Drug | Oral Dose | Peak | Half-life | Use |
Alprazolam (Xanax) | 0.5 mg PO | 1-2 hrs | 6-12 hrs. | Anxiolytic |
Chlordiazepoxide (Librium) | 25 mg PO | 2-4 hrs | 24-48 hrs (active metabolite up to 200 hrs) | Alcohol Withdrawal Anxiolytic |
Clonazepam (Klonopin) | 0.5 mg PO | 1-4 hrs | 30-40 hrs | Anticonvulsant Anxiolytic |
Diazepam (Valium) | 5 mg PO | 1-1.5 hrs | 48-100 hrs (active metabolite up to 200 hrs) | Alcohol Withdrawal Anticonvulsant Anxiolytic Muscle Relaxant |
Lorazepam (Ativan) | 1 mg PO | 2 hrs | 12 hrs | Alcohol Withdrawal Anticonvulsant Anxiolytic Hypnotic |
Temazepam (Restoril) | 10 mg PO | 1-2 hrs | 8-10 hrs | Anxiolytic Hypnotic |
- Hypnotics are used to induce sleep
- There is considerable variability in the reported ranges for peak concentration and half-life. Wherever possible, data is extracted from package inserts.
- Long-acting benzodiazepines have active metabolites.
- Dosing listed above is for equivalence in ORAL administration only.
- Careful consideration should be given to patient age, liver function, and co-ingestion of metabolic inhibitors or other non-benzodiazepine sedative medications (opioids, alcohol, etc).
Further Reading
Alcohol Withdrawal Syndrome: Improving Outcomes in the Emergency Department With Aggressive Management Strategies – Pharmacology EXTRA Supplement – (Pharmacology CME) Date Release: Mar 2021. This Pharmacology EXTRA CME supplement (free to Emergency Medicine Practice subscribers) reviews the management of alcohol withdrawal syndrome.
Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition and Treatment Date Release: Mar 2017. A review of the pathophysiology, diagnostic decision-making tools, and pharmaceutical treatment options to create a patient-tailored approach to sedative-hypnotic withdrawal.
Nonconvulsive Status Epilepticus: Overlooked and Undertreated (Pharmacology CME) Date Release: Oct 2019. Altered mental status is a common presentation in the ED, and time is of the essence in diagnosing NCSE and halting seizure activity.
References
- Benzodiazepines: How They Work And How To Withdraw (aka The Ashton Manual), Chapter : The Benzodiazepines, What They Do In The Body; Online Manual
- DailyMed, Official Provider of FDA Label Information; Website
- Management Of Benzodiazepine Withdrawal; Government Of South Australia; SA Health; WS2.4 Handout
Last Updated on January 24, 2023
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
