II. Class

  1. Long acting Benzodiazepine

IV. Dosing: Adults

  1. Anxiety Disorder
    1. Start 3.75 mg to 15 mg orally twice daily (or 7.5 mg to 15 mg orally once at bedtime)
    2. Typical dose: 15 mg orally twice daily
    3. Maximum Total Daily Dose: 60 mg in divided doses (15 mg maximum dose in elderly)
  2. Alcohol Withdrawal
    1. Day 1: 30 mg orally once, then give additional 30 to 60 mg/day divided in 3 to 4 doses
    2. Day 2: 45 to 90 mg/day divided in 3 to 4 doses
    3. Day 3: 22.5 to 45 mg/day divided in 3 to 4 doses
    4. Day 4: 15 to 30 mg/day divided in 3 to 4 doses
    5. Gradually taper and discontinue once patient stable on 7.5 mg once daily
    6. Maximum total daily dose: 90 mg/day divided
  3. Partial Seizures (adjunct, age >13 years)
    1. Start 7.5 mg orally 2 to 3 times daily
    2. May increase by no more than 7.5 mg/dose each week as needed
    3. Maximum total daily dose: 90 mg/day divided

V. Dosing: Children

  1. Partial Seizures (adjunct, age 9 to 12 years old)
    1. Start 7.5 mg orally twice daily
    2. May increase by no more than 7.5 mg/dose each week as needed
    3. Maximum total daily dose: 60 mg/day divided

VI. Pharmacokinetics

  1. Half Life: 40 to 50 hours (up to 100 hours)

VII. Metabolism

  1. Chlorazepate is decarboxylated first in the Gastrointestinal Tract to the active agent desmethyldiazepam, and then absorbed
  2. Desmethyldiazepam is then metabolized to Oxazepam via CYP3A4 and CYP2C19

VIII. Safety

  1. Pregnancy Category X (esp. first trimester)
  2. Avoid in Lactation
  3. Schedule IV Controlled Substance

X. References

  1. (2019) Med Lett Drugs Ther 61(1578): 121-6
  2. (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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