Short- to intermediate-acting benzodiazepine
Enhances GABA-A receptor activity, increasing inhibitory neurotransmission to reduce anxiety and agitation.
Anxiety disorders, acute alcohol withdrawal.
Benzodiazepine tapering, agitation in medically complex or elderly patients.
Oral capsules and tablets.
Usually 10 mg p.o. three times daily, titrated based on symptom severity and tolerance.
10–30 mg p.o. TID.
Metabolized via hepatic glucuronidation (phase II), bypassing CYP450 system, resulting in safer use in hepatic impairment. Half-life ranges 4–15 hours with no active metabolites.
Sedation, dizziness, impaired motor coordination.
Respiratory depression (especially with other CNS depressants), paradoxical reactions (rare).
Monitor sedation, cognition, respiratory status, and fall risk, especially in elderly.
Risk of concomitant opioid use increasing respiratory depression and death; caution advised.
Preferred in elderly, patients with hepatic dysfunction, traumatic brain injury (TBI), or cognitive impairment due to safer metabolism and lower accumulation risk. However, use cautiously in elderly due to increased risk of sedation and falls. Effective option for alcohol withdrawal and benzodiazepine tapering.