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Benzodiazepines

Dan Quan

Benzodiazepines, to varying degrees, have in common six major pharmacologic effects: sedative, hypnotic, anxiolytic, amnestic, anticonvulsant, and muscle relaxant.1,2 Benzodiazepines are commonly used for the treatment of anxiety, insomnia, seizures, and alcohol withdrawal.3–6 Midazolam, a benzodiazepine with a short duration of action, is also used for procedural sedation and general anesthesia (Table 177-1).

Table 177-1 Benzodiazepines
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Table 177-1 Benzodiazepines
Generic NameTime to Peak Effect†Elimination Half-Life (h)‡Duration of ActionActive Metabolite (half-life)Oral Dose Equivalent to Diazepam 10 milligrams PO (milligrams)
Short Acting
Alprazolam*1–2 h6–124–7 hNo0.5
Midazolam*IV 1–2 min3–6IV 2 hYes5
IM 10–15 minIM 4–6 h
PO 30–60 minPO 4–6 h
Oxazepam*20–30 min5–103–6 hNo20
Tetrazepam1–3 h156–8 hNo50–100
Triazolam*15–30 min2–56–7 hNo0.25–0.50
Intermediate Acting
Bromazepam1–3 h10–20<12 hYes5–6
Cinolazepam0.5–2.0 h99 hNo40
Estazolam*1 h10–24<12 hNo1–2
Flunitrazepam15–20 min18–244–6 hYes (36–200 h)1
Loprazolam0.5–4.0 h6–12<12 hNo1–2
Lorazepam*IV 5–20 min9–166–8 hNo1
IM 20–30 min
PO 30–60 min
Lormetazepam0.5–2.0 h10–12<12 hNo1–2
Nimetazepam15–30 min14–30<12 hNo5
Nitrazepam0.5–5.0 h16–48<12 hNo10
Premazepam2 h10–13<12 hNo3.75
Temazepam*80–100 min9–125–20 hNo20
Long Acting
Chlordiazepoxide*2 h5–305–30 hYes (36–200 h)25
Clonazepam*20–60 min20–80<12 hNo0.5
Clorazepate* 1–2 h488–24 hYes (36–200 h)15
Cloxazolam2–5 h6518–50 hNo1–2
Diazepam*IV 1–5 min20–50IV 15–60 minYes (36–200 h)10
PO 15–45 minPO 12–24 h
PR 5–45 min—
Flurazepam*30–60 min212 hYes (50–100 h)15–30
Flutoprazepam0.5–2.0 h60–9024 hYes2–3
Halazepam1–3 h—12–24 hYes (30–100 h)20–40
Ketazolam2.5–3.0 h30–10012–24 hYes (36–200 h)15–30
Medazepam—36–15010–12 hYes (36–200 h)10
Nordazepam2 h40–5012–14 hYes (50–120 h)10
Phenazepam1.5–4.0 h6012 hYes1
Pinazepam1–2 h20–2512–24 hYes (40–100 h)20
Prazepam2–6 h40–8012–24 hYes (36–200 h)10–20
Quazepam*0.5–2.0 h27–4112–24 hYes (28–80 h)20

*Available in the U.S.

†After oral ingestion, unless otherwise specified.

‡Parent compound.

During 2008, the American Association of Poison Control Centers received reports of 78,443 exposures to benzodiazepines; 30,856 were single drug exposures to a benzodiazepine.7 Isolated benzodiazepine overdose has a low mortality and death is rare.8,9

Although the ingestion of benzodiazepines alone appears to result in relatively few deaths, increased rates of morbidity do result from mixed overdose. In addition, because of ...

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