Drug | Adult oral total daily dose (mg)* | Comparative potency (mg)¶ | Onset after oral dose (hours) | Metabolism | Elimination half-life (hours)Δ |
Alprazolam | 0.5 to 6 | 0.5 | 1 | CYP3A4 to minimally active metabolites. | 11 to 15 16 (older adults) 20 (hepatic impairment) 22 (obesity) |
Alprazolam extended release | 0.5 to 6 once daily | 0.5 | 1 | ||
Bromazepamפ | 6 to 30 | 7.5 | 1 | CYP1A2. No active metabolite. | 8 to 20 |
Chlordiazepoxide§ | 5 to 100 | 10 | 1 | CYP3A4 to active metabolites. | 30 to 100 Prolonged in older adults and hepatic impairment |
Clonazepam | 0.5 to 4 | 0.25 to 0.5 | 0.5 to 1 | CYP3A4. No active metabolite. | 18 to 50 |
Clorazepate | 15 to 60 | 7.5 | 0.5 to 1 | CYP3A4 to active metabolite. | 36 to 200 |
Diazepam | 4 to 40 | 5 | 0.25 to 0.5 | CYP2C19 and 3A4 to active metabolites. | 50 to 100 Prolonged in older adults and renal or hepatic impairment |
Lorazepam immediate release | 0.5 to 6 0.5 to 4 (hypnotic) | 1 | 0.5 to 1 | Non-CYP glucuronidation in liver. No active metabolite. | 10 to 14 |
Lorazepam extended release | 1 to 6 mg¥ | 1 | 0.5 to 1 | Non-CYP glucuronidation in liver. No active metabolite. | 13 to 27 |
Oxazepam | 30 to 120 15 to 30 (hypnotic) | 15 to 30 | 1 to 2 | Non-CYP glucuronidation in liver. No active metabolite. | 5 to 15 |
Prazepamפ | 15 to 60 | 15 | 2 to 3 | CYP3A4 to active metabolites. | 30 to 200 Prolonged in older adults |
* Range of usual total daily dose for treatment of adults with anxiety or panic disorder typically given in divided doses 2 to 4 times daily.
¶ Important: Data shown are approximate equal potencies relative to lorazepam 1 mg orally and are not recommendations for initiation of therapy.
Δ Half-life of parent drug and pharmacologically active metabolite, if any.
◊ Not available in the United States.
§ Use only when other preferred agents are unavailable or not tolerated.
¥ To be used only when converting from immediate release lorazepam. Total daily dose is equal to the current total daily dose of immediate release lorazepam. Dose is given once daily in the morning after discontinuing immediate dose lorazepam tablets the night before.