4.1.2 Anxiolytics

Drugs used for anxiety not listed below:

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).

Diazepam
  • Tablets 2mg, 5mg, 10mg (£2.28 = 5mg three times a day)
  • Oral Solution 2mg in 5ml (£31.75 = 100ml)
  • Injection (emulsion - Diazemuls®) 10mg in 2ml (£0.91 = 2ml ampoule)
  • Rectal solution 2.5mg, 5mg, 10mg (£7.35 = 5 x 10mg)

Indications

  1. Short-term use in anxiety or insomnia
  2. Life-threatening acute drug-induced dystonic reactions
  3. Adjunct in acute alcohol withdrawal
  4. Status epilepticus
  5. Febrile convulsions
  6. 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. In the community, 500 micrograms/kg rectal diazepam for adults and children over 10kg, up to a maximum of 30mg, and repeated after 12 hours if necessary.
  2. Diazepam IV is associated with a high risk of venous thrombophlebitis, which is reduced by using an emulsion.

Notes

  1. Diazepam is the preferred benzodiazepine for the treatment of anxiety and in benzodiazepine withdrawal regimes.
Chlordiazepoxide
  • Capsule 5mg, 10mg

Indications

 

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