Clorazepate, also known as Tranxene, is a benzodiazepine, typically used in the treatment of anxiety and epileptic seizures. It is important to take this medication exactly as prescribed and to consult with your doctor prior to starting any other medications (prescribed or over the counter) while taking clorazepate, as adverse effects can occur.
Clorazepate brand names
- Tranxene
What is clorazepate prescribed for?
Clorazepate is approved by the US Food & Drug Administration for the treatment of anxiety disorders, management of epileptic seizures, and treating alcohol withdrawal [1].
This anti-anxiety medication is not recommended for prescription to children under the age of 9, as the safety and effectiveness of this has not been established [2].
Clorazepate is a Schedule IV controlled substance, because of its potential for addiction and abuse, so pharmacies will typically give a limited number of tablets and repeat prescriptions [2][3].
How does clorazepate work?
Clorazepate affects a neurotransmitter in the brain called GABA, resulting in a stabilization or reduction of certain brain activity. It affects various parts of the brain, such as the amygdala and the cerebral cortex, creating an anxiolytic, sedating, and anticonvulsant action, so can be used in the treatment of various conditions [4].
How is clorazepate usually taken?
Clorazepate is available as tablets, in 3.75mg, 7.5mg, and 15mg strengths, which should be taken whole without crushing.
Your prescription may depend on your condition, age, weight, and response to the medication. Your doctor will monitor your physical and mental health throughout your treatment and may adjust your dose if needed.
For the treatment of anxiety, you may be prescribed a daily dose of between 15-60mg, to be taken in divided doses. Your doctor may begin your prescription with a low dose and gradually increase it to a therapeutic dose. Clorazepate can be taken in one dose at night, to reduce daytime sedation [2].
To treat alcohol withdrawal, you will be prescribed daily doses of between 15-90mg for four days, which will then be reduced to 7.5-15mg until withdrawal symptoms have been stabilized.
To treat epileptic seizures, clorazepate can be taken alongside an anticonvulsant medication. It is typically prescribed as a dose of 7.5mg, to be taken three times per day.
For adults, the daily dose will not exceed a maximum of 90mg, while for children the maximum daily dose is 60mg [2].
It is important that you take your medication exactly as prescribed by your doctor, as taking too much, intentionally missing doses, or suddenly starting or stopping this medication can cause adverse effects.
If you forget to take your medication, you can take it as soon as you remember, or if it is close to the next dosage time, skip that dose and just take the next. Never take double your prescribed dose.
Clorazepate can cause withdrawal symptoms when stopped, as physical and emotional dependence can occur. The risk of this is increased with longer-term use, so it is advised that clorazepate is used short-term, for up to four months. Your doctor will slowly reduce your prescription, to prevent withdrawal symptoms [5].
How long does clorazepate stay in your system?
After taking a dose of clorazepate, you will feel the effects of the medication within an hour.
Clorazepate can take several days to entirely leave your system [4].
Withdrawal symptoms can last several months after stopping the medication if a physical dependency has occurred. You may be more likely to experience withdrawal symptoms if you have taken large doses for prolonged periods, or if the medication is misused or abused [5][6].
Clorazepate side effects
When starting a new medication, you may experience some common side effects. They will likely reduce on their own, but if they continue or become problematic, consult with your doctor immediately.
Common side effects of clorazepate include [1][2]:
- Feeling dizzy
- Feeling drowsy and tired
- Headache
- Nervousness
- Confusion
- Dry mouth
Serious side effects of clorazepate are less common but may still occur. If you experience any of the following, contact your doctor immediately:
- Shaking or tremors
- Slurred speech
- Impaired or blurredvision
- Unsteadiness
- Rash
- Fever
- Yellowing of the skin or eyes
- Change in mental state, including new or worsening depression, anxiety, agitation, or aggression
Clorazepate precautions
Clorazepate can cause suicidal thoughts and behaviors. If you or your family members notice any concerning changes in your mental state, or you experience any thoughts of harming yourself, contact your doctor or mental health professional immediately [1].
It is important that your doctor is aware of any past or present mental health conditions you have experienced, to enable safe monitoring of your condition while on this medication, or to decide if it is safe for you.
It is important to tell your doctor if you have ever had an alcohol or substance use disorder, as this medication can be addictive, so may not be suitable for you [2].
Depending on your dosage and duration of treatment, you may experience withdrawal symptoms when coming off this medication. Your doctor will likely reduce your prescription slowly to prevent this. Taking clorazepate exactly as prescribed by your doctor can also help to prevent withdrawal symptoms [5].
Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.
Inform your doctor if you have had liver, kidney, heart, or blood conditions, or glaucoma, as it may not be safe for you to take this medication, or your doctor may prefer to prescribe a lower dose and closely monitor your physical health throughout your treatment [1].
Ensure you tell your doctor if you are pregnant or planning to become pregnant, as clorazepate may cause harm to your fetus. Your doctor will inform you of any risks and alternative medications so you can make an informed decision about your treatment [2].
Tell your doctor if you are breastfeeding, as clorazepate may be excreted in breast milk so can cause harm to your baby. Your doctor can recommend alternative treatment options that are safer [7].
This medication can cause drowsiness and sedation, so it is important to avoid driving until you are aware of how clorazepate affects you and it is safe to do so.
Tell your doctor about all medications you are currently taking, or plan to take (including vitamins and dietary supplements), as they may cause adverse reactions.
Clorazepate interactions
Clorazepate causes a sedating effect, so it is not safe to use with any opiate medications, such as codeine, morphine, or tramadol, as this can increase the risk of serious side effects such as oversedation or breathing difficulties [2].
Other medications may interact with clorazepate, increasing the risk of side effects and decreasing the effectiveness of your medication, such as barbiturates, disulfiram, sedatives, tranquilizers, medications for seizure or nausea, and certain antidepressants [1].
It is advised to avoid alcohol while taking clorazepate, as alcohol can increase the sedating effects of the medication and worsen dizziness.
Always discuss your medications with your doctor before starting a new treatment.
Clorazepate storage
Always keep all medications out of reach of children.
Store clorazepate in its original packaging, in airtight containers, and at room temperature (68°F – 77°F).
If you need to dispose of medication that is out of date or no longer needed, contact a health care professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the trash, as this can create unnecessary risks.
What to do if you overdose on clorazepate
If you overdose on clorazepate, call a medical professional or Poison Control on 1-800-222-1222, or in case emergency medical attention is required, call 911. Symptoms of a clorazepate overdose may include fatigue, muscle weakness, confusion, slowed heart rate, breathing difficulties, and coma [2].
Frequently asked questions about clorazepate
Should I avoid certain foods while taking clorazepate?
You do not need to alter your diet while taking clorazepate. However, it is advised to avoid alcohol while on this medication, as it can increase the risk of sedation and side effects.
Is clorazepate addictive?
Clorazepate is considered an addictive substance and has the potential to be misused. Depending on the dosage and length of treatment, clorazepate can cause physical and emotional dependency, which can then lead to withdrawal symptoms when the medication is reduced or stopped [5].
Withdrawal symptoms may include changes in mood, trouble sleeping, headaches, muscle pain and stiffness, restlessness and agitation, confusion, delusions, and numbness in the hands and feet.
Sometimes people misuse clorazepate, continuing to take the medication after their prescription has been stopped, in order to prevent withdrawal symptoms. This can lead to ongoing and worsening dependence and addiction to the medication [6].
Similarly, if the medication has been used for some time, tolerance to clorazepate may increase, potentially resulting in the individual taking higher doses than are prescribed, in order to feel an effect. Again, this can increase the potential risk for abuse and dependence, as well as worsening withdrawal symptoms when the medication is stopped [2].
Because of this, clorazepate is usually only prescribed as a short-term treatment, which will be gradually reduced rather than stopped suddenly, to reduce withdrawal symptoms and the potential for addiction. As such, it is important to take it exactly as prescribed by your doctor.
- American Society of Health-System Pharmacists, Inc. (Revised 2021). Clorazepate. MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a682052.html
- Lundbeck Inc. (Revised 2010). Tranxene (Clorazepate Dipotassium) Tablets Label. Access Data FDA. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/017105s076lbl.pdf
- Gabay, M. (2013). The Federal Controlled Substances Act: Schedules and Pharmacy Registration. Hospital Pharmacy, 48(6), 473–474. Retrieved from https://doi.org/10.1310/hpj4806-473
- National Center for Biotechnology Information (2023). PubChem Compound Summary for CID 2809, Clorazepate. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/Clorazepate
- Rickels, K., Schweizer, E., Csanalosi, I., Case, W.G., & Chung, H. (1988). Long-Term Treatment of Anxiety and Risk of Withdrawal. Prospective Comparison of Clorazepate and Buspirone. Archives of General Psychiatry, 45(5), 444–450. Retrieved from https://doi.org/10.1001/archpsyc.1988.01800290060008
- Schmitz, A. (2016). Benzodiazepine Use, Misuse, and Abuse: A Review. The Mental Health Clinician, 6(3), 120–126. Retrieved from https://doi.org/10.9740/mhc.2016.05.120
- Bounds, C.G., & Nelson, V.L. (2022). Benzodiazepines. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470159/
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