For caregivers administering diazepam rectal gel:

• Discuss with the patient's medical doctor exactly when and how to use diazepam rectal gel.
• Discuss with the patient's medical doctor when you should call for emergency help.
• Read the instructions that you received with the medicine before you need to use it.
• Stay with the patient after administering diazepam rectal gel to check his or her condition as instructed by the doctor.

For patients taking clorazepate extended-release tablets :

• Swallow tablets whole.
• Do not crush, break, or chew before swallowing.

For patients taking alprazolam, diazepam, or lorazepam concentrated oral solution:

• Measure each dose carefully using the dropper provided with the medicine.
• It is recommended that each dose be mixed with water, soda or soda-like beverages, or semisolid food such as applesauce or pudding, just before it is taken.
• Take the entire mixture right away. It should not be saved to be used later.

For patients taking lorazepam sublingual tablets:

• Do not chew or swallow the tablet. This medicine is meant to be absorbed through the lining of the mouth. Place the tablet under your tongue (sublingual) and let it slowly dissolve there. Do not swallow for at least 2 minutes.

Take this medicine only as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If too much is taken, it may become habit-forming (causing mental or physical dependence).

If you think this medicine is not working properly after you have taken it for a few weeks, do not increase the dose. Instead, check with your doctor.

For patients taking this medicine on a regular schedule for epilepsy or other seizure disorder:

• In order for this medicine to control your seizures, it must be taken every day in regularly spaced doses as ordered by your doctor . This is necessary to keep a constant amount of the medicine in the blood. To help keep the amount constant, do not miss any doses.

For patients taking this medicine for insomnia:

• Do not take this medicine when your schedule does not permit you to get a full night's sleep (7 to 8 hours). If you must wake up before this, you may continue to feel drowsy and may experience memory problems, because the effects of the medicine have not had time to wear off.

For patients taking flurazepam:

• When you begin to take this medicine, your sleeping problem will improve somewhat the first night. However, 2 or 3 nights may pass before you receive the full effects of this medicine.

Dosing

The dose of benzodiazepines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of benzodiazepines. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets, or the amount of solution that you take, or the number of injections you receive, depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking benzodiazepines.

For alprazolam
• For oral dosage form (solution or tablets):
  • For anxiety:
    • Adults At first, 0.25 to 0.5 milligram (mg) three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 4 mg a day.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.
    • Older adults At first, 0.25 mg two or three times a day. Your doctor may increase your dose if needed.
  • For panic disorder:
    • Adults At first, 0.5 mg three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 10 mg a day.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.

For bromazepam
• For oral dosage form (tablets):
  • For anxiety:
    • Adults 6 to 30 milligrams (mg) a day, taken in smaller doses during the day.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.
    • Older adults At first, up to 3 mg a day. Your doctor may change your dose if needed.

For chlordiazepoxide
• For oral dosage form (capsules):
  • For anxiety:
    • Adults 5 to 25 milligrams (mg) three or four times a day.
    • Children 6 years of age and older 5 mg two to four times a day. Your doctor may increase your dose if needed.
    • Children younger than 6 years of age Use and dose must be determined by your doctor.
    • Older adults At first, 5 mg two to four times a day. Your doctor may increase your dose if needed.
  • For sedation during withdrawal from alcohol:
    • Adults At first, 50 to 100 mg, repeated if needed. However, the dose usually is not more than 400 mg a day.
    • Children Use and dose must be determined by your doctor.
• For injection dosage form:
  • For anxiety:
    • Adults At first, 50 to 100 mg, injected into a muscle or vein. Then, if needed, 25 to 50 mg three or four times a day.
    • Teenagers 25 to 50 mg, injected into a muscle or vein.
    • Children younger than 12 years of age Use and dose must be determined by your doctor.
    • Older adults 25 to 50 mg, injected into a muscle or vein.
  • For sedation during withdrawal from alcohol:
    • Adults At first, 50 to 100 mg, injected into a muscle or vein. If needed, the dose may be repeated in two to four hours.
    • Children Use and dose must be determined by your doctor.

For clobazam
• For oral dosage form (tablets):
  • For control of seizures:
    • Adults At first, 5 to 15 milligrams (mg) a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 80 mg a day.
    • Children 2 to 16 years of age At first, 5 mg a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg a day.
    • Children younger than 2 years of age Dose is based on body weight and must be determined by your doctor.

For clonazepam
• For oral dosage form (tablets):
  • For control of seizures:
    • Adults At first, 0.5 milligram (mg) three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 20 mg a day.
    • Infants and children younger than 10 years of age Dose is based on body weight and must be determined by your doctor.
  • For panic disorder:
    • Adults At first, 0.25 mg two times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 4 mg a day.
    • Children Use and dose must be determined by your doctor.

For clorazepate
• For oral dosage form (capsules or tablets):
  • For anxiety:
    • Adults and teenagers 7.5 to 15 mg two to four times a day. Or your doctor may want you to start by taking 15 mg at bedtime.
    • Children younger than 12 years of age Use and dose must be determined by your doctor.
    • Older adults At first, 3.75 to 15 mg a day. Your doctor may increase your dose if needed.
  • For sedation during withdrawal from alcohol:
    • Adults and teenagers At first, 30 mg. Your doctor will set up a schedule that will gradually reduce your dose.
    • Children younger than 12 years of age Use and dose must be determined by your doctor.
  • For control of seizures:
    • Adults and teenagers At first, up to 7.5 mg taken three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 90 mg a day.
    • Children 9 to 12 years of age At first, up to 7.5 mg two times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 60 mg a day.
    • Children younger than 9 years of age Use and dose must be determined by your doctor.
• For oral dosage form (extended-release tablets):
  • For anxiety:
    • Adults and teenagers Your doctor may change your dosage form to the extended-release tablet if you are already taking 3.75 or 7.5 milligrams (mg) of clorazepate three times a day. The extended-release tablet is taken one time each day.
    • Children younger than 12 years of age Use and dose must be determined by your doctor.
  • For control of seizures:
    • Adults, teenagers, and children 9 to 12 years of age Your doctor may change your dosage form to the extended-release tablet if you are already taking 3.75 or 7.5 milligrams (mg) of clorazepate three times a day. The extended-release tablet is taken one time each day.
    • Children younger than 9 years of age Use and dose must be determined by your doctor.

For diazepam
• For oral dosage form (solution or tablets):
  • For anxiety:
    • Adults 2 to 10 mg two to four times a day.
    • Children 6 months of age and older Dose is based on body weight or size and must be determined by your doctor.
    • Children younger than 6 months of age Use is not recommended.
    • Older adults 2 to 2.5 mg one or two times a day. Your doctor may increase your dose if needed.
  • For sedation during withdrawal from alcohol:
    • Adults At first, 10 mg three or four times a day. Your doctor will set up a schedule that will gradually decrease your dose.
    • Children Use and dose must be determined by your doctor.
  • For control of seizures:
    • Adults 2 to 10 mg two to four times a day.
    • Children 6 months of age and older Dose is based on body weight or size and must be determined by your doctor.
    • Children younger than 6 months of age Use is not recommended.
    • Older adults 2 to 2.5 mg one or two times a day. Your doctor may increase your dose if needed.
  • For relaxing muscles:
    • Adults 2 to 10 mg three or four times a day.
    • Children 6 months of age and older Dose is based on body weight or size and must be determined by your doctor.
    • Children younger than 6 months of age Use is not recommended.
    • Older adults 2 to 2.5 mg one or two times a day. Your doctor may increase your dose if needed.
• For injection dosage form:
  • For anxiety:
    • Adults 2 to 10 mg, injected into a muscle or vein.
    • Children Use and dose must be determined by your doctor.
    • For older adults 2 to 5 mg, injected into a muscle or vein.
  • For sedation during withdrawal from alcohol:
    • Adults At first, 10 mg injected into a muscle or vein. If needed, 5 to 10 mg may be given three or four hours later.
    • Children Use and dose must be determined by your doctor.
  • For sedation before surgery or other procedures:
    • Adults 5 to 20 mg, injected into a muscle or vein.
    • Children Use and dose must be determined by your doctor.
    • Older adults 2 to 5 mg, injected into a muscle or vein.
  • For control of seizures:
    • Adults At first, 5 to 10 mg, usually injected into a vein every ten to fifteen minutes, stopping if the total dose reaches 30 mg. If needed, this treatment may be repeated in two to four hours.
    • Children 5 years of age and older At first, 1 mg, usually injected into a vein every two to five minutes, stopping if the total dose reaches 10 mg. This treatment may be repeated in two to four hours.
    • Infants older than 30 days of age and children younger than 5 years of age At first, 0.2 to 0.5 mg, usually injected into a vein every two to five minutes, stopping if the total dose reaches 5 mg. This treatment may be repeated in two to four hours.
    • Newborns and infants 30 days of age and younger Use and dose must be determined by your doctor.
    • Older adults 2 to 5 mg, injected into a muscle or vein.
  • For relaxing muscle spasms:
    • Adults At first, 5 to 10 mg injected into a muscle or vein. The dose may be repeated in three or four hours.
    • Children Use and dose must be determined by your doctor.
    • Older adults 2 to 5 mg, injected into a muscle or vein.
  • For relaxing muscles in tetanus:
    • Adults At first, 5 to 10 mg injected into a muscle or vein. Your doctor may increase your dose if needed.
    • Children 5 years of age and older 5 to 10 mg, injected into a muscle or vein. The dose may be repeated every three to four hours if needed.
    • Infants older than 30 days of age and children younger than 5 years of age 1 to 2 mg, injected into a muscle or vein. The dose may be repeated every three to four hours if needed.
    • Newborns and infants 30 days of age and younger Use and dose must be determined by your doctor.
• For rectal dosage form (gel or solution):
  • For control of seizures:
    • Adults and teenagers Dose is based on body weight and must be determined by your doctor.
    • Children Dose is based on body weight and must be determined by your doctor.

For estazolam
• For oral dosage form (tablets):
  • For trouble in sleeping:
    • Adults 1 milligram (mg) at bedtime. Your doctor may increase your dose if needed. However, the dose usually is not more than 2 mg.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.

For flurazepam
• For oral dosage form (capsules or tablets):
  • For trouble in sleeping:
    • Adults 15 or 30 milligrams (mg) at bedtime.
    • Children younger than 15 years of age Use and dose must be determined by your doctor.
    • Older adults At first, 15 mg at bedtime. Your doctor may increase your dose if needed.

For halazepam
• For oral dosage form (tablets):
  • For anxiety:
    • Adults 20 to 40 milligrams (mg) three or four times a day.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.
    • Older adults 20 mg one or two times a day.

For lorazepam
• For oral dosage form (concentrate or tablets):
  • For anxiety:
    • Adults and teenagers 1 to 3 milligrams (mg) two or three times a day.
    • Children younger than 12 years of age Use and dose must be determined by your doctor.
    • Older adults 0.5 to 2 mg a day, taken in smaller doses during the day.
  • For trouble in sleeping:
    • Adults and teenagers 2 to 4 mg taken at bedtime.
    • Children younger than 12 years of age Use and dose must be determined by your doctor.
• For sublingual tablet dosage form:
  • For anxiety:
    • Adults 2 to 3 mg a day, in smaller doses placed under the tongue during the day. Your doctor may increase your dose if needed. However, the dose usually is not more than 6 mg a day.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.
    • Older adults At first, 0.5 mg a day. Your doctor may increase your dose if needed.
  • For sedation before surgery:
    • Adults Dose is based on body weight and will be determined by your doctor. However, the dose usually is not more than 4 mg, placed under the tongue, one to two hours before surgery.
    • Children Use and dose must be determined by your doctor.
• For injection dosage form:
  • For sedation before surgery or other procedures:
    • Adults Dose is based on body weight and will be determined by your doctor. However, the dose usually is not more than 4 mg, injected into a muscle or vein.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.
  • For control of seizures:
    • Adults At first, 4 mg slowly injected into a vein. The dose may be repeated after ten to fifteen minutes if needed.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.

For nitrazepam
• For oral dosage form (tablets):
  • For trouble in sleeping:
    • Adults 5 to 10 milligrams (mg) at bedtime.
    • Children Use and dose must be determined by your doctor.
    • Older adults At first, 2.5 mg taken at bedtime. Your doctor may increase your dose if needed.
  • For control of seizures:
    • Children less than 30 kilograms (66 pounds) of body weight Dose is based on body weight and will be determined by your doctor.

For oxazepam
• For oral dosage form (capsules or tablets):
  • For anxiety:
    • Adults 10 to 30 milligrams (mg) three or four times a day.
    • Children younger than 12 years of age Use and dose must be determined by your doctor.
    • Older adults At first, 5 mg one or two times a day or 10 mg three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 15 mg four times a day.
  • For sedation during withdrawal from alcohol:
    • Adults 15 to 30 mg three or four times a day.
    • Children younger than 12 years of age Use and dose must be determined by your doctor.

For quazepam
• For oral dosage form (tablets):
  • For trouble in sleeping:
    • Adults 7.5 to 15 milligrams (mg) at bedtime.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.

For temazepam
• For oral dosage form (capsules):
  • For trouble in sleeping:
    • Adults 15 milligrams (mg) at bedtime. Your doctor may change your dose if needed.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.
    • Older adults At first, 7.5 mg at bedtime. Your doctor may increase your dose if needed.

For triazolam
• For oral dosage form (tablets):
  • For trouble in sleeping:
    • Adults 0.125 to 0.25 milligram (mg) at bedtime.
    • Children younger than 18 years of age Use and dose must be determined by your doctor.
    • Older adults At first, 0.125 mg at bedtime. Your doctor may increase your dose if needed.

Missed dose

If you are taking this medicine regularly (for example, every day as for epilepsy) and you miss a dose, take it right away if you remember within an hour or so of the missed dose. However, if you do not remember until later, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children. Overdose of benzodiazepines may be especially dangerous in children.
• Store away from heat and direct light.
• Do not store the capsule or tablet form of this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the liquid form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For benzodiazepines, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to benzodiazepines. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. Certain benzodiazepine products may contain lactose, parabens, or soybean oil.

Pregnancy Chlordiazepoxide and diazepam have been reported to increase the chance of birth defects when used during the first 3 months of pregnancy. Although similar problems have not been reported with the other benzodiazepines, the chance always exists since all of the benzodiazepines are related.

Studies in animals have shown that clonazepam, lorazepam, and temazepam cause birth defects or other problems, including death of the animal fetus.

Too much use of a benzodiazepine during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects after birth. Also, use of benzodiazepines during pregnancy, especially during the last weeks, may cause body temperature problems, breathing problems, difficulty in feeding, drowsiness, or muscle weakness in the newborn infant.

Benzodiazepines given just before or during labor may cause weakness in the newborn infant. When diazepam is given in high doses (especially by injection) within 15 hours before delivery, it may cause breathing problems, muscle weakness, difficulty in feeding, and body temperature problems in the newborn infant.

Breast-feeding Benzodiazepines may pass into the breast milk and cause drowsiness, difficulty in feeding, and weight loss in nursing babies of mothers taking these medicines.

Children Most of the side effects of these medicines are more likely to occur in children, especially the very young. These patients are usually more sensitive than adults to the effects of benzodiazepines.

It is possible that using clonazepam for long periods of time may cause unwanted effects on physical and mental growth in children. If such effects do occur, they may not be noticed until many years later. Before this medicine is given to children for long periods of time, you should discuss its use with your child's doctor.

Older adults Most of the side effects of these medicines are more likely to occur in the elderly, who are usually more sensitive to the effects of benzodiazepines.

Taking benzodiazepines for trouble in sleeping may cause more daytime drowsiness in elderly patients than in younger adults. In addition, falls and related injuries are more likely to occur in elderly patients taking benzodiazepines.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking or receiving benzodiazepines it is especially important that your health care professional know if you are taking any of the following:

• Central nervous system (CNS) depressants (medicines that cause drowsiness) The CNS depressant effects of either these medicines or benzodiazepines may be increased; your doctor may want to change the dose of either or both medicines

• Fluvoxamine (e.g., Luvox) or
• Itraconazole (e.g., Sporanox) or
• Ketoconazole (e.g., Nizoral) or
• Nefazodone (e.g., Serzone) Higher blood levels of benzodiazepines may occur, increasing the chance that side effects will occur; your doctor may want to change the dose of either or both medicines, or give you a different medicine

• Alcohol abuse (or history of) or
• Drug abuse or dependence (or history of) Dependence on benzodiazepines may be more likely to develop

• Brain disease CNS depression and other side effects of benzodiazepines may be more likely to occur

• Difficulty in swallowing (in children) or
• Emphysema, asthma, bronchitis, or other chronic lung disease or
• Glaucoma or
• Hyperactivity or
• Mental depression or
• Mental illness (severe) or
• Myasthenia gravis or
• Porphyria or
• Sleep apnea (temporary stopping of breathing during sleep) Benzodiazepines may make these conditions worse

• Epilepsy or history of seizures Although some benzodiazepines are used in treating epilepsy, starting or suddenly stopping treatment with these medicines may increase seizures

• Kidney or liver disease Higher blood levels of benzodiazepines may result, increasing the chance that side effects will occur