Lorazepam is one of the long-acting benzodiazepines but is sometimes classified as “intermediate-acting” given its shorter half-life relative to the other traditionally long-acting BZDs. Lorazepam is also unique in that it does not undergo hepatic metabolism and consequently can be used in patients with liver disease.
Diazepam is indicated for several anxiety disorders, procedural anxiety, and seizure disorders. It can also be used in alcohol withdrawal syndrome.
Clonazepam has an onset of action of 20-40 minutes and can be used in patients with panic or seizure disorders.
Chlordiazepoxide is another one of the long-acting benzodiazepines and achieves peak serum concentration in 30 minutes to 2 hours.
Insomnia is a sleep disorder characterized by a decreased ability to initiate, maintain, and/or wake from sleep. Long-acting benzodiazepines can help manage this condition.
These medications can also be used in patients with anxiety disorders or preprocedural anxiety. This includes panic attacks.
Patients with epilepsy who experience seizures can be prescribed long-acting benzodiazepines for management. These drugs help to reduce excitatory neural pathways that may be epileptogenic. They can also be used for status epilepticus.
Eclampsia is the presence of seizures with preeclampsia (hypertension and end-organ damage). Long-acting benzodiazepines like diazepam can be given if the patient fails to respond to magnesium sulfate in treating their seizures.
Alcohol withdrawal syndrome is a constellation of clinical findings associated with alcohol use disorders. Several of these findings (tremor, insomnia, anxiety) are amenable to treatment with long-acting benzodiazepines.
The half-life for long-acting benzodiazepines is generally greater than 24 hours. Short-acting benzodiazepines can have half-lives shorter than 12 hours.
Benzodiazepines have a high potential for dependence and abuse. When prescribing these medications, routine follow-up and detailed history are important to assess for addiction / substance dependence. Patients who demonstrate symptoms that have been controlled for several months might raise suspicion for dependence.
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