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Black Box Warnings .
Risks from Concomitant Opioid Use
concomitant benzodiazepine use w/ opioids may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation
Addiction, Abuse, and Misuse
benzodiazepines expose users to risk of abuse, misuse, and addiction, can lead to overdose or death; commonly involves concomitant use w/ other meds, alcohol, and/or illicit substances, which is assoc. w/ incr. frequency of serious adverse outcomes; assess risk for abuse, misuse, and addiction before prescribing and throughout tx
Dependence and Withdrawal Reactions
cont. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. w/ longer tx duration and higher daily dose; use gradual taper to D/C after cont. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening
Adult Dosing .
Dosage forms: TAB: 0.25 mg
insomnia, short-term tx
- [0.25 mg PO qhs]
- Max: 0.5 mg/day; Info: start 0.125 mg PO qhs, max 0.25 mg/day in elderly pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
minimal sedation, procedural (off-label)
- [0.25-0.5 mg PO x1]
- Start: 1h prior to procedure; Info: for dental procedures; give 0.125 mg PO x1 in elderly or sensitive pts
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [adjust dose amount]
- hepatic impairment: start 0.125 mg qhs
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.