Benzodiazepine
Potentiates the effects of GABA at the GABA-A receptor by increasing the frequency of chloride channel opening, resulting in anxiolytic, sedative, muscle-relaxant, and anticonvulsant effects.
Generalized anxiety disorder (GAD), panic disorder
Acute agitation, refractory anxiety symptoms, short-term management of severe situational anxiety
Oral tablet, orally disintegrating tablet (ODT), extended-release tablet, oral solution
Start at 0.25–0.5 mg orally three times daily; titrate gradually based on response and tolerability
0.25–4 mg/day in divided doses
Rapid onset of action with short half-life (typically 6–12 hours); metabolized via CYP3A4; high risk of withdrawal symptoms with abrupt discontinuation
Sedation, dizziness, memory impairment, fatigue, emotional blunting, reduced concentration
Dependence, withdrawal (including seizures), respiratory depression, mood lability, paradoxical disinhibition (especially in elderly)
Monitor for sedation, cognitive and psychomotor effects, mood changes, and signs of misuse or dependence; reassess need regularly
Risk of profound sedation, respiratory depression, coma, and death when used with opioids. Risk of dependence, misuse, and withdrawal with prolonged use.
Use with caution in elderly adults and patients with dementia due to elevated risks of falls, delirium, and cognitive impairment. The short half-life and rapid onset increase the likelihood of rebound anxiety and withdrawal, particularly with abrupt discontinuation. Avoid in patients with a history of substance use disorder unless closely monitored. If used, prescribe the lowest effective dose for the shortest necessary duration.