clorazepate

Adjunctive therapy

Brands: TRANXENE

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is clorazepate?
Clorazepate (brand Tranxene) is a benzodiazepine prodrug indicated for the management of anxiety disorders or short-term relief of anxiety symptoms, adjunctive therapy for partial seizures, and symptomatic relief of acute alcohol withdrawal (label; product-dependent).
What is TRANXENE?
TRANXENE is a brand name for clorazepate.
What is TRANXENE (clorazepate) used for?
Label indications include: Anxiety disorders / short-term relief of anxiety symptoms; adjunctive therapy in partial seizures; and symptomatic relief of acute alcohol withdrawal (label; product-dependent).
What drug class is TRANXENE (clorazepate)?
Benzodiazepine prodrug; positive allosteric modulator of GABA-A receptors (via nordiazepam).
What strengths does TRANXENE (clorazepate) come in?
Tablets: 3.75 mg, 7.5 mg, 15 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: TRANXENE
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Anxiety disorders / short-term relief of anxiety symptoms; adjunctive therapy in partial seizures; and symptomatic relief of acute alcohol withdrawal (label; product-dependent).

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Clinical Highlights

Clorazepate (brand Tranxene) is a benzodiazepine prodrug indicated for the management of anxiety disorders or short-term relief of anxiety symptoms, adjunctive therapy for partial seizures, and symptomatic relief of acute alcohol withdrawal (label; product-dependent). Clorazepate is rapidly converted to the long-acting metabolite nordiazepam (half-life ~40–50 hours) (label). Longer duration can provide smoother coverage but increases accumulation, next-day impairment, falls, and cognitive slowing risk—especially in older adults and with polypharmacy.

Benzodiazepine risks include abuse/misuse, addiction, and clinically significant physical dependence with withdrawal reactions. These risks support defined duration and taper planning rather than open-ended use (label / safety guidance).
Boxed warning: Concomitant use with opioids can cause profound sedation, respiratory depression, coma, and death; co-prescribing is generally avoided when possible (label).
The compare view, clorazepate evidence feed, and clorazepate print page can help contextualize alternatives and support counseling about duration and tapering.
Best fit is usually targeted, time-limited use (e.g., severe anxiety bridge, alcohol withdrawal protocols, or seizure adjunct) where close follow-up and safety monitoring are feasible.

Dosing & Formulations

Tablets: 3.75 mg, 7.5 mg, 15 mg (label). Anxiety labeling: usual daily dose is 30 mg in divided doses; dose is adjusted within a range of 15–60 mg/day based on response and tolerance (label).

Elderly or debilitated patients: initiation at 7.5–15 mg/day is advised to reduce oversedation and falls (label).
Acute alcohol withdrawal labeling includes structured schedules (up to 90 mg/day maximum in the label) and is typically implemented with vital sign and sedation monitoring (label).
If discontinuing after regular use, gradual tapering is commonly used to reduce withdrawal reactions and rebound anxiety/insomnia (label).

Monitoring & Risks

Sedation/impairment: assess driving, falls, and daytime cognition; long-acting metabolite increases “carryover” risk. Dependence and withdrawal: monitor tolerance and withdrawal symptoms; avoid abrupt discontinuation, especially after prolonged use (label).

Behavioral effects: paradoxical agitation and disinhibition can occur; worsening symptoms generally prompts reassessment rather than escalation.
Seizure indication note: antiepileptic drugs carry warnings about mood changes and suicidality; monitor mood/behavior changes when used for seizure adjunct therapy (label).

Drug Interactions

Additive CNS/respiratory depression occurs with alcohol, opioids, antihistamines, sedating antipsychotics, and other hypnotics; total sedative burden drives harm (label/class). Long half-life increases the impact of new sedative prescriptions or alcohol use because impairment can persist for days.

If oversedation occurs, clinicians typically reduce total sedative load and reassess indication rather than adding additional sedatives.

Practice Notes

For chronic anxiety disorders, guidelines typically prioritize psychotherapy and SSRIs/SNRIs; benzodiazepines are often time-limited as bridges for severe symptoms. Long-acting benzodiazepines can be used as part of structured tapering strategies, but they still require careful monitoring for misuse and impairment.

When used for alcohol withdrawal, coordination with medical teams and structured monitoring of vitals/sedation is typical.
Document indication, duration, and taper strategy to prevent inadvertent long-term use and withdrawal risk.

References

Clorazepate dipotassium tablets prescribing information — DailyMed (2025)
ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management — Journal of Addiction Medicine (2020)
Evidence Based Pharmacological Treatment OF Anxiety Disorders — Depression and Anxiety (2014)
Guidelines FOR THE Pharmacological Treatment OF Anxiety Disorders, Obsessive Compulsive Disorder AND Posttraumatic Stress Disorder IN Primary Care — International Journal of Psychiatry in Clinical Practice (2012)