Drugs used for anxiety not listed below:

• Duloxetine (section 4.3.4 Other antidepressant drugs)
• Escitalopram (section 4.3.3 Selective serotonin re-uptake inhibitors)
• Lorazepam (see section 4.8.2 Drugs used in status epilepticus)
• Pregabalin (section 4.8.1 Control of the epilepsies)
• Venlafaxine (section 4.3.4 Other antidepressant drugs)

Benzodiazepines

Benzodiazepines should only be used for short-term treatment except in exceptional circumstances. Clear justification must be made and agreed between primary and secondary care for long-term treatment.

Benzodiazepines should only be prescribed for an anticipated maximum of 2-4 weeks; each single prescription should not exceed one month's supply.

Benzodiazepines are associated with a poorer outcome in the long term and should not be prescribed for the treatment of individuals with panic disorder (NICE CG113).

MHRA Drug Safety Update (March 2020): Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression.

• benzodiazepines (and benzodiazepine-like drugs) and opioid medicines (opioids) can both cause respiratory depression; when used together, additive effects on the central nervous system increase the risks of sedation, respiratory depression, coma, and death
• only prescribe benzodiazepines (or benzodiazepine-like drugs) and opioids together if there is no alternative
• if a decision is made to co-prescribe, use the lowest doses possible for the shortest duration of time and carefully monitor patients for signs of respiratory depression
• if there is any change in prescribing such as new interactions or dose adjustments, re-introduce close monitoring of the patient
• if co-prescribing methadone with a benzodiazepine or benzodiazepine-like drug, closely monitor for respiratory depression for at least 2 weeks following initiation or changes to prescribing because the respiratory depression effect of methadone may be delayed
• advise patients of the symptoms of respiratory depression and sedation and the need to seek immediate medical attention if these occur

Diazepam

• Tablets 2mg, 5mg, 10mg (£2.28 = 5mg three times daily)
• Oral solution sugar free 2mg in 5ml (£58.79 = 100ml)
• Injection (emulsion) 5mg in 1ml
• Injection (solution) 5mg in 1ml (£1.50 = 2ml amp)
• Rectal tubes 5mg, 10mg (£8.78 = 5 x 10mg tube)

Indications

• Short-term use in anxiety (up to 4 weeks only)
• Status epilepticus
• Febrile convulsions
• Muscle spasm
• Adjunct in acute alcohol withdrawal (hospital only)

Chlordiazepoxide

• Capsules 5mg, 10mg

Indications

• Adjunct in acute alcohol withdrawal

Notes

1. Changes to the SmPC for Librium regarding contraceptive requirements for males and females due to a possible genotoxic risk (May 2022): The UK Teratology Information Service (UKTIS) has reviewed the background to the SmPC update. Please click here for the UKTIS position statement.