List of benzodiazepines

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The below tables contain a sample list of benzodiazepines and benzodiazepine analogs that are commonly prescribed, with their basic pharmacological characteristics such as half-life and equivalent doses to other benzodiazepines also listed, along with their trade names and primary uses. The elimination half-life is how long it takes for half of the drug to be eliminated by the body. "Time to peak" refers to when maximum levels of the drug in the blood occur after a given dose. Benzodiazepines generally share the same pharmacological properties, such as anxiolytic, sedative, hypnotic, skeletal muscle relaxant, amnesic and anticonvulsant (hypertension in combination with other antihypertensive medications). Variation in potency of certain effects may exist amongst individual benzodiazepines. Some benzodiazepines produce active metabolites. Active metabolites are produced when a person's body metabolizes the drug into compounds that share a similar pharmacological profile to the parent compound and thus are relevant when calculating how long the pharmacological effects of a drug will last. Long-acting benzodiazepines with long-acting active metabolites such as diazepam and chlordiazepoxide are often prescribed for benzodiazepine or alcohol withdrawal as well as for anxiety if constant dose levels are required throughout the day. Shorter-acting benzodiazepines are often preferred for insomnia due to their lesser hangover effect.[1][2][3][4][5]

It is fairly important to note that elimination half-life of diazepam and chlordiazepoxide as well as other long half-life benzodiazepines is twice as long in the elderly compared to younger individuals. Individuals with an impaired liver also metabolize benzodiazepines more slowly. Many doctors[who?] make the mistake of not adjusting benzodiazepine dosage according to age in elderly patients. Thus, the approximate equivalent of doses below may need to be adjusted accordingly in individuals on short acting benzodiazepines who metabolize long-acting benzodiazepines more slowly and vice versa. The changes are most notable with long acting benzodiazepines as these are prone to significant accumulation in such individuals.[this quote needs a citation] For example, the equivalent dose of diazepam in an elderly individual on lorazepam may be half of what would be expected in a younger individual.[6][7] Equivalencies between individual benzodiazepines can differ by 400 fold on a mg per mg basis; awareness of this fact is necessary for the safe and effective use of benzodiazepines.[8]

Benzodiazépines en France

List[edit]

Data in the table below is taken from the Ashton "Benzodiazepine Equivalency Table".[9][medical citation needed]

Drug Name Common Brand Names* Initial Approval Year Time to Peak (Onset of action in hours) Elimination Half-Life (h) [active metabolite] (Average hours and days) Therapeutic use
Adinazolam Deracyn 1-2 3h (=0.12d) anxiolytic, antidepressant
Alprazolam Helex, Xanax, Xanor, Onax, Alprox, Restyl, Solanax, Tafil 1981 1-2 10–20 hours (15h=0.62d) anxiolytic, antidepressant
Bentazepam Thiadipona 1-3 2-4 hours (3h=0.12d) anxiolytic
Bretazenil[10] N/A ? 2.5 hours (=0.10d) anxiolytic, anticonvulsant
Bromazepam Lectopam, Lexaurin, Lexotanil, Lexotan, Bromam 1-3 20–40 hours (30h=1.25d) anxiolytic,

hypnotic

Brotizolam Lendormin, Dormex, Sintonal, Noctilan 0.5-2 4–5 hours (4.5h=0.19d) hypnotic
Camazepam Albego, Limpidon, Paxor 0.5-2 6-29 hours (17.5h=0.73d) anxiolytic
Chlordiazepoxide Librium, Risolid, Elenium 1960 1.5-4 5–30 hours [36–200 hours] (17,5h=0,73d [118h=4.92d]) anxiolytic
Cinazepam 2-4 60h (=2.5d) hypnotic, anxiolytic
Cinolazepam Gerodorm 0.5-2 9 hours (=0.37d) hypnotic
Clobazam Onfi, Frisium, Urbanol 2011 1-3 hours 8–60 hours (34h=1.41d) anxiolytic, anticonvulsant
Clonazepam Rivatril, Rivotril, Klonopin, Iktorivil, Paxam 1975 1-4 19.5–50 hours (34.75h=1.45d) anticonvulsant, anxiolytic, muscle relaxant
Clonazolam N/A Research chemical 0.5-1.5 10-18 hours anxiolytic, anticonvulsant, hypnotic, muscle relaxant
Clorazepate Tranxene, Tranxilium 1972 Variable 32–152 hours (92h=3.83d) anxiolytic, anticonvulsant
Clotiazepam Veratran, Clozan, Rize 1-3 4 hours (=0.17d) anxiolytic
Cloxazolam Sepazon, Olcadil 2-5 (?) 80–105 hours (92.5h= 3.85d) anxiolytic, anticonvulsant
Delorazepam Dadumir 1-2 80–105 hours (92,5hh=3.85d) anxiolytic, amnesic
Diazepam Antenex, Apaurin, Apzepam, Apozepam, Hexalid, Pax, Stesolid, Stedon, Valium, Vival, Valaxona 1963 1-1.5 32–47 hours [32–205] (39.5h=1.64d [118.5h=4.94d] anxiolytic, anticonvulsant, muscle relaxant
Diclazepam[11] Research chemical 1.5-3 220 hours (=7days+) anxiolytic, amnesic, anticonvulsant, hypnotic, muscle relaxant
Estazolam ProSom, Nuctalon 1990 1-5 10–31 hours (20.5h=0.85d) hypnotic, anxiolytic
Ethyl carfluzepate N/A 1-5 11–24 hours (17.5h=0.73d) hypnotic
Etizolam Etilaam, Etizest, Pasaden, Depas 1-2 6 hours (=0.25d) anxiolytic, hypnotic, amnesic, muscle relaxant, anticonvulsant
Ethyl loflazepate Victan, Meilax, Ronlax 2.5-3 73–119 hours (96h=4d) anxiolytic
Flubromazepam[12] Research chemical 1.5-4 (4-8) 100–220 hours (160h=6.67d) anxiolytic, hypnotic, amnesic, muscle relaxant, anticonvulsant
Flubromazolam Research chemical ? ? hypnotic
Flunitrazepam Rohypnol, Hipnosedon, Vulbegal, Fluscand, Flunipam, Ronal, Rohydorm, 1983 0.5-3 18–26 hours [36–200 hours] (22h=0.92d [118h=4.92d]) hypnotic
Flurazepam Dalmadorm, Dalmane 1970 1-1.5 40–250 hours (145h=6.04d) hypnotic
Flutazolam Coreminal ? 3.5 hours hypnotic
Flutoprazepam Restas 0.5-9 60–90 hours (75h=3.12d) hypnotic, anticonvulsant
Halazepam Paxipam 1981 1-3 30–100 hours (65h=2.71d) anxiolytic
Ketazolam Anxon N/A 2.5-3 30–100 hours [36–200] (65h=2.71d [118h=4.92d]) anxiolytic
Loprazolam Dormonoct 0.5-4 3.3–14.8 hours (9.05h=0.38d) hypnotic
Lorazepam Ativan, Lorenin, Lorsilan, Temesta, Tavor, Lorabenz 1977 2-4 9.5–20 hours (14.75h=0.61d) anxiolytic, amnesic, anticonvulsant, hypnotic, muscle relaxant[13][14][15]
Lormetazepam Loramet, Noctamid, Pronoctan 0.5-2 10 hours (=0.42d) hypnotic
Medazepam Nobrium, Ansilan, Mezapam, Rudotel, Raporan 1-1.5 36–200 hours (118h=4.92d) anxiolytic
Mexazolam Melex 1-2 [16] anxiolytic
Midazolam Dormicum, Versed, Hypnovel, Dormonid 1985 0.5-1 1.5–2.5 hours (2h=0.08d) hypnotic, anticonvulsant, amnesic, anxiolytic
Nifoxipam Research chemical ? ? hypnotic
Nimetazepam Erimin 0.5-3 14–30 hours (27h=1.12d) hypnotic
Nitrazepam Mogadon, Alodorm, Pacisyn, Dumolid, Nitrazadon 1965 0.5-3 17–48 hours (32.5h=1.35d) hypnotic, anticonvulsant
Nordiazepam Madar, Stilny ? 30–150 hours (90h=3.75d) anxiolytic
Oxazepam Seresta, Serax, Serenid, Serepax, Sobril, Oxabenz, Oxapax, Opamox 1965 3-4 4–11 hours (7.5h=0.31d) anxiolytic
Phenazepam Phenazepam 1.5-4 60 hours (=2.5d) anxiolytic, anticonvulsant
Pinazepam Domar ? 40–100 hours (70h=2.92d) anxiolytic
Prazepam Lysanxia, Centrax N/A 2-6 36–200 hours (118h=4.92d) anxiolytic
Premazepam N/A 2-6 10–13 hours (11.5h=0.48d) anxiolytic
Pyrazolam Pyrazolam, Bromazolam Research chemical 1-1.5 16-18[17] hours (17h=0.71d) anxiolytic, amnesic
Quazepam Doral 1985 1-5 39–120 hours (79.5h=3.31d) hypnotic
Rilmazafone Rhythmy ? [10.5 hours] hypnotic
Temazepam Restoril, Normison, Euhypnos, Temaze, Tenox 1981 0.5-3 4–10.5 hours (7.25h=0.30d) hypnotic, anxiolytic, muscle relaxant
Thienalprazolam Thienalprazolam, Deschloroetizolam, Thialprazolam Research chemical 1-2 10–40 hours (25h=1.04d) anxiolytic
Tetrazepam Myolastan 1-3 3–26 hours (14.5h=0.60d) Muscle relaxant
Triazolam Halcion, Rilamir 1982 0.5-2 2 hours (=0.08d) hypnotic

Atypical benzodiazepine receptor ligands[edit]

Drug Name Common Brand Names* Approval Date (FDA) Elimination Half-Life (h) [active metabolite] Primary Effects
DMCM  ?  ? anxiogenic, convulsant
Flumazenil** Anexate, Lanexat, Mazicon, Romazicon 1 hour antidote
Eszopiclone§ Lunesta 2004 6 hours hypnotic
Zaleplon§ Sonata, Starnoc 1999 1 hour hypnotic
Zolpidem§ Ambien, Nytamel, Sanval, Stilnoct, Stilnox, Sublinox (Canada), Xolnox, Zoldem, Zolnod 1992 2.6 hours hypnotic
Zopiclone§ Imovane, Rhovane, Ximovan; Zileze; Zimoclone; Zimovane; Zopitan; Zorclone, 4–6 hours hypnotic

* Not all trade names are listed. Click on drug name to see a more comprehensive list.

** Flumazenil is an imidazobenzodiazepine derivative,[18] and in layman's terms, it is a benzodiazepine overdose antidote that is given intravenously in Intensive Care Units (ICUs) to reverse the effects of benzodiazepine overdoses, as well for overdoses of the non-benzodiazepine "Z-drugs" such as Ambien and Lunesta.[19] Flumazenil is contraindicated for benzodiazepine-tolerant patients in overdose cases.[20] In such cases, the benefits are far outweighed by the risks, which include potential and severe seizures.[21][18] The method by which Flumazenil acts to prevent non-benzodiazepine tolerant overdose from causing potential harm is via preventing the benzodiazepines and Z-drugs from binding to the GABAA receptors via competitive inhibition which the Flumazenil creates. Clinical observation notating the patient's oxygen levels, respiratory, heart and blood pressure rates are used, as they are much safer than the potential seizure effects from Flumazenil. Supportive care to mediate any problems resulting from abnormal rates of the pulmonary, respiratory, and cardiovascular systems is typically the only treatment that is required in benzodiazepine-only overdoses.[22] In most cases, activated charcoal/carbon is often used to prevent benzodiazepines from being absorbed by the gastrointestinal tract, and the use of stomach-pumping/gastric lavage is no longer commonly used nor suggested by some toxicologists.[23] Even in cases where other central nervous system (CSN) depressants (such as in combined benzodiazepine and tricyclic antidepressant/TCA overdoses) are detected and/or suspected, endotrachial intubation for the airway path and supportive oxygen are typically implemented and are much safer than Flumazenil.[22]

Controversy[edit]

The UK's House of Commons has attempted to get a two to four week limit mandate for prescribing benzodiazepines to replace the two to four week benzodiazepine prescribing guidelines, which are merely recommended.[24][25]

See also[edit]

References[edit]

  1. ^ Golombok S, Lader M (August 1984). "The psychopharmacological effects of premazepam, diazepam and placebo in healthy human subjects". Br J Clin Pharmacol 18 (2): 127–33. doi:10.1111/j.1365-2125.1984.tb02444.x. PMC 1463527. PMID 6148956. 
  2. ^ de Visser SJ, van der Post JP, de Waal PP, Cornet F, Cohen AF, van Gerven JM (January 2003). "Biomarkers for the effects of benzodiazepines in healthy volunteers" (PDF). Br J Clin Pharmacol 55 (1): 39–50. doi:10.1046/j.1365-2125.2002.t01-10-01714.x. PMC 1884188. PMID 12534639. 
  3. ^ "Benzodiazepine Names". non-benzodiazepines.org.uk. Retrieved 2009-04-05. 
  4. ^ C. Heather Ashton (March 2007). "Benzodiazepine Equivalence Table". benzo.org.uk. Retrieved 2009-04-05. 
  5. ^ Bob, Dr (July 1995). "Benzodiazepine Equivalence Charts". dr-bob.org. Retrieved 2009-04-05. 
  6. ^ Salzman, Carl (15 May 2004). Clinical geriatric psychopharmacology (4th ed.). USA: Lippincott Williams & Wilkins. pp. 450–453. ISBN 978-0-7817-4380-8. 
  7. ^ Delcò F, Tchambaz L, Schlienger R, Drewe J, Krähenbühl S (2005). "Dose adjustment in patients with liver disease". Drug Saf 28 (6): 529–45. doi:10.2165/00002018-200528060-00005. PMID 15924505. 
  8. ^ Riss, J.; Cloyd, J.; Gates, J.; Collins, S. (Aug 2008). "Benzodiazepines in epilepsy: pharmacology and pharmacokinetics.". Acta Neurol Scand 118 (2): 69–86. doi:10.1111/j.1600-0404.2008.01004.x. PMID 18384456. 
  9. ^ Ashton, Dr. Heather (April 2007). "Benzodiazepine Equivalency Table". Retrieved 22 March 2015. 
  10. ^ van Steveninck AL et al. (1996). "Pharmacokinetic and pharmacodynamic interactions of bretazenil and diazepam with alcohol.". British Journal of Clinical Pharmacology 41 (6): 565–573. doi:10.1046/j.1365-2125.1996.38514.x. PMC 2042631. PMID 8799523. 
  11. ^ Moosmann, Bisel P, Auwärter V. (2014). "Characterization of the designer benzodiazepine diclazepam and preliminary data on its metabolism and pharmacokinetics.". The National Center for Biotechnology 1 (7-8): 1. doi:10.1002/dta.1628. PMID 24604775. 
  12. ^ J Mass Spectrom (2013). "Detection and identification of the designer benzodiazepine flubromazepam and preliminary data on its metabolism and pharmacokinetics.". The National Center for Biotechnology 1 (11): 1150–9. doi:10.1002/jms.3279. PMID 24259203. 
  13. ^ Shah, Dhwani; Borrensen, Dorothy (2011). "Benzodiazepines: A Guide to Safe Prescribing" (PDF). The Carlat Report: Psychiatry. 
  14. ^ Farinde, PharmD, PhD, Abimbola. "Benzodiazepine Equivalency Table". Medscape Reference. 
  15. ^ Vancouver Hospital Pharmaceutical Sciences. "Comparison of Benzodiazepines". 
  16. ^ Only active metabolites, chlornordiazepam and chloroxazepam, have appreciable effects, with 1.4 and 76 hour half-lives, respectively. See Psychomotor Effects of Mexazolam vs. Placebo in Healthy Volunteers, Clin Drug Invest. 2002;22(10)
  17. ^ [1]
  18. ^ a b http://www.gene.com/download/pdf/romazicon_prescribing.pdf
  19. ^ "Flumazenil Injection, Solution [App Pharmaceuticals, Llc]". Dailymed.nlm.nih.gov. Retrieved 2014-08-15. 
  20. ^ "DailyMed". Dailymed.nlm.nih.gov. Retrieved 2014-08-15. 
  21. ^ Gary R. Fleisher; Stephen Ludwig; Benjamin K. Silverman (2002). Synopsis of pediatric emergency medicine. Lippincott Williams & Wilkins. pp 409. ISBN 978-0-7817-3274-1. Retrieved 3/22/2013.
  22. ^ a b http://www.inchem.org/documents/pims/pharm/pim181.htm#DivisionTitle:8.1.1.1 Toxicological analyses. Retrieved 3/21/2013.)
  23. ^ Vale JA, Kulig K; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. (2004). "Position paper: gastric lavage". J Toxicol Clin Toxicol 42 (7): 933–943. doi:10.1081/CLT-200045006. PMID 15641639
  24. ^ "November | 2002". Appgita. Retrieved 15 August 2014. 
  25. ^ "APPG for Involuntary Tranquilliser Addiction". benzo.org.uk. Retrieved 21 March 2015. 

Further reading[edit]