Clorazepate
TRANXENE
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.
FDA-approved for
- anxiety (~1972)
- seizures (~1972)
FDA label
Read the full label on DailyMed ↗
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
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
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Cost, est. cash$10–$300/month
Generic entry1987
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, falls, dependence and additive respiratory depression with opioids or other CNS depressants.
Active metabolites
Mechanism of action: Clorazepate ballicule
Open Clorazepate in the interactive console ↗
Memory aids: mascots and interaction avatars
hot pink → benzo theme
