A. Indications. Benzodiazepines are used for the treatment of anxiety disorders, insomnia, seizure disorders, and detoxification from alcohol. They are also effective adjunctive agents for agitated psychotic or depressive states.
1. All benzodiazepines induce tolerance and are addictive. Short courses of treatment should be used whenever possible.
2. The primary indications for long-term treatment are chronic anxiety disorders such as generalized anxiety disorder and panic disorder.
3. When benzodiazepines are discontinued, the drug should be tapered slowly. Long-acting agents such as clonazepam and diazepam are preferable for long-term treatment because they cause less withdrawal and require less frequent dosing.
4. The 3-hydroxy-benzodiazepines (lorazepam, alprazolam, oxazepam) have no active metabolites and are the agents of choice in patients with impaired liver function.
5. Acute agitation usually is treated with lorazepam (Ativan), 2 mg IM because it is well tolerated and effective in most patients.
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