BENZODIAZEPINES (Systemic)

Some commonly used brand names are:

In the U.S.?

• Alprazolam Intensol ¹
• Ativan ¹²
• Dalmane ⁹
• Diastat ⁷
• Diazepam Intensol ⁷
• Dizac ⁷
• Doral ¹⁶
• Halcion ¹⁸
• Klonopin ⁵
• Librium ³
• Lorazepam Intensol ¹²
• Niravam ¹
• Paxipam ¹⁰
• ProSom ⁸
• Restoril ¹⁷
• Serax ¹⁴
• Tranxene-SD ⁶
• Tranxene-SD Half Strength ⁶
• Tranxene T-Tab ⁶
• Valium ⁷
• Xanax ¹

In Canada?

• Alti-Alprazolam ¹
• Alti-Bromazepam ²
• Alti-Clonazepam ⁵
• Alti-Triazolam ¹⁸
• Apo-Alpraz ¹
• Apo-Chlordiazepoxide ³
• Apo-Clonazepam ⁵
• Apo-Clorazepate ⁶
• Apo-Diazepam ⁷
• Apo-Flurazepam ⁹
• Apo-Lorazepam ¹²
• Apo-Oxazepam ¹⁴
• Apo-Temazepam ¹⁷
• Apo-Triazo ¹⁸
• Ativan ¹²
• Clonapam ⁵
• Dalmane ⁹
• Diazemuls ⁷
• Frisium ⁴
• Gen-Alprazolam ¹
• Gen-Bromazepam ²
• Gen-Clonazepam ⁵
• Gen-Triazolam ¹⁸
• Halcion ¹⁸
• Lectopam ²
• Mogadon ¹³
• Novo-Alprazol ¹
• Novo-Clopate ⁶
• Novo-Dipam ⁷
• Novo-Flupam ⁹
• Novo-Lorazem ¹²
• Novo-Poxide ³
• Novo-Temazepam ¹⁷
• Novo-Triolam ¹⁸
• Novoxapam ¹⁴
• Nu-Alpraz ¹
• Nu-Loraz ¹²
• PMS-Clonazepam ⁵
• PMS-Diazepam ⁷
• Restoril ¹⁷
• Rivotril ⁵
• Serax ¹⁴
• Somnol ⁹
• Tranxene ⁶
• Valium ⁷
• Vivol ⁷
• Xanax ¹
• Xanax TS ¹

Category

• Amnestic?Diazepam (parenteral only); Lorazepam (parenteral only)
• Antianxiety agent?Alprazolam; Bromazepam; Chlordiazepoxide; Clorazepate; Diazepam; Halazepam; Ketazolam; Lorazepam; Oxazepam; Prazepam
• Anticonvulsant?Clobazam; Clonazepam; Clorazepate; Diazepam; Lorazepam (parenteral only); Nitrazepam
• Antiemetic, incancer chemotherapy?Lorazepam (parenteralonly)
• Antipanic agent?Alprazolam; Chlordiazepoxide (parenteralonly); Clonazepam; Diazepam; Lorazepam
• Antitremor agent?Alprazolam; Chlordiazepoxide (oral only); Diazepam (oral only); Lorazepam (oral only)
• Sedative-hypnotic?Alprazolam; Bromazepam; Chlordiazepoxide; Clonazepam; Clorazepate; Diazepam; Estazolam; Flurazepam; Halazepam; Ketazolam; Lorazepam; Nitrazepam; Oxazepam; Prazepam; Quazepam; Temazepam; Triazolam
• Skeletal musclerelaxant adjunct?Diazepam; Lorazepam

Description

Benzodiazepines ((ben-zoe-dye-AZ-e-peens)) belong to thegroup of medicines called central nervous system (CNS) depressants (medicinesthat slow down the nervous system).

Some benzodiazepines are used to relieve anxiety. However, benzodiazepinesshould not be used to relieve nervousness or tension caused by the stressof everyday life.

Some benzodiazepines are used to treat insomnia (trouble in sleeping).However, if used regularly (for example, every day) for insomnia, they usuallyare not effective for more than a few weeks.

Many of the benzodiazepines are used in the treatment of other conditions,also. Diazepam is used to help relax muscles or relieve muscle spasm. Diazepaminjection is used before some medical procedures to relieve anxiety and toreduce memory of the procedure. Chlordiazepoxide, clorazepate, diazepam, andoxazepam are used to treat the symptoms of alcohol withdrawal. Alprazolamand clonazepam are used in the treatment of panic disorder. Clobazam, clonazepam,clorazepate, diazepam, and lorazepam are used in the treatment of certainconvulsive (seizure) disorders, such as epilepsy. The benzodiazepines mayalso be used for other conditions as determined by your doctor.

Benzodiazepines may be habit-forming (causing mental or physical dependence),especially when taken for a long time or in high doses.

These medicines are available only with your doctor's prescription, inthe following dosage forms:

Oral
• Alprazolam
  • Oral disintegrating tablets (U.S.)
  • Oral solution (U.S.)
  • Tablets (U.S. and Canada)
• Bromazepam
  • Tablets (Canada)
• Chlordiazepoxide
  • Capsules (U.S. and Canada)
• Clobazam
  • Tablets (Canada)
• Clonazepam
  • Tablets (U.S. and Canada)
• Clorazepate
  • Capsules (Canada)
  • Tablets (U.S.)
  • Extended-release tablets (U.S.)
• Diazepam
  • Oral solution (U.S. and Canada)
  • Tablets (U.S. and Canada)
• Estazolam
  • Tablets (U.S.)
• Flurazepam
  • Capsules (U.S. and Canada)
  • Tablets (Canada)
• Halazepam
  • Tablets (U.S.)
• Lorazepam
  • Oral concentrate (U.S.)
  • Tablets (U.S. and Canada)
  • Sublingual tablets (Canada)
• Nitrazepam
  • Tablets (Canada)
• Oxazepam
  • Capsules (U.S.)
  • Tablets (U.S. and Canada)
• Quazepam
  • Tablets (U.S.)
• Temazepam
  • Capsules (U.S. and Canada)
• Triazolam
  • Tablets (U.S. and Canada)

Parenteral
• Chlordiazepoxide
  • Injection (U.S.)
• Diazepam
  • Injection (U.S. and Canada)
• Lorazepam
  • Injection (U.S. and Canada)

Rectal
• Diazepam
  • For rectal solution (may be prepared in U.S. and Canada from diazepaminjection)
  • Rectal gel (U.S.)

Before Using This Medicine

In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For benzodiazepines,the following should be considered:

Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to benzodiazepines. Also tell your health care professionalif you are allergic to any other substances, such as foods, preservatives,or dyes. Certain benzodiazepine products may contain lactose, parabens, orsoybean oil.

Pregnancy?Chlordiazepoxide and diazepam have been reportedto increase the chance of birth defects when used during the first 3 monthsof pregnancy. Although similar problems have not been reported with the otherbenzodiazepines, the chance always exists since all of the benzodiazepinesare related.

Studies in animals have shown that clonazepam, lorazepam, and temazepamcause birth defects or other problems, including death of the animal fetus.

Too much use of a benzodiazepine during pregnancy may cause the baby tobecome dependent on the medicine. This may lead to withdrawal side effectsafter birth. Also, use of benzodiazepines during pregnancy, especially duringthe last weeks, may cause body temperature problems, breathing problems, difficultyin feeding, drowsiness, or muscle weakness in the newborn infant.

Benzodiazepines given just before or during labor may cause weakness inthe newborn infant. When diazepam is given in high doses (especially by injection)within 15 hours before delivery, it may cause breathing problems, muscle weakness,difficulty in feeding, and body temperature problems in the newborn infant.

Breast-feeding?Benzodiazepines may pass into the breast milk andcause drowsiness, difficulty in feeding, and weight loss in nursing babiesof mothers taking these medicines.

Children?Most of the side effects of these medicines are morelikely to occur in children, especially the very young. These patients areusually more sensitive than adults to the effects of benzodiazepines.

It is possible that using clonazepam for long periods of time may causeunwanted effects on physical and mental growth in children. If such effectsdo occur, they may not be noticed until many years later. Before this medicineis given to children for long periods of time, you should discuss its usewith your child's doctor.

Older adults?Most of the side effects of these medicines are morelikely to occur in the elderly, who are usually more sensitive to the effectsof benzodiazepines.

Taking benzodiazepines for trouble in sleeping may cause more daytime drowsinessin elderly patients than in younger adults. In addition, falls and relatedinjuries are more likely to occur in elderly patients taking benzodiazepines.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingor receiving benzodiazepines it is especially important that your health careprofessional know if you are taking any of the following:

• Central nervous system (CNS) depressants (medicines that cause drowsiness)?TheCNS depressant effects of either these medicines or benzodiazepines may beincreased; your doctor may want to change the dose of either or both medicines

• Fluvoxamine (e.g., Luvox) or
• Nefazodone (e.g., Serzone)?Higher blood levels of benzodiazepinesmay occur, increasing the chance that side effects will occur; your doctormay want to change the dose of either or both medicines, or give you a differentmedicine

• Itraconazole (e.g., Sporanox) or
• Ketoconazole (e.g., Nizoral)?These medicines should NOT beused if you are taking a benzodiazepine.

Other medical problems?The presence of other medicalproblems may affect the use of benzodiazepines. Make sure you tell your doctorif you have any other medical problems, especially:

• Alcohol abuse (or history of) or
• Drug abuse or dependence (or history of)?Dependence on benzodiazepinesmay be more likely to develop

• Brain disease?CNS depression and other side effects of benzodiazepinesmay be more likely to occur

• Difficulty in swallowing (in children) or
• Emphysema, asthma, bronchitis, or other chronic lung disease or
• Hyperactivity or
• Mental depression or
• Mental illness (severe) or
• Myasthenia gravis or
• Porphyria or
• Sleep apnea (temporary stopping of breathing during sleep)?Benzodiazepinesmay make these conditions worse

• Epilepsy or history of seizures?Although some benzodiazepinesare used in treating epilepsy, starting or suddenly stopping treatment withthese medicines may increase seizures

• Glaucoma, acute narrow angle?Benzodiazepines should NOT beused if you have this condition.

• Glaucoma, open angle?Benzodiazepines can be used but your doctorshould be monitoring your condition carefully.

• Kidney or liver disease?Higher blood levels of benzodiazepinesmay result, increasing the chance that side effects will occur

Proper Use of This Medicine

For caregiversadministering diazepam rectal gel:

• Discuss with the patient's medical doctor exactly when and how touse diazepam rectal gel.
• Discuss with the patient's medical doctor when you should call foremergency help.
• Read the instructions that you received with the medicine beforeyou need to use it.
• Stay with the patient after administering diazepam rectal gel tocheck his or her condition as instructed by the doctor.

For patients taking clorazepate extended-release tablets:

• Swallow tablets whole.
• Do not crush, break, or chew before swallowing.

For patients taking alprazolam, diazepam, or lorazepamconcentrated oral solution:

• Measure each dose carefully using the dropper provided with the medicine.
• It is recommended that each dose be mixed with water, soda or soda-likebeverages, or semisolid food such as applesauce or pudding, just before itis taken.
• Take the entire mixture right away. It should not be saved to beused later.

For patients taking lorazepam sublingual tablets:

• Do not chew or swallow the tablet. This medicine is meant to be absorbedthrough the lining of the mouth. Place the tablet under your tongue (sublingual)and let it slowly dissolve there. Do not swallow for at least 2 minutes.

For patients taking alprazolam oral disintegratingtablets:

• Make sure your hands are dry. Just prior to taking the tablet, removethe tablet from the bottle. Immediately place the tablet on top of the tongue.The tablet will dissolve in seconds, and you may swallow it with your saliva.You do not need to drink water or other liquid to swallow the tablet. If youhave split apart a tablet and only taken one half of the tablet, you shouldthrow away the unused part of the tablet right away because it may not remainstable.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not takeit for a longer time than your doctor ordered. If too much is taken, it maybecome habit-forming (causing mental or physical dependence).

If you think this medicine is not working properly after you have takenit for a few weeks, do not increase the dose.Instead, check with your doctor.

For patients taking this medicine on a regular schedule for epilepsy or other seizure disorder:

• In order for this medicine to control your seizures,it must be taken every day in regularly spaced doses as ordered by your doctor. This is necessary to keep a constant amount of the medicine in theblood. To help keep the amount constant, do not miss any doses.

For patients taking this medicine for insomnia:

• Do not take this medicine when your scheduledoes not permit you to get a full night's sleep (7 to 8 hours). Ifyou must wake up before this, you may continue to feel drowsy and may experiencememory problems, because the effects of the medicine have not had time towear off.

For patients taking flurazepam:

• When you begin to take this medicine, your sleepingproblem will improve somewhat the first night. However, 2 or 3 nights maypass before you receive the full effects of this medicine.

Dosing?The dose of benzodiazepines will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of benzodiazepines. If your dose isdifferent, do not change it unless your doctor tells you to do so.

The number of capsules or tablets, or the amount of solution that you take,or the number of injections you receive, depends on the strength of the medicine.Also, the number of doses you take each day, the timeallowed between doses, and the length of time you take the medicine dependon the medical problem for which you are taking benzodiazepines.

For alprazolam
• For oral dosage form (solution or tablets):
  • For anxiety:
    • Adults?At first, 0.25 to 0.5 milligram (mg) three times a day.Your doctor may increase your dose if needed. However, the dose usually isnot more than 4 mg a day.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?At first, 0.25 mg two or three times a day. Yourdoctor may increase your dose if needed.
  • For panic disorder:
    • Adults?At first, 0.5 mg three times a day. Your doctor mayincrease your dose if needed. However, the dose usually is not more than 10mg a day.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.

For bromazepam
• For oral dosage form (tablets):
  • For anxiety:
    • Adults?6 to 30 milligrams (mg) a day, taken in smaller dosesduring the day.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?At first, up to 3 mg a day. Your doctor may changeyour dose if needed.

For chlordiazepoxide
• For oral dosage form (capsules):
  • For anxiety:
    • Adults?5 to 25 milligrams (mg) three or four times a day.
    • Children 6 years of age and older?5 mg two to four times aday. Your doctor may increase your dose if needed.
    • Children younger than 6 years of age?Use and dose must be determinedby your doctor.
    • Older adults?At first, 5 mg two to four times a day. Your doctormay increase your dose if needed.
  • For sedation during withdrawal from alcohol:
    • Adults?At first, 50 to 100 mg, repeated if needed. However,the dose usually is not more than 400 mg a day.
    • Children?Use and dose must be determined by your doctor.
• For injection dosage form:
  • For anxiety:
    • Adults?At first, 50 to 100 mg, injected into a muscle or vein.Then, if needed, 25 to 50 mg three or four times a day.
    • Teenagers?25 to 50 mg, injected into a muscle or vein.
    • Children younger than 12 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?25 to 50 mg, injected into a muscle or vein.
  • For sedation during withdrawal from alcohol:
    • Adults?At first, 50 to 100 mg, injected into a muscle or vein.If needed, the dose may be repeated in two to four hours.
    • Children?Use and dose must be determined by your doctor.

For clobazam
• For oral dosage form (tablets):
  • For control of seizures:
    • Adults?At first, 5 to 15 milligrams (mg) a day. Your doctormay increase your dose if needed. However, the dose usually is not more than80 mg a day.
    • Children 2 to 16 years of age?At first, 5 mg a day. Your doctormay increase your dose if needed. However, the dose usually is not more than40 mg a day.
    • Children younger than 2 years of age?Dose is based on bodyweight and must be determined by your doctor.

For clonazepam
• For oral dosage form (tablets):
  • For control of seizures:
    • Adults?At first, 0.5 milligram (mg) three times a day. Yourdoctor may increase your dose if needed. However, the dose usually is notmore than 20 mg a day.
    • Infants and children younger than 10 years of age?Dose is basedon body weight and must be determined by your doctor.
  • For panic disorder:
    • Adults?At first, 0.25 mg two times a day. Your doctor may increaseyour dose if needed. However, the dose usually is not more than 4 mg a day.
    • Children?Use and dose must be determined by your doctor.

For clorazepate
• For oral dosage form (capsules or tablets):
  • For anxiety:
    • Adults and teenagers?7.5 to 15 mg two to four times a day.Or your doctor may want you to start by taking 15 mg at bedtime.
    • Children younger than 12 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?At first, 3.75 to 15 mg a day. Your doctor mayincrease your dose if needed.
  • For sedation during withdrawal from alcohol:
    • Adults and teenagers?At first, 30 mg. Your doctor will setup a schedule that will gradually reduce your dose.
    • Children younger than 12 years of age?Use and dose must bedetermined by your doctor.
  • For control of seizures:
    • Adults and teenagers?At first, up to 7.5 mg taken three timesa day. Your doctor may increase your dose if needed. However, the dose usuallyis not more than 90 mg a day.
    • Children 9 to 12 years of age?At first, up to 7.5 mg two timesa day. Your doctor may increase your dose if needed. However, the dose usuallyis not more than 60 mg a day.
    • Children younger than 9 years of age?Use and dose must be determinedby your doctor.
• For oral dosage form (extended-releasetablets):
  • For anxiety:
    • Adults and teenagers?Your doctor may change your dosage formto the extended-release tablet if you are already taking 3.75 or 7.5 milligrams(mg) of clorazepate three times a day. The extended-release tablet is takenone time each day.
    • Children younger than 12 years of age?Use and dose must bedetermined by your doctor.
  • For control of seizures:
    • Adults, teenagers, and children 9 to 12 years of age?Your doctormay change your dosage form to the extended-release tablet if you are alreadytaking 3.75 or 7.5 milligrams (mg) of clorazepate three times a day. The extended-releasetablet is taken one time each day.
    • Children younger than 9 years of age?Use and dose must be determinedby your doctor.

For diazepam
• For oral dosage form (solution or tablets):
  • For anxiety:
    • Adults?2 to 10 mg two to four times a day.
    • Children 6 months of age and older?Dose is based on body weightor size and must be determined by your doctor.
    • Children younger than 6 months of age?Use is not recommended.
    • Older adults?2 to 2.5 mg one or two times a day. Your doctormay increase your dose if needed.
  • For sedation during withdrawal from alcohol:
    • Adults?At first, 10 mg three or four times a day. Your doctorwill set up a schedule that will gradually decrease your dose.
    • Children?Use and dose must be determined by your doctor.
  • For control of seizures:
    • Adults?2 to 10 mg two to four times a day.
    • Children 6 months of age and older?Dose is based on body weightor size and must be determined by your doctor.
    • Children younger than 6 months of age?Use is not recommended.
    • Older adults?2 to 2.5 mg one or two times a day. Your doctormay increase your dose if needed.
  • For relaxing muscles:
    • Adults?2 to 10 mg three or four times a day.
    • Children 6 months of age and older?Dose is based on body weightor size and must be determined by your doctor.
    • Children younger than 6 months of age?Use is not recommended.
    • Older adults?2 to 2.5 mg one or two times a day. Your doctormay increase your dose if needed.
• For injection dosage form:
  • For anxiety:
    • Adults?2 to 10 mg, injected into a muscle or vein.
    • Children?Use and dose must be determined by your doctor.
    • For older adults?2 to 5 mg, injected into a muscle or vein.
  • For sedation during withdrawal from alcohol:
    • Adults?At first, 10 mg injected into a muscle or vein. If needed,5 to 10 mg may be given three or four hours later.
    • Children?Use and dose must be determined by your doctor.
  • For sedation before surgery or other procedures:
    • Adults?5 to 20 mg, injected into a muscle or vein.
    • Children?Use and dose must be determined by your doctor.
    • Older adults?2 to 5 mg, injected into a muscle or vein.
  • For control of seizures:
    • Adults?At first, 5 to 10 mg, usually injected into a vein everyten to fifteen minutes, stopping if the total dose reaches 30 mg. If needed,this treatment may be repeated in two to four hours.
    • Children 5 years of age and older?At first, 1 mg, usually injectedinto a vein every two to five minutes, stopping if the total dose reaches10 mg. This treatment may be repeated in two to four hours.
    • Infants older than 30 days of age and children younger than 5 yearsof age?At first, 0.2 to 0.5 mg, usually injected into a vein everytwo to five minutes, stopping if the total dose reaches 5 mg. This treatmentmay be repeated in two to four hours.
    • Newborns and infants 30 days of age and younger?Use and dosemust be determined by your doctor.
    • Older adults?2 to 5 mg, injected into a muscle or vein.
  • For relaxing muscle spasms:
    • Adults?At first, 5 to 10 mg injected into a muscle or vein.The dose may be repeated in three or four hours.
    • Children?Use and dose must be determined by your doctor.
    • Older adults?2 to 5 mg, injected into a muscle or vein.
  • For relaxing muscles in tetanus:
    • Adults?At first, 5 to 10 mg injected into a muscle or vein.Your doctor may increase your dose if needed.
    • Children 5 years of age and older?5 to 10 mg, injected intoa muscle or vein. The dose may be repeated every three to four hours if needed.
    • Infants older than 30 days of age and children younger than 5 yearsof age?1 to 2 mg, injected into a muscle or vein. The dose may be repeatedevery three to four hours if needed.
    • Newborns and infants 30 days of age and younger?Use and dosemust be determined by your doctor.
• For rectal dosage form (gel or solution):
  • For control of seizures:
    • Adults and teenagers?Dose is based on body weight and mustbe determined by your doctor.
    • Children?Dose is based on body weight and must be determinedby your doctor.

For estazolam
• For oral dosage form (tablets):
  • For trouble in sleeping:
    • Adults?1 milligram (mg) at bedtime. Your doctor may increaseyour dose if needed. However, the dose usually is not more than 2 mg.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.

For flurazepam
• For oral dosage form (capsules or tablets):
  • For trouble in sleeping:
    • Adults?15 or 30 milligrams (mg) at bedtime.
    • Children younger than 15 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?At first, 15 mg at bedtime. Your doctor may increaseyour dose if needed.

For halazepam
• For oral dosage form (tablets):
  • For anxiety:
    • Adults?20 to 40 milligrams (mg) three or four times a day.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?20 mg one or two times a day.

For lorazepam
• For oral dosage form (concentrate ortablets):
  • For anxiety:
    • Adults and teenagers?1 to 3 milligrams (mg) two or three timesa day.
    • Children younger than 12 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?0.5 to 2 mg a day, taken in smaller doses duringthe day.
  • For trouble in sleeping:
    • Adults and teenagers?2 to 4 mg taken at bedtime.
    • Children younger than 12 years of age?Use and dose must bedetermined by your doctor.
• For sublingual tablet dosage form:
  • For anxiety:
    • Adults?2 to 3 mg a day, in smaller doses placed under the tongueduring the day. Your doctor may increase your dose if needed. However, thedose usually is not more than 6 mg a day.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?At first, 0.5 mg a day. Your doctor may increaseyour dose if needed.
  • For sedation before surgery:
    • Adults?Dose is based on body weight and will be determinedby your doctor. However, the dose usually is not more than 4 mg, placed underthe tongue, one to two hours before surgery.
    • Children?Use and dose must be determined by your doctor.
• For injection dosage form:
  • For sedation before surgery or other procedures:
    • Adults?Dose is based on body weight and will be determinedby your doctor. However, the dose usually is not more than 4 mg, injectedinto a muscle or vein.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.
  • For control of seizures:
    • Adults?At first, 4 mg slowly injected into a vein. The dosemay be repeated after ten to fifteen minutes if needed.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.

For nitrazepam
• For oral dosage form (tablets):
  • For trouble in sleeping:
    • Adults?5 to 10 milligrams (mg) at bedtime.
    • Children?Use and dose must be determined by your doctor.
    • Older adults?At first, 2.5 mg taken at bedtime. Your doctormay increase your dose if needed.
  • For control of seizures:
    • Children less than 30 kilograms (66 pounds) of body weight?Doseis based on body weight and will be determined by your doctor.

For oxazepam
• For oral dosage form (capsules or tablets):
  • For anxiety:
    • Adults?10 to 30 milligrams (mg) three or four times a day.
    • Children younger than 12 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?At first, 5 mg one or two times a day or 10 mgthree times a day. Your doctor may increase your dose if needed. However,the dose usually is not more than 15 mg four times a day.
  • For sedation during withdrawal from alcohol:
    • Adults?15 to 30 mg three or four times a day.
    • Children younger than 12 years of age?Use and dose must bedetermined by your doctor.

For quazepam
• For oral dosage form (tablets):
  • For trouble in sleeping:
    • Adults?7.5 to 15 milligrams (mg) at bedtime.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.

For temazepam
• For oral dosage form (capsules):
  • For trouble in sleeping:
    • Adults?15 milligrams (mg) at bedtime. Your doctor may changeyour dose if needed.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?At first, 7.5 mg at bedtime. Your doctor may increaseyour dose if needed.

For triazolam
• For oral dosage form (tablets):
  • For trouble in sleeping:
    • Adults?0.125 to 0.25 milligram (mg) at bedtime.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.
    • Older adults?At first, 0.125 mg at bedtime. Your doctor mayincrease your dose if needed.

Missed dose?If you are taking this medicine regularly (forexample, every day as for epilepsy) and you miss a dose, take it right awayif you remember within an hour or so of the missed dose. However, if you donot remember until later, skip the missed dose and go back to your regulardosing schedule. Do not double doses.

Storage?To store this medicine:

• Keep out of the reach of children. Overdose of benzodiazepines maybe especially dangerous in children.
• Store away from heat and direct light.
• Do not store the capsule or tablet form of this medicine in the bathroom,near the kitchen sink, or in other damp places. Heat or moisture may causethe medicine to break down.
• Keep the liquid form of this medicine from freezing.
• Keep the oral disintegrating tablet form of this medicine in a tightlysealed bottle and discard any cotton that was included in the bottle
• Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

If youwill be taking a benzodiazepine regularly for a longtime:

• Your doctor should check your progress at regular visits to makesure that this medicine does not cause unwanted effects. If you are takinga benzodiazepine for convulsions (seizures), this is also important duringthe first few months of treatment.
• Check with your doctor at regular visits to see if you need to continuetaking this medicine.

If you are taking a benzodiazepine for epilepsy oranother seizure disorder:

• Your doctor may want you to carry a medical identification card orbracelet stating that you are taking this medicine.

If you are taking a benzodiazepine for insomnia(trouble in sleeping):

• If you think you need this medicine for more than 7 to 10 days, besure to discuss it with your doctor. Insomnia that lasts longer than thismay be a sign of another medical problem.
• You may have difficulty sleeping (rebound insomnia) for the firstfew nights after you stop taking this medicine.

Benzodiazepines may be habit-forming (causing mentalor physical dependence), especially when taken for a long time or inhigh doses. Some signs of dependence on benzodiazepines are:

• A strong desire or need to continue taking the medicine.
• A need to increase the dose to receive the effects of the medicine.
• Withdrawal effects (for example, irritability, nervousness, troublein sleeping, abdominal or stomach cramps, trembling or shaking) occurringafter the medicine is stopped.

If you have been taking this medicine in large dosesor for a long time, do not stop taking it without first checking with yourdoctor. Your doctor may want you to reduce gradually the amount youare taking before stopping completely. Stopping this medicine suddenly maycause withdrawal side effects, including seizures. Stopping this medicinesuddenly is most likely to cause seizures if you have been taking it for epilepsyor another seizure disorder.

This medicine will add to the effects of alcohol and other central nervoussystem (CNS) depressants (medicines that slow down the nervous system, possiblycausing drowsiness). Some examples of CNS depressants are antihistamines ormedicine for hay fever, other allergies, or colds; sedatives, tranquilizers,or sleeping medicine; prescription pain medicine or narcotics; barbiturates;medicine for seizures; muscle relaxants; or anesthetics, including some dentalanesthetics. This effect may last for a few days after you stop taking thismedicine. Check with your doctor before taking any ofthe above while you are taking this medicine.

If you think you or someone else may have taken anoverdose of this medicine, get emergency help at once. Taking an overdoseof a benzodiazepine or taking alcohol or other CNS depressants with the benzodiazepinemay lead to unconsciousness and possibly death. Some signs of an overdoseare continuing slurred speech or confusion, severe drowsiness, severe weakness,and staggering.

Before you have any medical tests, tell the medical doctor in charge thatyou are taking this medicine. The results of the metyrapone test may be affectedby chlordiazepoxide.

If you develop any unusual and strange thoughts or behavior while you aretaking this medicine, be sure to discuss it with your doctor. Some changesthat have occurred in people taking this medicine are like those seen in peoplewho drink alcohol and then act in a manner that is not normal. Other changesmay be more unusual and extreme, such as confusion, agitation, and hallucinations(seeing, hearing, or feeling things that are not there).

This medicine may cause some people, especially older persons, to becomedrowsy, dizzy, lightheaded, clumsy or unsteady, or less alert than they arenormally. Even if taken at bedtime, it may cause some people to feel drowsyor less alert on arising. Make sure you know how youreact to this medicine before you drive, use machines, or do anything elsethat could be dangerous if you are dizzy or are not alert.

Side Effects of This Medicine

Along with its needed effects,a medicine may cause some unwanted effects. Although not all of these sideeffects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possibleif any of the following side effects occur:

Less common

Anxiety; confusion (may be more commonin the elderly); fast, pounding, or irregular heartbeat; lack of memory of events taking place after benzodiazepineis taken (may be more common with triazolam); mentaldepression

Rare

Abnormal thinking, including disorientation, delusions (holdingfalse beliefs that cannot be changed by facts), or loss of sense of reality; agitation; behavior changes,including aggressive behavior, bizarre behavior, decreased inhibition, oroutbursts of anger; convulsions (seizures); hallucinations (seeing, hearing, or feeling things that are notthere); hypotension (low blood pressure); muscle weakness; skin rash or itching; sore throat, fever, and chills; trouble in sleeping; ulcers or sores in mouth orthroat (continuing); uncontrolled movements of body,including the eyes; unusual bleeding or bruising; unusual excitement, nervousness, or irritability; unusual tiredness or weakness (severe); yellow eyes or skin

Symptoms of overdose

Confusion (continuing); convulsions(seizures); drowsiness (severe) or coma; shakiness; slow heartbeat; slow reflexes; slurred speech (continuing); staggering; troubled breathing; weakness (severe)

For patients having chlordiazepoxide, diazepam, or lorazepam injected:

• Check with your doctor if there is redness, swelling, or pain atthe place of injection.

Other side effects may occurthat usually do not need medical attention. These side effects may go awayduring treatment as your body adjusts to the medicine. However, check withyour doctor if any of the following side effects continue or are bothersome:

More common

Clumsiness or unsteadiness; dizzinessor lightheadedness; drowsiness; slurred speech

Less common or rare

Abdominal or stomach cramps or pain; blurred vision or other changes in vision; changesin sexual desire or ability; constipation; diarrhea; dryness of mouth or increasedthirst; false sense of well-being; headache; increased bronchial secretions or wateringof mouth; muscle spasm; nausea or vomiting; problems with urination; trembling or shaking; unusual tirednessor weakness

Not all of the side effectslisted above have been reported for each of these medicines, but they havebeen reported for at least one of them. All of the benzodiazepines are similar,so any of the above side effects may occur with any of these medicines.

After you stop using thismedicine, your body may need time to adjust. During this time, check withyour doctor if you notice any of the following side effects:

More common

Irritability; nervousness; trouble in sleeping

Less common

Abdominal or stomach cramps; confusion; fast or pounding heartbeat; increased sense of hearing; increased sensitivityto touch and pain; increased sweating; loss of sense of reality; mental depression; muscle cramps; nauseaor vomiting; sensitivity of eyes to light; tingling, burning, or prickly sensations; trembling or shaking

Rare

Confusion as to time, place, or person; convulsions (seizures); feelings of suspicion ordistrust; hallucinations (seeing, hearing, or feelingthings that are not there)

Other side effects not listed above may also occur in some patients. Ifyou notice any other effects, check with your doctor.

Additional Information

Once a medicine has been approvedfor marketing for a certain use, experience may show that it is also usefulfor other medical problems. Although these uses are not included in productlabeling, some of the benzodiazepines are used in certain patients with thefollowing medical conditions:

• Nausea and vomiting caused by cancer chemotherapy
• Tension headache
• Tremors

Other than the above information, there is no additional information relatingto proper use, precautions, or side effects for these uses.