Anxiolytics: benzodiazepines (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Limit the use of benzodiazepines as anxiolytics to the lowest possible dose for the shortest possible time.

Long-term medication treatment of anxiety: consider licensed serotonergic antidepressants first-line: refer to guidance on Generalised anxiety disorder, BNF section 4.3.3 and to NICE guidance January 2011 on anxiety (http://guidance.nice.org.uk/CG113).

MHRA alert: Benzodiazepines and opioids - reminder of risk of potentially fatal respiratory depression (March 2020) (www.gov.uk).

DIAZEPAM - (First line)

Therapy notes

MHRA advice: Drugs and driving: blood concentration limits to be set for certain controlled drugs in a new legal offence (December 2014) (www.gov.uk)
MHRA alert: Benzodiazepines and opioids - reminder of risk of potentially fatal respiratory depression (March 2020) (www.gov.uk).

Notes:

  • Diazepam has a long half-life (24 to 48 hours) and, in addition to its short-term use in severe anxiety, is suitable for withdrawal regimens.
  • Dose conversions to diazepam: http://cks.nice.org.uk

Formulation and dosage details

Formulation:

Tablets 2mg, 5mg

Dosage:

  • Anxiety: 2mg 3 times daily increased if necessary to 15 to 30mg daily in divided doses.
  • Alcohol withdrawal (abstinence from alcohol must be assured): refer to BNF, NICE guidance January 2011 on anxiety (www.nice.org.uk) and to Drugs used in substance dependence.

Formulation and dosage details

Formulation:

Oral solution 2mg/5mL

Dosage:

  • Anxiety: 2mg 3 times daily increased if necessary to 15 to 30mg daily in divided doses.
  • Alcohol withdrawal (abstinence from alcohol must be assured): refer to BNF, NICE guidance January 2011 on anxiety (www.nice.org.uk) and to Drugs used in substance dependence.

LORAZEPAM

Therapy notes


MHRA advice: Drugs and driving: blood concentration limits to be set for certain controlled drugs in a new legal offence (December 2014) (www.gov.uk)
MHRA advice: Lorazepam: reduction of recommended maximum daily dose (December 2014) (www.gov.uk)
MHRA alert: Benzodiazepines and opioids - reminder of risk of potentially fatal respiratory depression (March 2020) (www.gov.uk).

Notes: 

Lorazepam is recommended for patients with evidence of grossly impaired liver function. 

Formulation and dosage details

Formulation:

Tablets 1mg

Dosage:

  • Management of agitation associated with severe and enduring mental illness: 1 to 4mg daily in divided doses. Older or debilitated patients, half the adult dose. 
  • Emergency sedation: Rapid Tranquilisation.

Formulation and dosage details

Formulation:

Injection 4mg/mL (licensed and unlicensed)

Dosage:

Use of the injection is limited to:

CHLORDIAZEPOXIDE

Therapy notes


MHRA alert: Benzodiazepines and opioids - reminder of risk of potentially fatal respiratory depression (March 2020) (www.gov.uk).

Formulation and dosage details

Formulation:

Capsules 5mg, 10mg (Restricted: to attenuating alcohol withdrawal symptoms only)

Dosage:

CLONAZEPAM

Therapy notes


MHRA advice: Drug-name confusion: reminder to be vigilant for potential errors (January 2018) (www.gov.uk)
MHRA advice: Drugs and driving: blood concentration limits to be set for certain controlled drugs in a new legal offence (December 2014) (www.gov.uk)
MHRA alert: Benzodiazepines and opioids - reminder of risk of potentially fatal respiratory depression (March 2020) (www.gov.uk).

Formulation and dosage details

Formulation:

Tablets 500 micrograms, 2mg (Restricted: specialist initiation/recommendation only)

Dosage:

  • Specialist treatment of chronic anxiety and disturbed behaviour associated with severe and enduring mental illness (off-label).

Editorial Information

Document Id: F072