oxazepam

General Information

Oxazepam is a benzodiazepine indicated for the management of anxiety disorders (or short-term relief of anxiety symptoms) and for symptoms of acute alcohol withdrawal (label).

It is primarily cleared by glucuronidation to an inactive metabolite, which reduces classic CYP interaction concerns; total sedative burden remains the key safety limiter.

Oxazepam is often grouped with lorazepam and temazepam as a “LOT” benzodiazepine because it relies on glucuronidation; this can simplify use in hepatic impairment, but overdose and respiratory depression risk with opioids or alcohol remains unchanged.

For alcohol withdrawal, use protocolized monitoring and taper as symptoms resolve; carrying benzodiazepines forward as an indefinite “baseline” anxiety medication is generally avoided.

As with all benzodiazepines, dependence and withdrawal risk increase with dose and duration; chronic maintenance for generalized anxiety is generally avoided when possible.

The oxazepam compare view, review the oxazepam evidence feed, and share the oxazepam print page for safe-use counseling.

Oxazepam is often considered when hepatic impairment or complex polypharmacy makes oxidative metabolism benzodiazepines harder to manage. Time-limited plans are typical, sedative stacking is generally avoided, and psychotherapy/SSRI/SNRI approaches are prioritized for chronic anxiety.

Mechanism of Action

Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.

Positive allosteric modulator of GABA-A receptors, producing anxiolytic and sedative effects through increased inhibitory neurotransmission.

Sedation, psychomotor impairment, and respiratory depression risk are driven by dose and co-administered CNS depressants.

With repeated use, tolerance and dependence can develop, with rebound anxiety/insomnia and withdrawal symptoms when stopped abruptly.

• GABA-A receptor positive allosteric modulation.

Metabolism and Pharmacokinetics

• Mean elimination half-life is ~8.2 hours (range 5.7–10.9 hours) (label).
• Major metabolite is an inactive glucuronide excreted in urine (label).
• In very elderly patients (>80), elimination half-life can increase due to reduced unbound clearance; low starting doses and frequent reassessment are common (label).

Dosing and Administration

• Dosing is divided and varies by indication and symptom severity; lowest-effective dosing for the shortest feasible duration is typical (label).
• Older patients require cautious dosing to reduce oversedation and falls (label).
• For alcohol withdrawal, follow a structured protocol and taper as symptoms resolve rather than continuing indefinitely.
• If used beyond a short course, taper gradually to discontinue.

Monitoring & Labs

• Reassess indication and symptom trajectory at each renewal; avoid chronic maintenance without a clear goal.
• Screen for opioid co-prescribing, alcohol use, sleep apnea/COPD, and fall risk before prescribing.
• Monitor for oversedation, confusion, and impaired coordination; adjust dose or discontinue if harms outweigh benefit.
• If used beyond a short course, document a gradual taper plan and monitor for withdrawal.

Sources: FDA/DailyMed label; benzodiazepine/anxiety guidance; ASAM alcohol withdrawal guideline.

Adverse Effects

Interactions

• Additive CNS/respiratory depression with opioids, alcohol, antihistamines, and other sedatives.
• Oxazepam is not primarily CYP-metabolized, but clinical risk rises with combined sedative load and comorbid respiratory disease.
• Avoid combining multiple hypnotics unless there is a clear rationale and close monitoring.

Other Useful Information

• For chronic anxiety, prioritize psychotherapy and SSRI/SNRI options and reserve benzodiazepines for time-limited, goal-directed use.
• Alcohol withdrawal prescribing should not automatically become chronic benzodiazepine therapy; reassess and taper as withdrawal resolves.
• After alcohol withdrawal, align on longer-term relapse prevention and anxiety treatment rather than leaving oxazepam available for indefinite “as needed” dosing.
• When discontinuing after longer use, taper gradually and monitor for rebound anxiety, insomnia, tremor, and functional relapse.
• Keep a single prescriber/single pharmacy when possible and reassess ongoing need at every renewal to reduce inadvertent long-term use.

References

1. Oxazepam prescribing information — DailyMed (2025)
2. ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
3. Evidence Based Pharmacological Treatment OF Anxiety Disorders — Depression and Anxiety (2014)
4. 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)
5. The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management — Journal of Addiction Medicine (2020)