Clorazepate

TRANXENE

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Pronunciation: klor-AZ-e-payt (TRAN-zeen)

Clorazepate ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Clorazepate ballicule

Clorazepate TRANXENE mascot mnemonic cartoon — Visual mnemonic: Clorazepate mascot
**“(Cloraze)peyton Trancing”**
hot pink → benzo theme

What it isLong-acting benzodiazepine prodrug converted to desmethyldiazepam; anxiety and alcohol withdrawal.

Why this oneGastric acid drives the conversion, giving a smooth onset and a long tail.

What limits itAccumulates in the elderly and in liver disease. Dependence as for the class; antacids blunt conversion.

Clorazepate molecular structure (skeletal formula) — Molecular structure: Clorazepate

Clorazepate prescription history

Animated chart of estimated U.S. prescriptions per year, Benzodiazepines (1961–2026). Clorazepate enters in 1972 (estimated).

FDA-approved for

anxiety (~1972)
seizures (~1972)

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilitySedation, falls, dependence and additive respiratory depression with opioids or other CNS depressants.

FDA label

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BOXED WARNING Concomitant use with opioids: profound sedation, respiratory depression, coma, death. Benzodiazepine abuse, misuse, and addiction (overdose/death). Physical dependence; abrupt discontinuation or rapid dose reduction can cause life-threatening withdrawal.

FDA dosing	Population	Start	Target	Max
Anxiety	Adult	30 mg/day divided (or 15 mg QHS single dose)	15-60 mg/day
Anxiety	Elderly/debilitated	7.5-15 mg/day	individualized
Acute alcohol withdrawal	Adult	Day 1: 30 mg, then 30-60 mg divided	Taper: Day 2 45-90 mg, Day 3 22.5-45 mg, Day 4 15-30 mg, then 7.5-15 mg	90 mg/day
Adjunct to antiepileptic drugs	Adult / >12 yr	7.5 mg TID	increase <=7.5 mg/week	90 mg/day
Adjunct to antiepileptic drugs	Children 9-12 yr	7.5 mg BID	increase <=7.5 mg/week	60 mg/day

Titration Epilepsy adjunct: increase by no more than 7.5 mg per week

Renal Undefined

Hepatic Undefined

Instructions

Discontinue by gradual taper to avoid withdrawal reactions
Elderly or debilitated: initiate at 7.5-15 mg/day
Anxiety: may be given as a single 15 mg dose at bedtime

Available strengths

tab 3.75, 7.5, 15 mg

Contraindications

Acute narrow-angle glaucoma

Cautions

CNS depression/drowsiness; impaired driving and machine operation
Respiratory depression with opioids/CNS depressants
Dependence and withdrawal reactions
Abnormal liver and kidney function tests reported

Adverse reactions

Drowsiness (most frequent)
Dizziness
Gastrointestinal complaints
Nervousness
Blurred vision
Dry mouth
Headache
Mental confusion
Ataxia

Pregnancy Undefined

Lactation Undefined

Cost

Clorazepate (TRANXENE)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
3.75 mg	tab	30 qd	$15.72	not offered
7.5 mg	tab	30 qd	$25.16	not offered
15 mg	tab	30 qd	$24.24	not offered

Generic entry1987

Active metabolites

Nordiazepam

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Memory aids: interaction avatars

CYP3A4 substrate

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Self-check

What drives clorazepate conversion?
Gastric acid.
What can blunt clorazepate conversion?
Antacids.