of panic is usually started at 0.5 mg taken three times a day, but may require more than 4 mg per day. In clinical studies, participants have used dosages up to 10 mg per day, but the appropriate dose must be determined for each individual by starting at a low dose and slowly increasing until the desired effect is observed (as long as the drug is tolerated without serious side effects). After a period free of attacks, a carefully controlled dosage reduction and weaning may be attempted.

Cautions and Warnings

Alprazolam should not be used by people with a known allergy to it or people who have glaucoma. The drug depresses the central nervous system, so it may not be appropriate to operate heavy machinery or drive a motor vehicle when taking it.

Like other benzodiazepines, alprazolam can be dangerous when taken with alcohol. Alcohol intensifies the depressive effect of benzodiazepines.

All benzodiazepines are habit-forming, and alprazolam is particularly likely to be addictive, even after relatively short-term use at the recommended doses. This usually means that, over time, increasing doses are needed to achieve the same effect. This differs from person to person, but in general, after several months of use, addiction is common. The risk of dependency seems to be higher in people treated with relatively high doses (greater than 4 mg per day) and in those treated for more than eight to twelve weeks. Because treatment of panic disorder often requires doses over 4 mg per day, the risk of dependence among these people is greater than that for those treated for anxiety. Withdrawal reactions may occur when dosages of the drug are reduced for any reason.

Early-morning anxiety, a type of withdrawal reaction that occurs in between doses, has been observed in people with panic disorder taking prescribed amounts of the drug.

Side Effects

Side effects of the drug usually appear at the beginning of therapy and usually disappear upon continued medication. Most often the side effects include drowsiness, light-headedness, or dizziness. More serious side effects, although reported rarely, are seizures, hallucinations, taste alteration, double vision, liver toxicity, and jaundice.

Withdrawal symptoms include insomnia, headache, anxiety, fatigue, irritability, difficulty thinking or remembering, nausea, vomiting, diarrhea, weight loss, sweating, and rapid heartbeat.

Pregnancy/Breast-Feeding

Benzodiazepines, including alprazolam, can cause birth defects when taken during pregnancy. Taken late in pregnancy, they may increase the risk that the baby will be born dependent on the drug. Pregnant women should avoid using alprazolam.

HIV can be passed from a woman to her child through breast milk. In areas where nutritional alternatives are readily available, breast-feeding is discouraged for HIV-positive women. Benzodiazepines are excreted in human milk and can cause serious effects in infants. Because of the potential toxicity of the drug, women should consider alternatives to breast-feeding while taking the drug.

Use In Children

The safety and effectiveness of alprazolam in children under eighteen have not been studied.

Use in the Elderly

Elderly or debilitated people may be particularly susceptible to side effects of alprazolam. The starting dose for them is usually 0.25 mg two or three times a day. The dose may be gradually increased if needed and tolerated.

Drug Interactions

Oral contraceptives and cimetidine may increase the concentration of alprazolam in the blood and potentially increase the risk of side effects. Benzodiazepines intensify the central nervous system depression caused by other psychoactive medications, anticonvulsants, antihistamines, and alcohol.

Alprazolam increases levels of imipramine and desipramine in the body, potentially increasing the risk of side effects.

Food Interactions

Alprazolam is absorbed into the body most effectively when taken on an empty stomach, but it can be taken with food if necessary.

Other Drugs Used for Similar Conditions

Many different benzodiazepines are available by prescription. They include lorazepam, diazepam, chlordiazepoxide, oxazepam, temazepam, flurazepam, and triazolam. The drugs differ somewhat in the side effects they produce, their potencies, the time it takes for them to work, and the tendency for them to cause withdrawal symptoms.

Buspirone is an antianxiety medication that is not part of the benzodiazepine class. It is not addictive or sedating and has less tendency to slow down mental and physical reactions. On the other hand, it is not effective for many people.

Chlordiazepoxide

Brand Names (Manufacturers)

Libritabs (Roche); Librax (Roche); Librium (Roche)

Type of Drug

Psychoactive-antianxiety agent

Used For

Chlordiazepoxide is used for the short-term relief of anxiety. It is also used to treat withdrawal symptoms of alcoholism and to prevent apprehension and anxiety.

General Information

Chlordiazepoxide was the first of a class of psychoactive drugs called benzodiazepines. Benzodiazepines are the most commonly used antianxiety drugs because they are fairly safe, they rapidly reduce symptoms of anxiety, and they don't have to be taken on an ongoing basis to be effective.

Chlordiazepoxide or other benzodiazepines are appropriate for short-term use in people experiencing extreme stress or anxiety.

Chlordiazepoxide is available as tablets for oral administration.

Treatment

The optimum dosage of chlordiazepoxide is determined by the diagnosis and the age and condition of the individual. For anxiety, the oral drug is generally used at 5 to 25 mg three or four times daily. The upper range is usually reserved for relief of severe anxiety disorders. Elderly people and children generally take lower doses: an initial dose of 10 mg or less per day is common.

The injectable form of the drug is preferred for treating withdrawal symptoms of acute alcoholism. The adult dosage is 50 to 100 mg injected into a muscle or given intravenously, repeated in two to four hours as necessary. When used for simple anxiety, the initial dose of the injectable is 50 to 100 mg initially, then reduced to 25 to 50 mg three or four times daily if necessary. Dose reductions are usually required for children and for elderly and/or debilitated people.

Cautions and Warnings

Chlordiazepoxide should not be used by anyone with a known allergy to it. The drug depresses the central nervous system, so it may not be appropriate to operate heavy machinery or drive a motor vehicle when taking it.

Like other benzodiazepines, chlordiazepoxide can be dangerous when taken with alcohol, because alcohol intensifies the depressive effect of benzodiazepines.

Taking chlordiazepoxide can be habit-forming. It appears that physical or psychological dependency may require several months of daily use, but dependency can sometimes occur much sooner. Rapid withdrawal after long-term use can lead to increased anxiety, insomnia, tremors, and in severe cases, seizures.

Side Effects

The most common side effects of chlordiazepoxide include drowsiness, confusion, and loss of balance, especially among elderly or debilitated people. Less commonly, people experience constipation, depression, headache, low blood pressure, incontinence, jaundice, changes in sex drive, nausea, changes in salivation, skin rash, and in women, menstrual irregularities.

For people who use the drug routinely, periodic blood counts and liver function tests are recommended because both an increase or decrease in white blood cell count may occur after use of the drug.

Pregnancy/Breast-Feeding

Chlordiazepoxide has not been formally studied in pregnant women. There is some evidence that it increases the risk of fetal deformities when used during the first trimester of pregnancy. Taken later in pregnancy, it may increase the risk that the baby will become addicted to it. Pregnant women are encouraged to discuss the benefits and potential risks of using chlordiazepoxide with their physician before deciding whether or not to use the drug.

HIV can be passed from a woman to her child through breast milk. In areas where nutritional alternatives are readily available, breast-feeding is discouraged for HIV-positive women. Chlordiazepoxide is excreted in human milk and can cause serious side effects in infants. Because of the potential toxicity of the drug, women should consider alternatives to breast-feeding while taking it.

Use In Children

Because there is little information about the safety and effectiveness of the drug for them, the oral form of the drug is not recommended in children under six years of age, and the injectable is not recommended for children under twelve.

Use in the Elderly

Elderly or debilitated people should receive the smallest effective dosage. Ten milligrams or less per day is recommended for initial treatment, only to be increased gradually as needed and tolerated.

Drug Interactions

Chlordiazepoxide may decrease the effectiveness of carbamazepine, levodopa, and oral anticoagulants such as warfarin. It may increase the effects of phenytoin. Disulfiram, oral contraceptives, isoniazid, and cimetidine can increase the blood levels of chlordiazepoxide, potentially increasing the risk of side effects. Rifampin may decrease the effectiveness of chlordiazepoxide.

Food Interactions

Chlordiazepoxide is absorbed most effectively into the body when taken on an empty stomach, but if necessary, it can be taken with food to minimize stomach upset.

Other Drugs Used for Similar Conditions

Many different benzodiazepines are available for prescription use. They include lorazepam, diazepam, alprazolam, oxazepam, temazepam, flurazepam, and triazolam. The drugs differ somewhat in the side effects they produce, their potencies, the time it takes for them to work, their duration of action, and the tendency for them to cause withdrawal symptoms.

Buspirone is an antianxiety medication that is not part of the benzodiazepine class. It is not addictive or sedating and has less tendency to slow down mental and physical reactions in people who take it. On the other hand, it is not effective for many people.

To treat anxiety accompanied by depression, a number of manufacturers market chlordiazepoxide/amitriptyline combinations.

Diazepam

Brand Names (Manufacturers)

Valium (Roche); Valrelease (Roche)

Type of Drug

Psychoactive-antianxiety agent

Used For

Diazepam is primarily used for the treatment of anxiety. It is also sometimes used to relax muscles, treat seizures, or to reduce the symptoms of acute alcohol withdrawal. Diazepam is also used to reduce anxiety before surgical procedures.

General Information

Diazepam belongs to a class of psychoactive drugs called benzodiazepines. Benzodiazepines are the most commonly used antianxiety drugs because they are fairly safe, they rapidly reduce the symptoms of anxiety, and they don't have to be taken on an ongoing basis to be effective.

Diazepam is available as tablets, capsules, and solution for oral administration as well as a solution for intravenous administration.

Treatment

The usual dosage of diazepam for adults is 2 to 10 mg two to four times a day, depending on the severity of symptoms and the diagnosis.

Elderly people usually take reduced doses, starting at 2 to 2.5 mg once or twice a day, increasing the dosage as tolerated and only when necessary.

Diazepam is not for use in children under six years of age. Older children may receive 1 to 2.5 mg three to four times a day initially, increased gradually as needed and tolerated.

Cautions and Warnings

Diazepam should not be used by people who are allergic to the drug or people who have glaucoma unless they are receiving appropriate antiglaucoma therapy. The drug depresses the central nervous system, so it may not be appropriate to operate heavy machinery or drive a motor vehicle when taking diazepam.

Like other benzodiazepines, diazepam can be dangerous when taken with alcohol. Alcohol intensifies the depressive effect of benzodiazepines.

Taking diazepam can be habit-forming. It appears that physical or psychological dependency may require several months of daily use, but dependency can sometimes occur much sooner. Rapid withdrawal after long-term use can lead to increased anxiety, insomnia, tremors, and in severe cases, seizures.

Abrupt withdrawal of diazepam when used with anticonvulsants may also cause a temporary increase in the frequency and/or severity of seizures.

Side Effects

The most common side effects of diazepam include drowsiness, fatigue, and loss of balance. Less commonly, people taking the drug experience confusion, constipation, depression, headache, low blood pressure, incontinence, jaundice, changes in sex drive, nausea, changes in salivation, skin rash, slurred speech, tremor, difficulty urinating, vertigo, and blurred vision.

On rare occasion, individuals have experienced a deficiency in certain white blood cells called neutrophils after taking diazepam. For this reason, periodic blood counts and liver-function tests are recommended for people who use diazepam routinely.

Pregnancy/Breast-Feeding

Diazepam may cause an increased risk for fetal deformities when used during the first trimester of pregnancy. Diazepam taken later in pregnancy may increase the risk that the baby will become dependent on it. Pregnant women should discontinue using the drug.

HIV can be passed from a woman to her child through breast milk. In areas where nutritional alternatives are readily available, breast-feeding is discouraged for HIV-positive women. Diazepam is excreted in human milk and can cause serious side effects in infants. Because of the potential toxicity of the drug, women should consider alternatives to breast-feeding while taking it.

Use In Children

Newborn infants have immature kidney and liver function and are often unable to metabolize drugs and excrete them from their bodies. In infants under thirty days of age, diazepam has caused prolonged central nervous system depression, possibly caused by the immature kidney function. The drug is not recommended for children under six months of age.

For older children, diazepam may effectively be used at lower doses than those given to adults. In general, the dose is started at 1 to 2.5 mg, taken three or four times daily, gradually increased as needed and tolerated.

Use in the Elderly

Older adults may be more susceptible to the side effects of the drug and may require reduced doses.

Drug Interactions

Phenothiazines, cimetidine, oral contraceptives, narcotics, barbiturates, alcohol, monoamine oxidase inhibitors, and other antidepressants may intensify the effect of diazepam and increase the risk of serious side effects.

Diazepam may decrease the effectiveness of carbamazepine, levodopa, and blood thinners and may increase the effects of phenytoin.

Concurrent use with rifampin may decrease the effectiveness of diazepam.

Food Interactions

Diazepam is absorbed most rapidly into the body when taken on an empty stomach, but it may be taken with food if it causes stomach upset.

Other Drugs Used for Similar Conditions

Many different benzodiazepines are available for prescription use. They include lorazepam, chlordiazepoxide, alprazolam, oxazepam, temazepam, flurazepam, and triazolam, among others.

The drugs differ somewhat in their side effects, potencies, the time it takes for them to work, and their tendency to cause withdrawal symptoms.

Buspirone is an antianxiety medication that is not part of the benzodiazepine class. It is not addictive or sedating and has less tendency to slow down mental and physical reactions in the people who take it. On the other hand, it is not effective for many people.

Flurazepam

Brand Name (Manufacturer)

Dalmane (Roche)

Type of Drug

Psychoactive-sedative

Used For

Flurazepam is used for the short-term treatment of insomnia.

General Information

Anxiety, depression, and many medications can cause sleep problems in people with HIV infection. Flurazepam, one of the most widely used sleeping pills in the United States, is a member of a class of psychoactive drugs called benzodiazepines. All of these drugs reduce anxiety or cause drowsiness to some degree. They differ mostly in the degree of their effects and the duration of their action. Flurazepam is one of the longer-acting benzodiazepines, so it may be more likely to cause a "hangover" effect.

Like other benzodiazepines, flurazepam can cause dependency. Withdrawal symptoms may include convulsions, tremors, abdominal pain, muscle cramps, vomiting, sweating, restlessness, perceptual disturbances, and insomnia. The risk of addiction is increased in people with a history of alcoholism, drug use, or marked personality disorders.

Treatment

The dose should be adjusted for the age, condition, and health of the individual. The usual adult dosage is 30 mg taken at bedtime. For some people, especially those who are elderly or debilitated, 15 mg may be sufficient. It may take one or two days of consecutive use before flurazepam is fully effective, and after stopping the drug, it may take a few days for its effects to wear off.

Cautions and Warnings

Flurazepam should not be used by anyone with a known allergy to it.

Sleep disorders may be symptoms of other physical or psychiatric problems. Eliminating the underlying cause of sleeplessness, if it can be determined, may be a better long-term solution to the problem.

Flurazepam, like other benzodiazepines, may be habit-forming if taken for more than three or four days in a row. Consequently, it is possible for a person taking the drug to develop withdrawal symptoms if the drug is suddenly discontinued, including convulsions, tremors, muscle cramps, insomnia, agitation, diarrhea, vomiting, and sweating.

As with all psychoactive drugs, the minimum effective dosage should be used because some of the drug's side effects are dose-related. Elderly people are especially susceptible to the dose-related side effects of the drug.

Flurazepam depresses the central nervous system. People taking the drug should not drive an automobile or operate heavy machinery. Because flurazepam is a relatively long-acting benzodiazepine, its effects on alertness may continue into the day after taking the drug.

Side Effects

The most common side effects of the drug include dizziness, drowsiness, light-headedness, staggering, loss of muscle coordination, and falling.

Other less frequent side effects of the drug include headache, heartburn, upset stomach, nausea, vomiting, diarrhea, constipation, stomach pain, nervousness, talkativeness, apprehension, irritability, weakness, heart palpitations, body and joint pain, and difficulty urinating.

Severe sedation, lethargy, disorientation, and coma have been reported on rare occasions.

Pregnancy/Breast-Feeding

Flurazepam should not be used during pregnancy. Although flurazepam has not been formally studied in pregnant women, other benzodiazepines have caused birth defects when used during the first trimester of pregnancy. There have also been cases of severe side effects of flurazepam in infants whose mothers took the drug during pregnancy.

HIV may be passed from a woman to her child through breast milk. In areas where nutritional alternatives are readily available, breast-feeding is discouraged for HIV-positive women. Flurazepam is excreted in breast milk and may cause serious side effects in newborn infants. Because of the potential toxicity of the drug, women should consider alternatives to breast-feeding while taking it.

Use In Children

The safety and effectiveness of flurazepam have not been studied in children under the age of fifteen, so there are no recommendations about its use for them.

Use in the Elderly

Older adults may be more susceptible to the side effects of the drug and may require reduced doses.

Drug Interactions

Flurazepam produces additive central nervous system depression when used with anticonvulsants, antihistamines, alcohol, and other drugs that produce central nervous system depression.

Oral contraceptives, cimetidine, disulfiram, probenecid, and isoniazid may increase the effects of flurazepam by increasing blood levels of the drug. Cigarette smoking, rifampin, and theophylline may reduce blood levels of flurazepam, potentially reducing the drug's effectiveness.

Flurazepam may increase the amount of phenytoin or digoxin in the blood, increasing the risk of side effects. Flurazepam used with clozapine has caused respiratory collapse in some people. Clozapine should not be used until at least one week after flurazepam is stopped.

Food interactions

None reported.

Other Drugs Used for Similar Conditions

A number of drugs are available for treatment of insomnia. Barbiturates such as secobarbital or phenobarbital are occasionally used. More commonly, sedatives such as lorazepam, diazepam, triazolam, or promethazine are used. There is no ideal treatment for insomnia. Choosing one depends primarily on which can be tolerated, which side effects a person is at risk for, and which proves to be the most effective for the individual.

Lorazepam

Brand Name (Manufacturer)

Ativan (Wyeth-Ayerst)

Type of Drug

Psychoactive-tranquilizer

Used For

Lorazepam is used in adults for the treatment of anxiety. In addition, the injectable form of the drug is used as a sedative and as a presurgical medication for people who prefer not to remember the events of the day of their surgery.

General Information

Lorazepam belongs to a class of psychoactive drugs called benzodiazepines. Benzodiazepines are the most commonly used antianxiety drugs because they are fairly safe, rapidly reduce the symptoms of anxiety, and don't have to be taken on a ongoing basis to be effective. All benzodiazepines cause dose-related suppression of the central nervous system, varying from slight impairment to deep sedation. Lorazepam is one of the more sedating benzodiazepines.

Like other benzodiazepines, lorazepam can cause dependency. Withdrawal symptoms may include convulsions, tremors, abdominal pain, muscle cramps, vomiting, sweating, restlessness, perceptual disturbances, and insomnia. The risk of addiction is increased in people with a history of alcoholism, drug use, or marked personality disorders.

While lorazepam is available as tablets and a solution for intravenous injection, most people will use the tablets.

Treatment

The dose of lorazepam should be optimized for each individual. As with other psychoactive drugs, the minimum effective dosage should be used to minimize the risk of side effects. In general, treatment is started at a low dose and gradually increased as necessary and as tolerated. The usual dosage range for healthy adults is 2 to 6 mg per day given in divided doses. For anxiety, most people require an initial dosage of 2 to 3 mg per day, split into two or three doses.
Lower doses may be required for elderly people and people with kidney or liver impairment.

Cautions and Warnings

Lorazepam should not be used by anyone with a known allergy to it. It should also not be used by people with acute narrow-angle glaucoma.

Lorazepam is metabolized in the liver and excreted by the kidney. Consequently, it should be used with caution by people with kidney or liver impairment.

Lorazepam depresses the central nervous system. People taking the drug should not drive an automobile or operate dangerous machinery.

Side Effects

Side effects to the drug usually occur early in treatment and disappear as treatment continues. The most frequent side effects in clinical trials were sedation (reported by about 16% of people taking the drug), dizziness (7%), weakness (4%), and unsteadiness (3%). Less frequent side effects include disorientation, depression, nausea, change in appetite, headache, sleep disturbance, agitation, and skin reactions. Transient amnesia or memory impairment has been reported after the use of other benzodiazepines.

Pregnancy/Breast-Feeding

Although lorazepam has not been formally studied in pregnant women, use of other benzodiazepines (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has sometimes resulted in fetal malformations.

HIV may be passed from a woman to her child through breast milk. In areas where nutritional alternatives are readily available, breast-feeding is discouraged for HIV-positive women. Lorazepam is excreted in breast milk and it may accumulate in nursing infants. Because of the potential toxicity of the drug, women should consider alternatives to breast-feeding while taking it.

Use In Children

There is little clinical data regarding the use of lorazepam in children, therefore no recommendations about its use in this population can be made.

Use in the Elderly

People over the age of fifty may have deeper and more prolonged sedation when using lorazepam. In addition, elderly people may be at increased risk for the drug's other side effects, which include unsteadiness and disorientation. In general, elderly people will use a reduced dosage of the drug to obtain the same therapeutic effects.

Drug Interactions

Lorazepam produces additive central nervous system depression when used with anticonvulsants, antihistamines, alcohol, and other drugs that produce central nervous system depression.

Smoking may reduce the effectiveness of lorazepam by reducing blood levels of the drug. The effects of lorazepam may be prolonged when taken with cimetidine, oral contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranolol, rifampin, or valproic acid.

Theophylline may reduce lorazepam's sedative effects.

Antacids or ddI should be taken two hours before or after lorazepam, because they interfere with the drug's absorption into the body.

Phenytoin and digoxin blood levels are increased when taken with lorazepam, potentially increasing the risk of side effects from these drugs. Lorazepam may reduce blood levels of levodopa, potentially reducing its effectiveness.

Food Interactions

Lorazepam is absorbed most effectively into the body when taken on an empty stomach, but it may be taken with food if it causes an upset stomach.

Other Drugs Used for Similar Conditions

Many different benzodiazepines are available for prescription use. They include alprazolam, diazepam, chlordiazepoxide, and flurazepam among others. The drugs in the class differ somewhat in the side effects they produce, their potencies, the time it takes for them to work, and the tendency for them to be addictive or cause withdrawal symptoms.

Buspirone is an antianxiety medication that is not part of the benzodiazepine class. It is not addictive and is less likely to be sedating. It also has less tendency to slow down mental and physical reactions in the people who take it. On the other hand, it is not effective for many people.

Oxazepam

Brand Name (Manufacturer)

Serax (Wyeth-Ayerst)

Type of Drug

Psychoactive-tranquilizer

Used For

Oxazepam is used for the short-term relief of anxiety, including anxiety associated with depression. It is also used to treat withdrawal symptoms of alcoholism.

General Information

Oxazepam is a member of a class of psychoactive drugs called benzodiazepines. Benzodiazepines are the most commonly used antianxiety drugs because they are fairly safe, they rapidly reduce the symptoms of anxiety, and they do not have to be taken on an ongoing basis in order to be effective. All benzodiazepines cause dose-related suppression of the central nervous system, varying from slight impairment to deep sedation.

Oxazepam is a short-acting benzodiazepine, which means that the drug is rapidly eliminated from the body. This reduces the risk that the drug will cause a "hangover" effect the day after it is taken. It also reduces the risk the drug will accumulate in the body to high levels that may cause side effects.

Like other benzodiazepines, oxazepam can cause dependency. Withdrawal symptoms may include convulsions, tremors, abdominal pain, muscle cramps, vomiting, sweating, restlessness, perceptual disturbances, and insomnia. The risk of dependency is increased in people with a history of alcoholism, drug use, or marked personality disorder. However, clinical studies show that oxazepam is less likely to cause addiction than diazepam, lorazepam, alprazolam, or triazolam.

Oxazepam is available as tablets and capsules for oral administration.

Treatment

The dosage of oxazepam should be adjusted for each individual. As with other psychoactive drugs, the minimum effective dosage should be used to reduce the risk of side effects. The dosage is generally started low and increased as necessary and tolerated.

For treatment of mild-to-moderate anxiety, the usual adult dosage is 10 to 15 mg, taken three or four times a day. For severe cases, the dosage may be doubled. Older people generally receive 10 mg, three or four times a day, to be increased as necessary to 15 mg per day.

Cautions and Warnings

Oxazepam should not be used by people who know they are allergic to it. Oxazepam depresses the central nervous system. People taking the drug should not drive an automobile or operate dangerous machinery.

Because of their increased risk of side effects, people with a history of low blood pressure should take the drug with caution.

Side Effects

People rarely discontinue using oxazepam because of side effects. Transient mild drowsiness is common for the first few days of therapy. If it persists, the dosage of the drug should be reduced. In a few instances, dizziness, vertigo, headache, or rarely fainting has occurred after taking the drug. Occasionally, the drug may cause excitement or stimulation during the first two weeks of therapy. Rarely, allergic reactions, nausea, vomiting, lethargy, swelling, slurred speech, tremor, changes in sex drive, white blood cell deficiency, and liver toxicity occur.

Pregnancy/Breast-Feeding

Oxazepam has not been formally studied in pregnant women. However, other benzodiazepines have caused serious birth defects when taken by pregnant women. Pregnant women are encouraged to discuss the benefits and potential risks of oxazepam with their physician before deciding to use the drug.

HIV may be passed from a woman to her child through breast milk. In areas where nutritional alternatives are readily available, breast-feeding is discouraged for HIV-positive women. Oxazepam is excreted in breast milk and causes sedation in infants. Because of the potential risk of the drug, women should consider alternatives to breast-feeding while taking it.

Use In Children

Children over twelve years of age can use the lowest adult dosage, to be increased as necessary and tolerated. Little data are available regarding the use of the drug for children under twelve. The drug is not recommended for children under the age of six years because it has not been formally studied in them.

Use in the Elderly

Elderly people are more susceptible to the dose-related side effects of the drug and should use the reduced dosages listed above.

Drug Interactions

Oxazepam can cause additive central nervous system depression when used with anticonvulsants, antihistamines, alcohol, and other drugs that produce central nervous system depression. Cimetidine, isoniazid, and valproic acid may increase oxazepam levels in the blood, potentially increasing the risk of side effects. Oxazepam may reduce the effectiveness of oral contraceptives and increase the risk of phenytoin toxicity. Concomitant use of oxazepam with lithium may cause serious reductions in body temperature.

Food Interactions

None reported.

Other Drugs Used for Similar Conditions

Many different benzodiazepines are available for prescription use. They include lorazepam, diazepam, chlordiazepoxide, temazepam, flurazepam, and triazolam, among others. The drugs differ somewhat in the side effects they produce, their potencies, the time it takes them to work, and the tendency for them to cause withdrawal symptoms. Generally, oxazepam is considered to be one of the safer benzodiazepines.

Buspirone is an antianxiety medication that is not part of the benzodiazepine class. It is not addictive and is less likely to be sedating or to impair mental and physical alertness in people who take it. On the other hand, it needs to be taken many times each day and it is not effective for many people.

Temazepam

Brand Name (Manufacturer)

Restoril (Sandoz)

Type of Drug

Psychoactive-sedative

Used For

Temazepam is used for the short-term treatment of insomnia.

General Information

Anxiety, depression, and many medications can cause sleep problems in people with HIV infection. Temazepam is a member of a class of psychoactive drugs called benzodiazepines. All of these drugs reduce anxiety or cause drowsiness to some degree. Compared with other benzodiazepines, temazepam is relatively long-acting and is useful for people who wake up too early. Its primary disadvantage is that it can cause a hangover, making the person using the drug feel drowsy and/or light-headed the following day.

Temazepam is available as capsules for oral administration.

Treatment

The usual adult dose of temazepam is 15 mg, taken before bedtime. Doses as small as 7.5 mg or as high as 30 mg may be appropriate for some people. In elderly or debilitated people, 7.5 mg is the recommended starting dose until individual response is known.

Cautions and Warnings

Temazepam should not be used by people who know they are allergic to it or other benzodiazepines (such as diazepam, lorazepam, chlordiazepoxide, alprazolam, oxazepam, triazolam, or flurazepam).

Sleep disorders may be symptoms of other physical or psychiatric problems. Eliminating the underlying cause of sleeplessness, if it can be determined, may be a better long-term solution to the problem. If people do not respond within seven to ten days of treatment with temazepam, there may be another underlying illness. Worsening insomnia or the appearance of new abnormalities of thinking or behavior may be the consequence of an unrecognized psychiatric or physical disorder.

The smallest effective dose should be used because some of the side effects are dose-related. Elderly people are especially susceptible to dose-related side effects of the drug. Similarly, the drug should be used with caution in people with a history of kidney disease, liver disease, chronic breathing insufficiency, or sleep apnea (stoppage of breathing during sleep).

Like other benzodiazepines, temazepam can cause dependency. Withdrawal symptoms may include convulsions, tremor, abdominal pain, muscle cramps, vomiting, sweating, restlessness, perceptual disturbances, and insomnia.

Temazepam depresses the central nervous system. People taking the drug should not drive an automobile or operate heavy machinery.

Side Effects

The most common side effects of temazepam are dizziness and daytime drowsiness. Other side effects that occurred in more than 1% of people taking the drug in clinical trials included lethargy, hangover, anxiety, diarrhea, euphoria, weakness, confusion, and vertigo. Less frequently, allergic reactions, loss of appetite, loss of balance, heart palpitations, backache, vomiting, burning eyes, amnesia, and hallucinations were reported.

Pregnancy/Breast-Feeding

Temazepam may cause serious birth defects and should be avoided during pregnancy. If taken near the time of delivery, the drug may cause sedation and reluctance to feed in the newborn baby.

HIV can be passed from a woman to her child through breast milk. In areas where nutritional alternatives are readily available, breast-feeding is discouraged for HIV-positive women. Newborns from mothers who take temazepam during pregnancy may suffer withdrawal symptoms. Because of the potential toxicity of the drug, women should consider alternatives to breast-feeding while taking it.

Use In Children

Temazepam is not recommended for children because its safety and efficacy have not yet been demonstrated for them in clinical trials.

Use in the Elderly

Older adults may be more susceptible to the side effects of temazepam and generally receive reduced doses. Because the drug is long-lasting, it is generally not prescribed for elderly people. Another, shorter-acting benzodiazepine called oxazepam is often prescribed instead when elderly people require help sleeping.

Drug Interactions

Temazepam may intensify the effect of other central nervous system depressants, including alcohol, narcotic pain relievers, antihistamines, barbiturates, and some antidepressants.

Oral contraceptives, cimetidine, disulfiram, probenecid, isoniazid, and macrolide antibiotics (azithromycin, clarithromycin, or erythromycin) may increase blood levels of temazepam, potentially increasing the risk of its side effects. Cigarette smoking, rifampin, and theophylline may reduce temazepam blood levels.

Temazepam may increase blood levels of AZT, phenytoin, or digoxin, potentially increasing the risk of side effects of these drugs. Temazepam may decrease blood levels of levodopa.

Benzodiazepines used with clozapine have led to respiratory failure in some people. Temazepam should be stopped for at least a week before starting clozapine.

Food Interactions

Temazepam may be taken with or without food.

Other Drugs Used for Similar Conditions

A number of drugs are available for treatment of insomnia. Barbiturates such as secobarbital or phenobarbital are occasionally used. More commonly, sedatives such as triazolam, lorazepam, diazepam, or promethazine are used. There is no definitive treatment for insomnia. The choice of drug will primarily depend on which drugs can be tolerated, the side effects for which a person is at risk, and which drugs prove to be effective for the individual.

Triazolam

Brand Name (Manufacturer)

Halcion (Upjohn)

Type of Drug

Psychoactive-sleeping agent

Used For

Triazolam is used for the short-term treatment of insomnia.

General Information

Anxiety, depression, and many medications can cause sleep problems in people with HIV infection. Triazolam is one of the most widely used sleeping pill in the United States, primarily because it eliminates the next-day "hangover" caused by many other sleeping medications.

Triazolam is a member of a class of psychoactive drugs called benzodiazepines. All of these drugs reduce anxiety or cause drowsiness to some degree. They differ mostly in the degree of their effects. Triazolam, especially at higher doses, appears to cause more memory problems than other benzodiazepines. There have also been reports of violent behavior and psychosis after using the drug, but it is not known whether or not the drug actually caused the behavior.

Like other benzodiazepines, triazolam can cause dependency. Withdrawal symptoms may include convulsions, tremor, abdominal pain, muscle cramps, vomiting, sweating, restlessness, perceptual disturbances, and insomnia. Some people taking the drug will experience withdrawal symptoms between doses. The risk of dependence is increased in people with a history of alcoholism, drug use, or marked personality disorders.

Triazolam is available as tablets for oral administration.

Treatment

The recommended dose for most adults is 0.25 mg at bedtime. A dose of 0.125 mg may be adequate for some people. A dose of 0.5 mg should only be used for people who do not respond adequately to a lower dose. Lower doses are recommended for elderly or disabled people.

Cautions and Warnings

Triazolam should not be used by people who know they are allergic to it or other benzodiazepines (such as diazepam, lorazepam, chlordiazepoxide, alprazolam, oxazepam, temazepam, or flurazepam).

Sleep disorders may be symptoms of other physical or psychiatric problems. Eliminating the underlying cause of sleeplessness, if it can be determined, may be a better long-term solution to the problem. If people do not respond within seven to ten days, there may be another underlying illness. Worsening insomnia or the appearance of new abnormalities of thinking or behavior may be the consequence of an unrecognized psychiatric or physical disorder.

The smallest effective dose should be used because some of the side effects are dose-related. Elderly people are especially susceptible to dose-related side effects of the drug. Similarly, the drug should be used with caution in people with a history of kidney disease, liver disease, chronic pulmonary insufficiency, or sleep apnea (stoppage of breathing during sleep).

Triazolam depresses the central nervous system. People taking the drug should not drive an automobile or operate heavy machinery.

Side Effects

Triazolam may cause behavioral changes. It is difficult to determine if the changes are caused by the drug, are spontaneous, or are the result of some underlying illness.

Respiratory depression and sleep apnea have infrequently been reported in people with breathing disorders.

The most common side effects of triazolam are drowsiness, dizziness, or light-headedness. Another common side effect is loss of coordination.

An overdose can occur when a person takes as little as two mg of triazolam, which is four times the recommended maximum dose. Symptoms include confusion, impaired coordination, slurred speech, coma, and in some cases death.

Pregnancy/Breast-Feeding

Triazolam may cause fetal damage and should be avoided during pregnancy. HIV can be passed from a woman to her child through breast milk. In areas where nutritional alternatives are readily available, breast-feeding is discouraged for HIV-positive women. Newborns from mothers who take triazolam during pregnancy may suffer withdrawal symptoms. Because of the potential toxicity of the drug, women should consider alternatives to breast-feeding while taking it.

Use In Children

The safety and effectiveness of the drug have not been studied in children under eighteen.

Use in the Elderly

Elderly or debilitated people should start the drug at a low dose, 0.125 mg per day, to decrease the risk of oversedation, dizziness, or impaired coordination. The maximum dose for elderly or debilitated people is 0.25 mg per day.

Drug Interactions

Triazolam produces additive central nervous system depression when used with anticonvulsants, antihistamines, alcohol, and other drugs that produce central nervous system depression.

Cimetidine and erythromycin lengthen the time that triazolam stays in the body. Dose reductions in these cases may be necessary to avoid excessive blood levels of triazolam.

Food Interactions

Triazolam may be taken with or without food.

Other Drugs Used for Similar Conditions

A number of drugs are available for treatment of insomnia. Barbiturates such as secobarbital or phenobarbital are occasionally used. More commonly, sedatives such as lorazepam, diazepam, or promethazine are used. There is no definitive treatment for insomnia. The choice of drug will primarily depend on which drugs can be tolerated, the side effects for which a person is at risk, and which drugs prove to be effective for the individual.