List of benzodiazepines

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The tables below contain a sample list of benzodiazepines and benzodiazepine analogs that are commonly prescribed, with their basic pharmacological characteristics, such as half-life and equivalent doses to other benzodiazepines, also listed, along with their trade names and primary uses. The elimination half-life is how long it takes for half of the drug to be eliminated by the body. "Time to peak" refers to when maximum levels of the drug in the blood occur after a given dose. Benzodiazepines generally share the same pharmacological properties, such as anxiolytic, sedative, hypnotic, skeletal muscle relaxant, amnesic, and anticonvulsant effects. Variation in potency of certain effects may exist amongst individual benzodiazepines. Some benzodiazepines produce active metabolites. Active metabolites are produced when a person's body metabolizes the drug into compounds that share a similar pharmacological profile to the parent compound and thus are relevant when calculating how long the pharmacological effects of a drug will last. Long-acting benzodiazepines with long-acting active metabolites, such as diazepam and chlordiazepoxide, are often prescribed for benzodiazepine or alcohol withdrawal as well as for anxiety if constant dose levels are required throughout the day. Shorter-acting benzodiazepines are often preferred for insomnia due to their lesser hangover effect. [1] [2] [3] [4] [5]

Contents

It is fairly important to note that elimination half-life of diazepam and chlordiazepoxide, as well as other long half-life benzodiazepines, is twice as long in the elderly compared to younger individuals. Due to increased sensitivity and potentially dangerous adverse events among elderly patients, it is recommended to avoid prescribing them as specified by the 2015 American Geriatrics Society Beers Criteria. [6] Individuals with an impaired liver also metabolize benzodiazepines more slowly. Thus, the approximate equivalent of doses below may need to be adjusted accordingly in individuals on short acting benzodiazepines who metabolize long-acting benzodiazepines more slowly and vice versa. The changes are most notable with long acting benzodiazepines as these are prone to significant accumulation in such individuals and can lead to withdrawal symptoms.[ citation needed ] For example, the equivalent dose of diazepam in an elderly individual on lorazepam may be half of what would be expected in a younger individual. [7] [8] Equivalent doses of benzodiazepines differ as much as 20 fold. [9] [10] [11]

Pharmacokinetic properties of various benzodiazepines

Equivalency data in the table below is taken from the Ashton "Benzodiazepine Equivalence Table". [4] [12] [13] [14]

Drug NameCommon Trade Names [lower-alpha 1] Year Approved

(US FDA)

Typical Oral Dosage Formulations

(mg)

Approx. Equivalent Oral Dose to 10 mg Diazepam [lower-alpha 2] (mg)Peak Onset of Action

(hours)

Elimination Half-life of Active Metabolite (hours)Primary Therapeutic Use
Adinazolam Deracyn Research chemical 1–23 anxiolytic, antidepressant
Alprazolam Xanax, Helex, Xanor, Trankimazin, Onax, Alprox, Misar, Restyl, Solanax, Tafil, Neurol, Frontin, Kalma, Ksalol, Farmapram19810.25, 0.5, 1, 20.51–3 [16] 11-13 [10–20] [16] anxiolytic, antidepressant [17]
Bentazepam [lower-alpha 3] Thiadipona251–32–4 anxiolytic
Bretazenil [18] 2.5 anxiolytic, anticonvulsant
Bromazepam Lexotanil, Lexotan, Lexilium, Lectopam, Lexaurin, Lexatin, Bromam19811.5, 3, 661–520–40 anxiolytic,

hypnotic, muscle relaxant

Bromazolam Research chemical2 , 42 anxiolytic
Brotizolam [lower-alpha 4] Lendormin, Dormex, Sintonal, Noctilan0.250.50.5–24–5 hypnotic
Camazepam Albego, Limpidon40 [19] 1–36–11 anxiolytic
Chlordiazepoxide Librium, Risolid, Elenium19605, 10, 25251.5–636–200 anxiolytic
Cinazepam Levana0.5, 1, 22–460 hypnotic, anxiolytic
Cinolazepam Gerodorm400.5–29 hypnotic
Clobazam Onfi, Frisium, Urbanol20115, 10, 20201–58–60 anxiolytic, anticonvulsant
Clonazepam Rivatril, Rivotril, Klonopin, Iktorivil, Paxam19750.5, 1, 20.5-11–519.5–50 anticonvulsant, anxiolytic
Clonazolam Research chemical0.25, 0.50.20.5-13-4 [20] hypnotic, anticonvulsant
Clorazepate Tranxene, Tranxilium19723.75, 5, 7.515Variable32–152 anxiolytic, anticonvulsant
Clotiazepam [lower-alpha 3] Veratran, Clozan, Rize5, 10101–34 anxiolytic
Cloxazolam Cloxam, Sepazon, Olcadil1, 2, 41.5 [19] 2–555–77 [19] anxiolytic, anticonvulsant
Delorazepam Dadumir0.5, 1, 21-1.51–279< [21] anxiolytic, amnesic
Deschloroetizolam [lower-alpha 4] Research chemical1, 24 anxiolytic
Diazepam Antenex, Apaurin, Apzepam, Apozepam, Diazepan, Hexalid, Normabel, Pax, Stesolid, Stedon, Tranquirit, Valium, Vival, Valaxona19632, 5, 10101–1.532–205 anxiolytic, anticonvulsant, muscle relaxant, amnesic
Diclazepam [22] Research chemical1, 221.5–342 anxiolytic, muscle relaxant
Estazolam ProSom, Nuctalon19901, 22 [19] 3–510–24 hypnotic, anxiolytic
Ethyl carfluzepate Not approved21–511–24 hypnotic
Etizolam [lower-alpha 4] Etilaam, Etizest, Pasaden, DepasOften sold as a research chemical, but is approved for human use in many countries. Controlled substance in some US states, Canada, Germany, Austria, and others. [23] [24] 121–35-7 anxiolytic, muscle relaxant, anticonvulsant
Ethyl loflazepate Victan, Meilax, Ronlax2 [19] 2.5–373–119 anxiolytic
Flualprazolam Research chemical0.5, 10.251-212-22 anxiolytic, hypnotic
Flubromazepam [25] TemplexResearch chemical4, 8, 1241.5–8100–220 anxiolytic, hypnotic, amnesic, muscle relaxant, anticonvulsant
Flubromazolam RemnonResearch chemical0.25, 0.50.0750.5-510-20 [26] hypnotic
Flubrotizolam [lower-alpha 4] Research chemical0.75 anxiolytic
Fluclotizolam [lower-alpha 4] Research chemical0.25-0.5 anxiolytic
Flunitrazepam Rohypnol, Hipnosedon, Vulbegal, Fluscand, Flunipam, Ronal, Rohydorm, Hypnodorm19721, 21.50.5–318–200 hypnotic
Flunitrazolam Research chemical0.25, 0.50.10.5-15-13 hypnotic
Flurazepam Dalmadorm, Dalmane, Fluzepam19703020-251–1.540–250 hypnotic
Flutazolam Coreminal4101-347-100 hypnotic
Flutemazepam Research chemical10.5-58-20 hypnotic, anxiolytic, anticonvulsant, muscle relaxant [27]
Flutoprazepam Restas19841, 22.50.5–987 [28] hypnotic, anticonvulsant, muscle relaxant
Halazepam Alapryl, Paxipam198120, 40403–615-35 [30-100] anxiolytic
Ketazolam Anxon, Sedotime198015, 30, 45202.5–630-100 [36-200] anxiolytic
Loprazolam Dormonoct, Havlane19831, 21.52–56–20 [29] hypnotic
Lorazepam Ativan, Orfidal, Lorenin, Lorsilan, Temesta, Tavor, Lorabenz19770.5, 1, 2, 2.512–410–20 anxiolytic, anticonvulsant, hypnotic, muscle relaxant [30] [14] [31]
Lormetazepam Loramet, Noctamid, Pronoctan19841, 21.50.5–210-12 hypnotic, anxiolytic
Meclonazepam Research chemical6 anxiolytic
Medazepam Nobrium, Ansilan, Mezapam, Rudotel, Raporan10104-836–200 anxiolytic
Metizolam [lower-alpha 4] Research chemical1, 2, 42–412 anxiolytic
Mexazolam Melex, Sedoxil0.5, 11–2 anxiolytic
Midazolam Dormicum, Flormidal, Versed, Hypnovel, Dormonid19857.5, 1510 (oral)

4 (IV)

0.5–11.8-6 hypnotic, anticonvulsant
Nifoxipam Research chemical0.5, 1, 2 hypnotic
Nimetazepam Erimin, Lavol198452.5-50.5–314–30 hypnotic
Nitemazepam Research chemical20.5-510-27 hypnotic, anticonvulsant
Nitrazepam Mogadon, Alodorm, Pacisyn, Dumolid, Nitrazadon19655, 1050.5–717–48 hypnotic, anticonvulsant
Nitrazolam Research chemical0.5, 1 hypnotic
Nordazepam Madar, Stilny5, 7.5, 1510-1530–150 anxiolytic
Norflurazepam Research chemical547-100 hypnotic
Oxazepam Seresta, Serax, Serenid, Serepax, Sobril, Oxabenz, Oxapax, Oxascand, Ox-Pam, Opamox, Alepam, Medopam, Murelax, Noripam, Purata196510, 15, 30, 50303–44–11 anxiolytic
Phenazepam Phenazepam, PhenzitatResearch chemical1.5–460 anxiolytic, anticonvulsant
Pinazepam Domar, Duna5, 1040–100 anxiolytic
Prazepam Demetrin, Lysanxia, Prazene, Centrax197610, 20, 3015-202–636–200 anxiolytic
Premazepam Not approved152–610–13 anxiolytic
Pyrazolam Research chemical0.25, 0.5, 11–1.516–18 [32] anxiolytic, amnesic
Quazepam Doral, Quiedorm198515201–539–120 hypnotic
Rilmazafone Rhythmy11 hypnotic
Temazepam Restoril, Normison, Euhypnos, Temaze, Tenox198110, 2015-200.5–34–11 hypnotic, anxiolytic, muscle relaxant
Tetrazepam Myolastan, Clinoxam, Epsipam, Musaril501–33–26 muscle relaxant, anxiolytic
Triazolam Halcion, Rilamir, Notison, Somese19800.125, 0.250.50.5–22 hypnotic
Drug NameCommon Trade NamesYear ApprovedTypical Dosages of Oral Tablets

(mg)

Approx. Equivalent Oral Dose to 10mg Diazepam (mg)Peak onset of action (hours)Elimination Half-life of Active Metabolite (hours)Primary Therapeutic Use

Atypical benzodiazepine receptor ligands

Drug NameCommon Trade NamesYear approved(US FDA)Elimination Half-life

of Active Metabolite(hours)

Primary Therapeutic Use
DMCM anxiogenic, convulsant
Flumazenil [lower-alpha 5] Anexate, Lanexat, Mazicon, Romazicon1 antidote
Eszopiclone §Lunesta20046 hypnotic
Zaleplon §Sonata, Starnoc19991 hypnotic
Zolpidem §Ambien, Nytamel, Sanval, Stilnoct, Stilnox, Sublinox (Canada), Xolnox, Zoldem, Zolnod19922.6 hypnotic
Zopiclone §Imovane, Rhovane, Ximovan; Zileze; Zimoclone; Zimovane; Zopitan; Zorclone, Zopiklone4–6 hypnotic
  1. Not all trade names are listed.
  2. An alternative table published by the state of South Australia uses equivalent approximate oral dosages to 5 mg diazepam. [15]
  3. 1 2 Technically this is a thienodiazepine, but produces very similar effects as benzodiazepines.
  4. 1 2 3 4 5 6 Technically this is a thienotriazolodiazepine, but produces very similar effects as benzodiazepines.
  5. Flumazenil is an imidazobenzodiazepine derivative, [33] and in layman's terms, it is a benzodiazepine overdose antidote that is given intravenously in Intensive Care Units (ICUs) to reverse the effects of benzodiazepine overdoses, as well for overdoses of the non-benzodiazepine "Z-drugs" such as zolpidem. [34] Flumazenil is contraindicated for benzodiazepine-tolerant patients in overdose cases. [34] In such cases, the benefits are far outweighed by the risks, which include potential and severe seizures. [33] [35] The method by which flumazenil acts to prevent non-benzodiazepine tolerant overdose from causing potential harm is via preventing the benzodiazepines and Z-drugs from binding to the GABAA receptors via competitive inhibition which the flumazenil creates. Clinical observation notating the patient's oxygen levels, respiratory, heart and blood pressure rates are used, as they are much safer than the potential seizure effects from flumazenil. Supportive care to mediate any problems resulting from abnormal rates of the pulmonary, respiratory, and cardiovascular systems is typically the only treatment that is required in benzodiazepine-only overdoses. [36] In most cases, activated charcoal/carbon is often used to prevent benzodiazepines from being absorbed by the gastrointestinal tract, and the use of stomach-pumping/gastric lavage is no longer commonly used nor suggested by some toxicologists. [37] Even in cases where other central nervous system (CNS) depressants (such as in combined benzodiazepine and tricyclic antidepressant/TCA overdoses) are detected and/or suspected, endotrachial intubation for the airway path and supportive oxygen are typically implemented and are much safer than flumazenil. [36]

Controversy

In 2015 the UK's House of Commons attempted to get a two to four week limit mandate for prescribing benzodiazepines to replace the two to four week benzodiazepine prescribing guidelines, which are merely recommended. [38]

Binding data and structure-activity relationship

A variety of Benzodiazepines along with their molecular structure. Benzodiazepines en France.jpg
A variety of Benzodiazepines along with their molecular structure.

A large number of benzodiazepine derivatives have been synthesised and their structure-activity relationships explored in detail. [39] [40] [41] [42] This chart contains binding data for benzodiazepines and related drugs investigated by Roche up to the late 1990s (though in some cases the compounds were originally synthesised by other companies such as Takeda or Upjohn). [43] [44] [45] [46] [47] [48] Other benzodiazepines are also listed for comparison purposes, [49] [50] [51] but it does not however include binding data for;

While binding or activity data are available for most of these compounds also, the assay conditions vary between sources, meaning that in many cases the values are not suitable for a direct comparison. Many older sources used animal measures of activity (i.e. sedation or anticonvulsant activity) but did not measure in vitro binding to benzodiazepine receptors. [57] [58] See for instance Table 2 vs Table 11 in the Chem Rev paper, Table 2 lists in vitro pIC50 values matching those below, while Table 11 has pEC50 values derived from in vivo assays in mice, which show the same activity trends but cannot be compared directly, and includes data for compounds such as diclazepam and flubromazepam which are not available in the main data set.


Also note;


See also

Related Research Articles

<span class="mw-page-title-main">Benzodiazepine</span> Class of depressant drugs

Benzodiazepines, colloquially called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, insomnia, and seizures. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955 and was made available in 1960 by Hoffmann–La Roche, who soon followed with diazepam (Valium) in 1963. By 1977, benzodiazepines were the most prescribed medications globally; the introduction of selective serotonin reuptake inhibitors (SSRIs), among other factors, decreased rates of prescription, but they remain frequently used worldwide.

<span class="mw-page-title-main">Diazepam</span> Benzodiazepine sedative

Diazepam, first marketed as Valium, is a medicine of the benzodiazepine family that acts as an anxiolytic. It is commonly used to treat a range of conditions, including anxiety, seizures, alcohol withdrawal syndrome, muscle spasms, insomnia, and restless legs syndrome. It may also be used to cause memory loss during certain medical procedures. It can be taken orally, as a suppository inserted into the rectum, intramuscularly, intravenously or used as a nasal spray. When injected intravenously, effects begin in one to five minutes and last up to an hour. Orally, effects begin after 15 to 60 minutes.

<span class="mw-page-title-main">Lorazepam</span> Benzodiazepine medication

Lorazepam, sold under the brand name Ativan among others, is a benzodiazepine medication. It is used to treat anxiety, trouble sleeping, severe agitation, active seizures including status epilepticus, alcohol withdrawal, and chemotherapy-induced nausea and vomiting. It is also used during surgery to interfere with memory formation and to sedate those who are being mechanically ventilated. It is also used, along with other treatments, for acute coronary syndrome due to cocaine use. It can be given orally, transdermal, intravenously (IV), or intramuscularly When given by injection, onset of effects is between one and thirty minutes and effects last for up to a day.

<span class="mw-page-title-main">Zolpidem</span> Hypnotic medication

Zolpidem, sold under the brand name Ambien among others, is a medication primarily used for the short-term treatment of sleeping problems. Guidelines recommend that it be used only after cognitive behavioral therapy for insomnia and behavioral changes, such as sleep hygiene, have been tried. It decreases the time to sleep onset by about fifteen minutes and at larger doses helps people stay asleep longer. It is taken by mouth and is available in conventional tablets, sublingual tablets, or oral spray.

<span class="mw-page-title-main">Flumazenil</span> GABA receptor antagonist drug and benzodiazepine antidote

Flumazenil is a selective GABAA receptor antagonist administered via injection, otic insertion, or intranasally. Therapeutically, it acts as both an antagonist and antidote to benzodiazepines, through competitive inhibition.

<span class="mw-page-title-main">Zopiclone</span> Hypnotic medication

Zopiclone, sold under the brand name Imovane among others, is a nonbenzodiazepine used to treat difficulty sleeping. Zopiclone is molecularly distinct from benzodiazepine drugs and is classed as a cyclopyrrolone. However, zopiclone increases the normal transmission of the neurotransmitter gamma-aminobutyric acid (GABA) in the central nervous system, via modulating GABAA receptors similarly to the way benzodiazepine drugs do.

<span class="mw-page-title-main">Eszopiclone</span> Hypnotic medication

Eszopiclone, sold under the brand name Lunesta among others, is a medication used in the treatment of insomnia. Evidence supports slight to moderate benefit up to six months. It is taken by mouth.

<span class="mw-page-title-main">Nordazepam</span> Benzodiazepine derivative medication

Nordazepam is a 1,4-benzodiazepine derivative. Like other benzodiazepine derivatives, it has amnesic, anticonvulsant, anxiolytic, muscle relaxant, and sedative properties. However, it is used primarily in the treatment of anxiety disorders. It is an active metabolite of diazepam, chlordiazepoxide, clorazepate, prazepam, pinazepam, and medazepam.

<span class="mw-page-title-main">Alpidem</span> Anxiolytic medication

Alpidem, sold under the brand name Ananxyl, is a nonbenzodiazepine anxiolytic medication which was briefly used to treat anxiety disorders but is no longer marketed. It was previously marketed in France, but was discontinued due to liver toxicity. Alpidem is taken by mouth.

<span class="mw-page-title-main">Adinazolam</span> Triazolobenzodiazepine drug

Adinazolam is a tranquilizer of the triazolobenzodiazepine (TBZD) class, which are benzodiazepines (BZDs) fused with a triazole ring. It possesses anxiolytic, anticonvulsant, sedative, and antidepressant properties. Adinazolam was developed by Jackson B. Hester, who was seeking to enhance the antidepressant properties of alprazolam, which he also developed. Adinazolam was never FDA approved and never made available to the public market; however, it has been sold as a designer drug.

<span class="mw-page-title-main">Camazepam</span> Chemical compound

Camazepam is a benzodiazepine psychoactive drug, marketed under the brand names Albego, Limpidon and Paxor. It is the dimethyl carbamate ester of temazepam, a metabolite of diazepam. While it possesses anxiolytic, anticonvulsant, skeletal muscle relaxant and hypnotic properties it differs from other benzodiazepines in that its anxiolytic properties are particularly prominent but has comparatively limited anticonvulsant, hypnotic and skeletal muscle relaxant properties.

<span class="mw-page-title-main">Etizolam</span> Benzodiazepine analog drug

Etizolam is a thienodiazepine derivative which is a benzodiazepine analog. The etizolam molecule differs from a benzodiazepine in that the benzene ring has been replaced by a thiophene ring and triazole ring has been fused, making the drug a thienotriazolodiazepine.

<span class="mw-page-title-main">Bretazenil</span> Chemical compound

Bretazenil (Ro16-6028) is an imidazopyrrolobenzodiazepine anxiolytic drug which is derived from the benzodiazepine family, and was invented in 1988. It is most closely related in structure to the GABA antagonist flumazenil, although its effects are somewhat different. It is classified as a high-potency benzodiazepine due to its high affinity binding to benzodiazepine binding sites where it acts as a partial agonist. Its profile as a partial agonist and preclinical trial data suggests that it may have a reduced adverse effect profile. In particular bretazenil has been proposed to cause a less strong development of tolerance and withdrawal syndrome. Bretazenil differs from traditional 1,4-benzodiazepines by being a partial agonist and because it binds to α1, α2, α3, α4, α5 and α6 subunit containing GABAA receptor benzodiazepine receptor complexes. 1,4-benzodiazepines bind only to α1, α2, α3 and α5GABAA benzodiazepine receptor complexes.

<span class="mw-page-title-main">Chlordiazepoxide</span> Benzodiazepine class sedative and hypnotic medication

Chlordiazepoxide, trade name Librium among others, is a sedative and hypnotic medication of the benzodiazepine class; it is used to treat anxiety, insomnia and symptoms of withdrawal from alcohol and other drugs.

<span class="mw-page-title-main">Ro15-4513</span> Chemical compound

Ro15-4513(IUPAC: Ethyl-8-azido-5,6-dihydro-5-methyl-6-oxo-4H-imidazo-1,4-benzodiazepine-3-carboxylate) is a weak partial inverse agonist of the benzodiazepine class of drugs, developed by Hoffmann–La Roche in the 1980s. It acts as an inverse agonist, and can therefore be an antidote to the acute impairment caused by alcohols, including ethanol, isopropanol, tert-butyl alcohol, tert-amyl alcohol, 3-methyl-3-pentanol, methylpentynol and ethchlorvynol.

<span class="mw-page-title-main">Imidazenil</span> Benzodiazepine drug

Imidazenil is an experimental anxiolytic drug which is derived from the benzodiazepine family, and is most closely related to other imidazobenzodiazepines such as midazolam, flumazenil, and bretazenil.

<span class="mw-page-title-main">Pyrazolam</span> Benzodiazepine

Pyrazolam (SH-I-04) is a benzodiazepine derivative originally developed by a team led by Leo Sternbach at Hoffman-La Roche in the 1970s. It has since been "rediscovered" and sold as a designer drug since 2012.

<span class="mw-page-title-main">Diclazepam</span> Benzodiazepine medication

Diclazepam (Ro5-3448), also known as chlorodiazepam and 2'-chloro-diazepam, is a benzodiazepine and functional analog of diazepam. It was first synthesized by Leo Sternbach and his team at Hoffman-La Roche in 1960. It is not currently approved for use as a medication, but rather sold as an unscheduled substance. Efficacy and safety have not been tested in humans.

<span class="mw-page-title-main">Flubromazolam</span> Triazolobenzodiazepine drug

Flubromazolam (JYI-73) is a triazolobenzodiazepine (TBZD), which are benzodiazepine (BZD) derivatives. Flubromazolam is reputed to be highly potent, and concerns have been raised that clonazolam and flubromazolam in particular may pose comparatively higher risks than other designer benzodiazepines, due to their ability to produce strong sedation and amnesia at oral doses of as little as 0.5 mg. Life-threatening adverse reactions have been observed at doses of only 3 mg of flubromazolam.

<span class="mw-page-title-main">Desmethylflunitrazepam</span> Chemical compound

Desmethylflunitrazepam (also known as norflunitrazepam, Ro05-4435 and fonazepam) is a benzodiazepine that is a metabolite of flunitrazepam and has been sold online as a designer drug. It has an IC50 value of 1.499 nM for the GABAA receptor.

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