What is it? | Anxiolytic |
Mechanism of action | Benzodiazepine |
Starting dose | 0.5–1 mg |
Time to maximal effect | 2.5 hours17
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Formulation | Tablet—can be halved |
Indication | Anxiety, panic, agitation |
Common adverse effects | ‘Apnoea; asthenia; coma; disinhibition; extrapyramidal symptoms; hypothermia; memory loss; speech slurred; suicide attempt’16
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Contraindications | Severe hepatic failure, untreated sleep apnoea, myasthenia gravis, severe respiratory failure16
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Caution | ‘Avoid prolonged use (and abrupt withdrawal thereafter); debilitated patients (reduce dose) (in adults); elderly (reduce dose) (in adults); history of alcohol dependence or abuse; history of drug dependence or abuse; myasthenia gravis; personality disorder (within the fearful group—dependent, avoidant, obsessive-compulsive) may increase risk of dependence; respiratory disease’16
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Licencing | Off license route of a licensed formulation |
Benefits | Sublingual benzodiazepine, widely used in usual practice |
Risks | Common misconception that the sublingual route is licensed due to widespread use |
Cost | £3.29 for 28×1 mg tablets |