oxazepam SERAX
Class: BenzodiazepineFDA Indications: Anxiety Disorders, Anxiety Associated With Depression, Acute Alcohol Withdrawal
Off-Label Use:
Prescribing
FDA Schedule IVForms: 10, 15, 30mg capsule
Dose Range: 30-120 mg/day
Starting: 10-30 mg, tid-qid
Precautions
Serious Side Effects: Overdose can result in hypotension, respiratory depression, and comaSide Effects: sedation/somnolence, dizziness, headache, edema, nausea
Pharmacodynamics
1° MOA: GABAAR PAMTarget: GABAA: α2 (moderate) α1 (low-moderate), γ2 (low-moderate),
Pharmacokinetics
t½: 8 (5.5-10.5)° TMAX: 3°Absorption Rate: Slow
Lipid Solubility: Low-moderate
Substrate of: Solely via conjugation
Inhibits: ∅ ; Induces: ∅
Active Metabolites: ∅
DDIs
- - CNS depression with combined use of opioids
Misc
- - a metabolite of diazepam, prazepam, and temazepam
- - metabolized by phase II enzymes to glucuronides and then largely renally excreted
Special Populations
Category D—↑ risk of oral cleft by 0.01%, use just before delivery associated with floppy infant syndrome, 3rd trimester use can cause withdrawal in newborns
Excreted in breast milk. Drowsiness, lethargy, or weight loss in nursing infants have been observed in case reports following maternal use of some benzodiazepines
Start low, 10 mg tid, titrate cautiously
2019 BEE℞S Recommendation: Avoid. Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long- acting agents; in general, all benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults. May be appropriate for seizure disorders, RBD, benzodiazepine withdrawal, EtOH withdrawal, severe GAD, and periprocedural anesthesia.
There are no dosage adjustments provided in the manufacturer's labeling
No dosage adjustments recommended in manufacturer's labeling, however, pharmacokinetic studies have been shown that hepatic dysfunction is not expected to significantly decrease clearance.