In addition to anxiety, benzodiazepines are indicated for muscle tension, insomnia, status epilepticus (diazepam), myoclonic epilepsy (clonazepam), preoperative anesthesia, and alcohol withdrawal. One benzodiazepine, the triazolobenzodiazepine alprazolam, is also indicated for anxiety associated with depression (as is lorazepam), and some studies have shown that alprazolam also parallels imipramine and phenelzine in having both antipanic and antidepressant properties (see Chapter 3: "Antidepressants"). Clonazepam is also approved in the treatment of panic disorder, and it is likely that all benzodiazepines are effective in the treatment of panic if given at high enough doses.

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Figure 6–1. Chemical structures of anxiolytic benzodiazepines.
Table Reference Number

Note. CNS = central nervous system; FDA = U.S. Food and Drug Administration.

Benzodiazepines (e.g., diazepam, clonazepam, alprazolam): overview


Generalized anxiety (FDA approved)

Panic disorder (FDA approved for alprazolam, clonazepam)

Insomnia (FDA approved)

Seizure disorder (FDA approved for clonazepam)

Muscle relaxation


Side effects




Safety in overdose

Safe in overdose up to 30 times the normal daily dose. Usual symptoms of overdose include sedation, drowsiness, ataxia, and slurred speech. May result in respiratory depression in combination with other CNS depressants. Management includes gastric lavage, forced emesis, and assisted ventilation.

Dosage and administration

Varies by benzodiazepine and indication; see Table 6–1Table 6–1.


Taper by no more than 25% of total dose per week after long-term administration. Withdrawal includes insomnia, agitation, anxiety, and, rarely, seizures.

Drug interactions

Additive CNS depression with ethanol, barbiturates, and other CNS depressants

Drugs that triazolo-benzodiazepine levels include: cytochrome P450 3A4 inhibitors, ketoconazole, fluconazole, nefazodone

Drugs that triazolo-benzodiazepine levels include: carbamazepine

Table Reference Number
Table 6–1. Benzodiazepines: names, formulations and strengths, and anxiolytic dosage range
Table Reference Number
Table 6–2. Benzodiazepines: absorption and pharmacokinetics


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