Tranxene (clorazepate) belongs to the class of drugs called benzodiazepines. It is an anxiolytic, which means it has properties that are useful in treating anxiety and panic-related conditions. It is also used in alcohol withdrawal. Apart from these uses, it is also prescribed as an additive in the management of convulsions and epilepsy.

How Does Tranxene Work?

This drug acts on gamma-aminobutyric acid (GABA) receptors found in various regions of the brain. These receptors are also known as benzodiazepine receptors. The action of Tranxene on GABA receptors increases the inhibitory action of the neurotransmitter in that region of the brain. This action on GABA receptors appears to produce the medication’s anxiolytic, sedative, and anticonvulsant actions.

Dosage FAQs

  • What is a safe dose of this medication?
    • Anxiety: For individuals experiencing anxiety, an average dose would be administered at 30 mg per day, orally, in divided doses. The dose is then adjusted gradually in the range of 15 mg to 60 mg per day. For elderly individuals, dosage should be adjusted to a maximum of 7.5 mg taken orally in a single dose or divided into two doses throughout the day.
    • Acute Alcohol Withdrawal: The therapy is spread over a period of five days:
      • Day 1: Initial oral dose of 30 mg is administered once, followed by 30 mg to 60 mg in divided doses. The maximum daily dose should not exceed 90 mg.
      • Day 2: A dose between 45 mg to 90 mg is administered orally in divided doses.
      • Day 3: 22.5 mg to 45 mg oral dose is administered in divided doses.
      • Day 4: 15 mg to 30 mg oral dose is administered in divided doses.
      • Day 5: 7.5 mg to 15 mg is administered in divided doses.
      • Tranxene should be discontinued when the person in treatment is stable.
         
  • How is this drug processed in my body?
    Tranxene is well-absorbed in the gastrointestinal tract and has a bioavailability of 91%. It is widely distributed and is highly bound to plasma proteins (97-98%). After metabolizing in the liver, it produces the active metabolite desmethyl-diazepam and is further metabolized to oxazepam, both of which are partial agonist of the GABA receptors. The peak plasma levels of Tranxene are reached between 30 minutes and two hours after oral administration. It is removed from the body in the urine.
     
  • Is this drug safe to use if I am pregnant?
    Tranxene may cause an increased risk of congenital malformations if used during the first trimester of pregnancy. It also enters breast milk and should not be used by nursing mothers. If you are pregnant or become pregnant during treatment, be sure to discuss alternative treatments with your health care provider.
     

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    How can I get the most out of my treatment with this medication?
    Various types of psychotherapy are regularly used to treat anxiety and those in treatment for issues related to alcohol dependency. If you are prescribed this drug for either condition, consider finding a therapist or counselor with whom you can pair your medication treatment. Many bodies of research highlight the efficacy of pairing medication with psychotherapy and several studies have demonstrated how this combined treatment approach may lead to better, longer-lasting mental health outcomes.

Possible Side Effects

This medication shares many of the same side effects of other benzodiazepines, including:

  • Cognitive impairment
  • Confusion
  • Drowsiness
  • Dizziness
  • Nervousness
  • Headache
  • Gastrointestinal complaints such as nausea, vomiting, and diarrhea
  • Dry mouth
  • Blurred vision
  • Anterograde amnesia
  • An increased risk of falls for elderly individuals
  • Ataxia

Drug Interactions

If you are prescribed this medication, ensure that you disclose all medications, vitamins, and supplements you take regularly to your doctor. The following drug interactions may occur with this treatment:

  • Triprolidine: Triprolidine and Tranxene have depressive effects on the central nervous system. Taking them together may increase these effects.
  • Monoamine Oxidase Inhibitors (MAOIs): MAOIs can lower blood pressure and increase sedation. On concomitant administration with this category of drugs, the respiratory system is also affected.
  • Sedatives or Sleeping Pills: These medications may cause severe sedation and could become fatal when taken with Tranxene.
  • Carbamazepine, Tricyclic Antidepressants, Phenytoin, and Theophylline: These drugs can decrease the effectiveness of Tranxene.

Additionally, the following drugs may affect the metabolism of Serax and/or increase the risk of toxicity if administered with Serax:

  • Cimetidine
  • Clozapine
  • Fluconazole
  • Ketoconazole
  • Indinavir
  • Nelfinavir
  • Itraconazole
  • Omeprazole
  • Ritonavir
  • Saquinavir
  • Voriconazole
  • Telithromycin
  • Oral contraceptives

Safe Withdrawal from Tranxene

You should not stop taking this medication abruptly. In order to reduce the withdrawal symptoms, you should gradually taper down the dose. Consult your physician and develop a safe plan to reduce the medication in your system. Possible symptoms of withdrawal include:

Reference:

  1. Rickels R, Ryan M. Pharmacotherapy of generalized anxiety disorder. Journal of Clinical Psychiatry 2002; 63(suppl 14):9–16.
  2. Sramek JJ, Zarotsky V, Cutler NR. Generalised anxiety disorder. Drugs 2002; 62:1635–1648.
  3. Ballanger JC, Davidson JR, Lecrubier Y, et al. Consensus statement on generalized anxiety disorder from the international consensus group on depression and anxiety. Journal of Clinical Psychiatry 2001; 62(suppl 11):53–58
  4. Authier, N.; Balayssac, D.; Sautereau, M.; Zangarelli, A.; Courty, P.; Somogyi, AA.; Vennat, B.; Llorca, PM.; Eschalier, A. (November 2009). "Benzodiazepine dependence: focus on withdrawal syndrome". Annales Pharmaceutiques Francaises 67 (6): 408–13. doi:10.1016/j.pharma.2009.07.001. PMID 19900604.

Page content reviewed by James Pendleton, ND.