Dosing and uses of Serax (oxazepam)
Adult dosage forms and strengths
capsule: Schedule IV
- 10mg
- 15mg
- 30mg
Anxiety
Mild/moderate: 10-15 mg PO q6-8hr PRn
Severe, agitation or assoc with depression: 15-30 mg PO q6-8hr PRn
Alcohol Withdrawal
15-30 mg PO q6-8hr PRn
Pediatric dosage forms and strengths
capsule: Schedule IV
- 10mg
- 15mg
- 30mg
Anxiety
<6 years: Not recommended
6-12 years: Not established; use with caution
>12 years
- Mild/moderate: 10-15 mg PO q6-8hr PRN
- Severe, agitation or assoc with depression: 15-30 mg PO q6-8hr PRN
Geriatric dosage forms and strengths
Drug of choice in elderly when benzodiazepine indicated because of short half-life
Anxiety
10 mg q8-12hr; may gradually increase to total dose of 30-45 mg/day PRn
Ethanol Withdrawal
10-30 mg PO q8-12hr PRn
Serax (oxazepam) adverse (side) effects
Frequency not defined
Sedation
Ataxia
Confusion
Memory impairment
Dizziness
Drowsiness
Muscle weakness
Syncope edema
Leukopenia, blood dyscrasias
Decreased libido
Rash
Incontinence
Menstrual irregularities
Jaundice
Blured vision; diplopia
Warnings
Contraindications
Documented hypersensitivity
Acute alcohol intoxication
Myasthenia gravis (allowable in limited circumstances)
Narrow angle glaucoma (questionable)
Severe respiratory depression
Depressed neuroses, psychotic reactions
IV use in shock, coma, depressed respiration, patients who recently received other respiratory depressants
Cautions
Use caution in respiratory diseases (COPD), cardiovascular disease (hypotension), sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicide ideation, history of drug abuse
May impair ability to perform hazardous tasks
Associated with anterograde amnesia
Paradoxical reactions (heractivity or aggressive behavior) may occur
Use caution in debilitated patients and the elderly
Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use
Pregnancy and lactation
Pregnancy category: d
Lactation: Avoid during breastfeeding
Minor tranquilizers should be avoided in 1st trimester of pregnancy due to increased risk of congenital malformations
Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence)
Prenatal benzodiazepine exposure slightly increased oral cleft risk (limited or inconsistent evidence)
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Serax (oxazepam)
Mechanism of action
Binds receptors at several sites within the CNS, including the limbic system and reticular formation. Effects may be mediated through GABA receptor system. Increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the nuronal membrane
Pharmacokinetics
Half-life elimination: 2.8-5.7 hr
Peak plasma time: 3 hr
Peak plasma concentration: 450 ng/mL
Metabolism: Glucuronic acid conjugation
Metabolites: No active metabolites
Protein binding: 86-99%
Excretion: Urine
