Psychiatry Resident (PGY3)
Site Last Updated February 03, 2008
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Generic TRADE |
Equivalent Dose/Class |
Peak Level/ ABSORPTION RATE |
Average* Half-life (hr) |
Active Metabolites |
Comments (V = therapeutic use) |
INITIAL MAX DOSE |
USUAL DOSE RANGE |
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SHORT ACTING: more rebound anxiety effect & withdrawal reactions, better sedative/hypnotic; preferred over long acting in elderly (less accumulation) & in patients with liver disorders (easier metabolized) |
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Alprazolam XANAX (0.25,0.5) (1 mg tab, TS 2 mg) |
0.5mg D ← Preg |
1-2° Medium |
12 (9-20) |
Minor Oxidation |
√ Anxiety, Panic attacks Severe withdrawal & some ? antidepressant effect DIs: Level ↑ by: diltiazem, Luvox, ketoconazole, grapefruit juice, nefazodone, Prozac, ritonavir; (down arrow) by: theophylline. |
0.25mg 4-10mg |
0.25mg po tid 0.5mg po tid |
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Lorazepam ATIVAN (0.5,1,2mg po tab; 0.5,1,2 sl tab; 4mg/ml a mg |
1mg X ← Preg 3-Hydroxy |
PO 1-4° SL/IM 1° IV q5-10 min Medium |
15 (8-24) |
None Conjugation |
√ Anxiety, Preanesthetic; Other: sedative, muscle relaxant, alcohol withdrawal; acute mania; Fewer DI's, √ Status epilepticus -slower onset but longer duration vs. diazepam; IM well absorbed |
0.5mg 10mg |
0.5mg po tid 1mg po tid 2mg po tid |
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Oxazepam SERAX (10,15,30mg tab) |
15mg D 3-Hydroxy |
1-4° Medium |
8 (3-25) |
None Conjugation |
√ Anxiety, alcohol withdrawal Other: sedative Less affected by liver dysfunction; Fewer DI's |
10mg 120mg |
15mg po hs 30mg po hs 30mg po tid |
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Temazepam RESTORIL (15,30mg cap) |
10mg X ← Preg 3-Hydroxy |
2-3° Medium |
11 (3-25) |
None Conjugation |
√ Sedative/hypnotic; Other: anxiolytic May delay but not suppress REM sleep; fewer DI's |
15mg 60mg |
15mg po hs 30mg po hs |
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Triazolam HALCION (0.125,0.25mg tab) |
0.25mg X ← Preg Triazolo |
1-2 ° Rapid |
2 (1.5-5) |
None Oxidation |
√ Sedative/hypnotic; DI's as per alprazolam Behavioral disturbances in elderly; prone to withdrawal / rebound effects |
0.125mg 0.5mg |
0.125mg po hs 0.25mg po hs |
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LONG ACTING: less rebound symptoms; better choice when tapering off of BZDs (e.g. clonazepam/diazepam);withdrawal may be delayed 1-2 wk for 2-Keto group; bedtime dose option for hypnotic & anxiolysis |
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Chlordiazepoxide LIBRIUM (5,10,25mg cap) |
25mg D ← Preg 2-Keto |
1-4° Medium |
100 |
Yes Oxidation |
√ Anxiety, preanesthetic, alcohol withdrawal Other: sedation; Slower onset vs. diazepam |
5mg 200-400mg
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25mg po tid 50mg po tid |
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Clonazepam KLONOPIN (0.5,1,2mg tab) |
0.25mg D ← Preg Nitro |
1-4° Rapid |
34 (19-60) |
None Oxidation & Nitro reduction |
√ Anticonvulsant, Panic attack; Other: sedative, social phobia, akathisia, acute mania, restless leg syndrome & neuralgic pain
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0.25mg 10-20mg Used for BZ withdrawal
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0.5mg po tid 1mg po bid 2mg po tid |
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Clorazepate |
10mg D ← Preg 2-Keto |
0.5-2° Rapid |
100 Inactive until metabolized |
Yes Oxidation |
Hydrolyzed in GI → ↓ clorazepate level by antacids √ Anxiety, panic, alcohol withdrawal, seizures
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3.75mg 60-90mg
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3.75mg po bid 7.5mg po bid 15mg po bid |
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Diazepam VALIUM (2,5,10mg tab; 10mg/2ml amp;
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5mg D ← Preg 2-Keto |
PO 1-2° IM 1° IV 8 min Rapid |
100 |
Yes Oxidation |
√ Anxiety, muscle relaxant, seizures, alcohol withdrawal & preanesthetic; Other: sedative Quicker onset & ↓ duration of action vs. lorazepam, IM causes pain
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2mg 40mg
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2mg po tid 5mg po tid |
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Flurazepam DALMANE (15,30mg cap) |
15mg X ← Preg 2-Keto |
0.5-1° Rapid |
100 (40-250) |
Yes Oxidation |
√ Sedative/hypnotic; Quick onset but accumulates → hangover → confusion, etc.
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15mg 60mg
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15mg po hs 30mg po hs |
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