Drugs used for anxiety not listed below:

• Duloxetine (see 4.3.4 Other antidepressant drugs)
• Escitalopram (see 4.3.3 Selective serotonin re-uptake inhibitors)
• Lorazepam (see 4.8.2 Drugs used in status epilepticus)
• Pregabalin (see 4.8.1 Control of the epilepsies)
• Venlafaxine (see 4.3.4 Other antidepressant drugs)

Benzodiazepines

Benzodiazepines should only be used for short-term treatment except in exceptional circumstances. Clear justification must be made and agreed between primary and secondary care for long-term treatment.

Benzodiazepines should only be prescribed for an anticipated maximum of 2-4 weeks; each single prescription should not exceed one month's supply.

Benzodiazepines are associated with a poorer outcome in the long term and should not be prescribed for the treatment of individuals with panic disorder (NICE CG113).

MHRA Drug Safety Update (March 2020): Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression.

• benzodiazepines (and benzodiazepine-like drugs) and opioid medicines (opioids) can both cause respiratory depression; when used together, additive effects on the central nervous system increase the risks of sedation, respiratory depression, coma, and death
• only prescribe benzodiazepines (or benzodiazepine-like drugs) and opioids together if there is no alternative
• if a decision is made to co-prescribe, use the lowest doses possible for the shortest duration of time and carefully monitor patients for signs of respiratory depression
• if there is any change in prescribing such as new interactions or dose adjustments, re-introduce close monitoring of the patient
• if co-prescribing methadone with a benzodiazepine or benzodiazepine-like drug, closely monitor for respiratory depression for at least 2 weeks following initiation or changes to prescribing because the respiratory depression effect of methadone may be delayed
• advise patients of the symptoms of respiratory depression and sedation and the need to seek immediate medical attention if these occur

Diazepam

• Tablets 2mg, 5mg, 10mg (£2.10 = 5mg three times a day)
• Oral solution sugar free 2mg/5ml (£57.19 = 100ml)
• Injection (emulsion) 10mg/2ml
• Rectal solution tube 5mg/2.5ml, 10mg/2.5ml (£8.78 = 5 x 10mg tube)

Indications

• Short-term use in anxiety or insomnia
• Life-threatening acute drug-induced dystonic reactions
• Adjunct in acute alcohol withdrawal
• Status epilepticus
• Febrile convulsions
• Muscle spasm

Dose

• Status epilepticus, febrile convulsions, by intravenous injection, 10mg at a rate of 1ml (5mg) per minute, repeated once after 10 minutes if necessary; child under 12 years, 300–400 micrograms/kg (maximum 10mg) (unlicensed dose), repeated once after 10 minutes if necessary
• Status epilepticus, by rectum as rectal solution, adult and child over 12 years, 10–20mg, repeated once after 10–15 minutes if necessary; elderly 10mg; neonate (unlicensed) 1.25–2.5mg; child 1 month–1 year (unlicensed) 5mg; 1–2 years 5mg; 2–12 years 5–10mg

Notes

1. Diazepam IV is associated with a high risk of venous thrombophlebitis, which is reduced by using an emulsion
2. Diazepam is the preferred benzodiazepine for the treatment of anxiety and in benzodiazepine withdrawal regimes.

Chlordiazepoxide

• Capsule 5mg, 10mg

Indications

• Adjunct in acute alcohol withdrawal (section 4.10 Drugs used in substance dependence)

Notes

1. Changes to the SmPC for Librium regarding contraceptive requirements for males and females due to a possible genotoxic risk (May 2022): The UK Teratology Information Service (UKTIS) has reviewed the background to the SmPC update. Please click here for the UKTIS position statement.