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Drug Name Common Trade Names [a] Year Approved Typical Oral Dosage Formulations (mg) Approx. Equivalent Oral Dose to 10 mg Diazepam [b] (mg) Peak Onset of Action (hours) Elimination Half-life of Active Metabolite (hours) Primary Therapeutic Use Adinazolam: Deracyn: Research chemical: 1–2: 3: anxiolytic, antidepressant: Alprazolam
Rebound anxiety, more severe than baseline anxiety, is also a common withdrawal symptom when discontinuing diazepam or other benzodiazepines. [80] Diazepam is therefore only recommended for short-term therapy at the lowest possible dose owing to risks of severe withdrawal problems from low doses even after gradual reduction. [ 81 ]
Withdrawal is best managed by transferring the physically dependent patient to an equivalent dose of diazepam because it has the longest half-life of all of the benzodiazepines, is metabolised into long-acting active metabolites and is available in low-potency tablets, which can be quartered for smaller doses. [152]
The consensus is to reduce dosage gradually over several weeks, e.g. 4 or more weeks for diazepam doses over 30 mg/day, [1] with the rate determined by the person's ability to tolerate symptoms. [120] The recommended reduction rates range from 50% of the initial dose every week or so, [121] to 10–25% of the daily dose every 2 weeks. [120]
An Australian study (2004) of overdose admissions between 1987 and 2002 found alprazolam, which happens to be the most prescribed benzodiazepine in Australia and the United States, to be more toxic than diazepam and the other three benzodiazepines which it was compared to (alprazolam, diazepam, oxazepam, chlordiazepoxide, and clonazepam).
Keppra (levetiracetam) – an anticonvulsant drug which is sometimes used as a mood stabilizer and has potential benefits for other psychiatric and neurologic conditions such as Tourette syndrome, anxiety disorder, and Alzheimer's disease; Klonopin – anti-anxiety and anti-epileptic medication of the benzodiazepine class
Tofisopam [3] (Emandaxin, Grandaxin, Sériel) is an anxiolytic that is marketed in several European countries. [4] Chemically, it is a 2,3-benzodiazepine. Unlike other anxiolytic benzodiazepines (which are generally 1,4- or 1,5-substituted) however, tofisopam does not have anticonvulsant, sedative, [5] skeletal muscle relaxant, motor skill-impairing or amnestic [6] properties.
Repeated administration of a medication is also different from single dosing, as many drugs have active metabolites that can build up in the body. [6] Patient variables such as sex, age, and organ function may also influence the effect of the drug on the system. These variables are rarely included in equianalgesic charts. [7] [3] [8]