Oxazepam: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on July 4, 2023.

1. How it works

• Oxazepam may be used for the short-term treatment of anxiety and alcohol withdrawal.
• Experts aren't exactly sure how oxazepam works, but believe its effects are due to its ability to strongly bind to the GABA-benzodiazepine receptor complex, which enhances the affinity for GABA (a neurotransmitter that blocks impulses between nerve cells in the brain). Low levels of GABA have been linked to anxiety, mood disorders, seizure disorders, and pain. Medicines that enhance GABA tend to calm and sedate.
• Oxazepam belongs to the class of medicines known as benzodiazepines.

2. Upsides

• May be used short-term (less than four months) to relieve symptoms of anxiety in anxiety-related disorders.
• May also be used short-term for the relief of symptoms related to alcohol withdrawal, such as agitation, tremor, delirium tremors, or hallucinations.
• May be used short-term for its calming effects to relieve tension, agitation, and irritability. These uses are generally off-label, that is, prescribed for conditions that are not FDA-approved.
• Less sedating and shorter-acting than some other benzodiazepines.
• Considered a preferred benzodiazepine in geriatric patients and people with liver disease because of its short elimination half-life and lack of active metabolites.
• Oxazepam has fewer side effects compared with diazepam; however, its anti-seizure activity is not as strong.
• Generic oxazepam is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Mild drowsiness is common during the initial treatment with oxazepam; however, this is usually short-lasting, although a dosage reduction may be required. People should not drive, operate machinery, or perform tasks that require mental alertness if affected. Alcohol should be avoided because it can enhance these effects. Use the smallest effective dosage for the shortest possible time to avoid oversedation.
• Dizziness, headache, and vertigo are other common side effects.
• Oxazepam may rarely cause a drop in blood pressure, especially when going from a lying down or sitting position to standing. This may increase a person's risk of falls. This effect may be more likely to happen in elderly people.
• Other rare side effects include rashes, nausea, lack of energy, edema, slurred speech, tremor, hepatic and sexual dysfunction; and the dosage of oxazepam may need to be reduced. Blood counts and liver function tests may be needed periodically.
• Withdrawal symptoms (tremors, abdominal and muscle cramps, vomiting, sweating, and rarely seizures) may occur if oxazepam has been taken long-term or at higher-than-recommended dosages and then stopped abruptly; discontinue slowly on a doctor's advice. Even after regular dosing, mild withdrawal symptoms, such as low mood or insomnia, may occur if oxazepam is discontinued abruptly. Gradually taper oxazepam off.
• Oxazepam should not be used during pregnancy because it has been associated with an increased risk of birth defects. Oxazepam is incompatible with breastfeeding.
• Paradoxical reactions (the opposite of what is expected), such as over-excitation, anxiety, hallucinations, insomnia, and rage have been reported, mainly in people with other mental health concerns. Seek medical advice if these occur.
• May not be suitable for some people including those with glaucoma, respiratory disease, kidney or liver disease, or those with a history of substance abuse or addictive disorders.
• Oxazepam is addictive and can cause dependence. May not be suitable for people with a history of substance abuse or addictive disorders. Legitimate supplies of oxazepam should be kept out of sight of potential drug seekers. Take into account the person's condition and other medications being taken before prescribing and assess the risk of abuse, misuse, and addiction.
• Short-acting and may need to be administered three or four times daily.
• May interact with several other medicines, including opioids and other drugs that have sedation as a side effect. Be cautious when using benzodiazepines in combination with opioid addiction medications. See prescribing information for a full list of interactions.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Oxazepam may be used short-term to relieve anxiety; however, it is addictive and withdrawal symptoms may be experienced when you stop taking it.

5. Tips

• Short-acting, so needs to be given three to four times daily if relief from anxiety is required for the whole day.
• Habit-forming so should only be used by the person it was prescribed for. Do not share with anyone else.
• Take only as directed by your doctor. Do not increase the dosage without your doctor's advice. Side effects from oxazepam are more likely with higher dosages.
• Oxazepam may increase your risk of falls, particularly if you need to get up in the middle of the night to go to the toilet. Remove any fall hazards from your house (such as loose rugs) and slowly get out of bed when getting up in the middle of the night.
• Seek immediate medical advice if you experience any unusual side effects from oxazepam such as aggressiveness, hallucinations, withdrawal symptoms, or bizarre behaviors. Go to an emergency room or call 911 if you have trouble breathing or serious side effects such as seizures.
• Talk to your doctor or pharmacist before buying other medications over the counter to check that they are compatible with oxazepam. Always tell your doctor or pharmacist what other medications or substances you are taking, both illegal and legal, including alcohol.

6. Response and effectiveness

• Oxazepam has a slower onset of action (30-60 minutes) than some other benzodiazepines (such as diazepam).
• Peak effects are reached in two to three hours and the effects usually wear off within six to eight hours which means oxazepam typically needs to be taken three to four times a day when used for anxiety.

7. Interactions

Medicines that interact with oxazepam may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with oxazepam. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with oxazepam include:

• anti-anxiety medications, including other benzodiazepines, such as diazepam and lorazepam
• anticonvulsants such as valproate
• antidepressants, such as amitriptyline, imipramine, nortriptyline
• antihistamines that cause sedation, such as diphenhydramine
• barbiturates
• duloxetine
• monoamine oxidase inhibitors, such as selegiline, isocarboxazid, or phenelzine
• opioid analgesics such as codeine, oxycodone, and morphine (may cause profound sedation, respiratory depression, coma, or death)
• oral contraceptives
• muscle relaxants such as cyclobenzaprine
• probenecid
• scopolamine
• sleeping pills, such as zolpidem
• some medications used to treat mental illness, such as clozapine and thioridazine
• theophylline.

Alcohol may worsen the side effects of oxazepam such as drowsiness and dizziness. Avoid.

Note that this list is not all-inclusive and includes only common medications that may interact with oxazepam. You should refer to the prescribing information for oxazepam for a complete list of interactions.

References

• Oxazepam. Revised: 03/2023. TruPharma, LLC. https://www.drugs.com/pro/oxazepam.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use oxazepam only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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