Management of anxiety disorders and short-term relief of anxiety or anxiety associated with depressive symptoms.
One of several preferred benzodiazepines in geriatric patients and patients with liver disease (because of its short elimination half-life and lack of active metabolites).
Dosage and Administration
General
Use the smallest effective dosage (especially in geriatric or debilitated patients and in those with low serum albumin) to avoid oversedation.
In patients who have received prolonged (e.g., for several months) therapy, avoid abrupt discontinuance, since manifestations of withdrawal can be precipitated; gradually taper dosage.
Anxiety
Periodically reassess the usefulness of the drug. Efficacy beyond 4 months not systematically evaluated. Administer for the shortest possible period of time; frequent dosage adjustments may be required.
Administration
Oral Administration
Administer orally in divided doses, generally 3 or 4 times daily.
Dosage
Pediatric Patients
Anxiety Disorders
Oral
Children 6–12 years of age: Dosage not clearly established.
Adults
Alcohol Withdrawal
Oral
15–30 mg 3 or 4 times daily.
Anxiety Disorders
Oral
Mild to moderate anxiety: 10–15 mg 3 or 4 times daily.
Severe anxiety: 15–30 mg 3 or 4 times daily.
Special Populations
Hepatic Impairment
No specific dosage recommendations.
Renal Impairment
No specific dosage recommendations.
Geriatric Patients
Initially, 10 mg 3 times daily. Increase dosage to 15 mg 3 or 4 times daily if needed and tolerated. Use the smallest effective dosage to avoid oversedation.
Other Populations
Use the smallest effective dosage in debilitated patients and patients with low serum albumin concentrations to avoid oversedation.
Many manufacturers state that benzodiazepines are contraindicated in patients with acute angle-closure glaucoma but may be administered to patients with open-angle glaucoma who are receiving appropriate therapy; however, clinical rationale for this contraindication has been questioned.
Warnings/Precautions
Warnings
CNS Effects
Performance of activities requiring mental alertness and physical coordination may be impaired.
Concurrent use of other CNS depressants may cause additive or potentiated CNS depression. (See Specific Drugs under Interactions.)
Psychiatric Indications
Avoid use in patients with depressive neuroses or psychotic reactions in which anxiety is not prominent.
Abuse Potential
Possible tolerance, psychologic dependence, and physical dependence following prolonged use.
Patients with a history of drug or alcohol dependence or abuse are at risk of habituation or dependence; use only with careful surveillance in such patients.
Withdrawal Syndrome
Abrupt discontinuance may result in symptoms of withdrawal (similar to barbiturates). Symptoms may be relieved by tapering the dosage.
Fetal/Neonatal Morbidity
Retrospective studies suggest increased risk of congenital malformations in infants of mothers who received anxiolytics (chlordiazepoxide, diazepam, meprobamate) during the first trimester of pregnancy. Since use of anxiolytics is rarely urgent, their use during the first trimester almost always should be avoided.
General Precautions
Hypotension
Hypotension reported rarely. Administer with caution to patients in whom a drop in BP might lead to cardiac complications, particularly geriatric patients.
Suicide
Use with caution in depressed patients; potential for suicidal tendencies. Prescribe and dispense drug in the smallest feasible quantity.
Category D. (See Fetal/Neonatal Morbidity under Cautions.)
Lactation
Many benzodiazepines are distributed into milk. Not known whether oxazepam is distributed into milk. Discontinue nursing or the drug.
Pediatric Use
Safety and efficacy not established in children <6 years of age.
Dosage for children 6–12 years of age not clearly established.
Geriatric Use
Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults. Possibility of greater sensitivity to the drug (e.g., sedation, hypotension, paradoxical excitation) in some geriatric individuals.
Select initial dosage at the lower end of the usual range because of potential for greater sensitivity and age-related decreases in hepatic or renal function. (See Geriatric Patients under Dosage and Administration.)
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