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The risk of dependence is increased with the agents that are rapidly absorbed and with shorter half-lives, i.e., alprazolam and diazepam. Although tolerance to the anxiolytic effects is uncommon, avoid use in patients with a history of substance use disorder. Although beneficial for the acute relief of anxiety, long-term use of benzodiazepines is not recommended due to the risk of dependence.However, benzodiazepines may worsen symptoms in patients with comorbid depression or PTSD.Benzodiazepines may be more effective than antidepressants for social anxiety disorder.Benzodiazepines are often used to “bridge” patients who are starting an "antidepressant" for anxiety, since the therapeutic effects may be delayed, and patients may experience stimulating side effects initially.Start tapentadol at 1/3 to 1/2 the usual starting dose Monitor for increased sedative/CNS depressant effects Monitor for sedative effects, and adjust dose of one or both as needed Increased sedative/CNS depressant effects Reduce lorazepam starting dose by 50% adjust dose further as neededĪlprazolam, clonazepam, diazepam – ritonavir (Norvir)Īlprazolam, diazepam – saquinavir (Invirase) Monitor phenytoin levels, and adjust dose as needed Increased risk of cardiorespiratory depressionĪvoid use of parenteral benzodiazepines and IM olanzapineĭiazepam – phenyton (Dilantin), fosphenytoin (Cerebyx) Reduce starting dose of alprazolam by 50% adjust dose further as neededĪlprazolam, diazepam – Fosamprenavir (Lexiva)Ĭhlordiazepoxide, clonazepam – ketoconazoleĭiazepam, lorazepam – olanzapine (Zyprexa) Monitor levels of digoxin, and reduce dose as neededĪdjust dose of diazepam as needed, or change to a benzodiazepine eliminated by glucuronidation If necessary, adjust dose of alprazolam as needed Oxazepam (Serax®): the initial dose is 10-15 mg daily the dose can be increased by 10 mg daily in divided doses (three times a day) the usual therapeutic dose is 90 mg total/day, with three times a day dosing.Lorazepam (Ativan®): The initial dose is 0.5 mg twice a day the dose can be increased by 1 mg daily in divided doses (twice daily or three times a day) the usual therapeutic dose is 2-8 mg total/day, with twice daily or three times a day dosing.An IM dose of 10 mg can be administered every 4 hours if needed for alcohol withdrawal.
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