oxazepam

ROUTE	ONSET	PEAK	DURATION
PO	45–90 min	unknown	6–12 hr

Contraindicated in:

Hypersensitivity;
Cross-sensitivity with other benzodiazepines may exist;
Comatose patients or those with pre-existing CNS depression;
Uncontrolled severe pain;
Angle-closure glaucoma;
Some products contain tartrazine and should be avoided in patients with known intolerance.

Use Cautiously in:

Hepatic impairment (may be preferred over some benzodiazepines due to short half-life);
History of suicide attempt or substance use disorder;
Severe chronic obstructive pulmonary disease;
Myasthenia gravis;
OB: Use late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, feeding difficulties) in neonates;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <6 yr (safety and effectiveness not established);
Geri: Appears on Beers list. ↑ risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults. If possible, avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: tachycardia

Derm: rash

EENT: blurred vision

GI: constipation, diarrhea, drug-induced hepatitis, nausea, vomiting

GU: urinary problems

Hemat: leukopenia

Neuro: dizziness, drowsiness, confusion, depression, hangover, headache, impaired memory, paradoxical excitation, slurred speech

Resp: respiratory depression

Misc: physical dependence, psychological dependence, tolerance

Interactions ⬆ ⬇

Drug-drug:

Use with opioids or other CNS depressants, including other benzodiazepines, nonbenzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
May ↓ the therapeutic effectiveness of levodopa.
Hormonal contraceptives or phenytoin may ↓ levels and effectiveness.
Theophylline may ↓ sedative effects.

Drug-Natural Products:

Kava-kava, valerian, skullcap, chamomile, or hops can ↑ risk of CNS depression.

Route/Dosage ⬆ ⬇

PO (Adults ): Antianxiety agent: 10–30 mg 3–4 times daily. Sedative/hypnotic/management of alcohol withdrawal: 15–30 mg 3–4 times daily.
PO Geriatric Patients ): 5 mg 1–2 times daily initially or 10 mg 3 times daily; may ↑ as needed.

Availability ⬆ ⬇

(Generic available)

Capsules: 10 mg; 15 mg; 30 mg
Tablets: 10 mg; 15 mg; 30 mg

Assessment ⬆ ⬇

Assess patient for anxiety and orientation, mood and behavior.
Assess level of sedation (respiratory depression, ataxia, dizziness, slurred speech) periodically during therapy.
Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict the amount of drug available to patient. Assess regularly for continued need for treatment.
Assess risk for addiction, abuse, or misuse prior to administration and periodically during therapy.
Geri: Assess CNS effects and risk of falls. Institute falls prevention strategies.

Lab Test Considerations:

Monitor CBC and liver function tests periodically during prolonged therapy.
- May ↓ thyroidal uptake of ¹²³I and ¹³¹I.

Implementation ⬆ ⬇

Medication should be tapered at completion of therapy (taper by 0.5 mg every 3 days). Sudden cessation of medication may lead to withdrawal (insomnia, irritability, nervousness, tremors).
PO: Administer with food if GI irritation becomes a problem.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to take missed doses within 1 hr; otherwise omit and resume regular schedule. Do not double or ↑ dose. If dose is less effective after a few weeks, notify health care provider.
Caution patient not to stop taking oxazepam without consulting health care provider. Abrupt withdrawal may cause sweating, vomiting, muscle cramps, tremors, and seizures; may be life-threatening.
Inform patient that oxazepam is usually prescribed for short-term use; do not take more than prescribed or for a longer period than prescribed.
Advise patient that oxazepam is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children and in a location not accessible by others.
Teach other methods to ↓ anxiety, such as exercise, support group, relaxation techniques.
May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Advise patient to avoid the use of alcohol or other CNS depressants, including opioids, concurrently with lorazepam; may cause respiratory depression and overdose. Instruct patient to consult health care provider before taking Rx, OTC, or herbal products concurrently with this medication.
Geri: Instruct patient and family how to ↓ falls risk at home.
Advise patient to notify health care provider of medication regimen prior to treatment or surgery.
Emphasize the importance of follow-up exams to monitor effectiveness of medication.
Rep: May cause fetal harm. Advise women of reproductive potential to use a nonhormonal method of contraception during use and to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Monitor infants exposed to oxazepam during 2nd and 3rd trimester or immediately prior to or during childbirth for ↓ fetal movement and/or fetal heart rate variability, floppy infant syndrome, dependence, and symptoms of withdrawal (hypertonia, hyperreflexia, hypoventilation, irritability, tremors, diarrhea, vomiting); may occur shortly after delivery up to 3 wk after birth. Monitor breastfed infants for sedation and poor sucking. Encourage pregnant patients to enroll in the North American Antiepileptic Drug Pregnancy Registry by calling 1-888-233-2334; information is available at www.aedpregnancyregistry.org.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇