Oxazepam
Serax
Benzodiazepine Anxiolytic (BZD)Schedule IVGeneric availableTDM data
Oxazepam is the first 3-hydroxybenzodiazepinone and potentiates GABA-A receptor-mediated inhibition in the CNS. Short-acting with mean elimination half-life of 8.2 hours (range 5.7-10.9 hours). Key distinguishing feature: metabolized exclusively via direct glucuronidation without active metabolites, making it exceptionally safe in liver disease and elderly patients.
Compare Oxazepam →FDA-Approved Indications
- Anxiety disorders or short-term relief of anxiety
- Anxiety/tension with stress of everyday life
- Anxiety associated with depression
- Anxiety, tension, agitation, irritability in elderly patients
- Alcohol withdrawal anxiety
Common Off-Label Uses
- Adjunct to SSRIs/SNRIs during anxiety treatment initiation
- Benzodiazepine taper (switch from long-acting to oxazepam for controlled taper)
- Anxiety in patients with hepatic impairment (preferred benzo due to glucuronidation-only metabolism)
What Sets This Drug Apart
- ONLY major metabolite is inactive glucuronide — no active metabolite burden unlike other benzos
- First 3-hydroxybenzodiazepinone with significantly greater safety factors than chlordiazepoxide/diazepam
- Safe in hepatic impairment — direct glucuronidation pathway unaffected by hepatic dysfunction
- Minimal age-related kinetic changes in patients <80 years; elderly with hepatic/renal disease should be carefully evaluated
- Useful for anxiety in elderly AND acute alcohol withdrawal — broad indication range
- Not indicated in psychotic disorders — important contraindication limiting population
Boxed Warning
Opioid co-use: profound sedation, respiratory depression, coma, death risk
Boxed Warning
Abuse, misuse, addiction: can lead to overdose or death
Boxed Warning
Dependence and withdrawal: abrupt discontinuation may precipitate life-threatening withdrawal