|Systematic (IUPAC) name|
|Trade names||Etilaam, Etizest|
|Oral, sublingual, rectal|
3.4 hours(main metabolite is 8.2 hours)
|CAS Registry Number||Y|
|N (what is this?)|
Etizolam (marketed under the brand name Etilaam, Etizola, Sedekopan, Etizest, Pasaden or Depas) is a benzodiazepine analog. The etizolam molecule differs from a benzodiazepine in that the benzene ring has been replaced by a thiophene ring, making the drug a thienodiazepine. It possesses amnesic, anxiolytic, anticonvulsant, hypnotic, sedative and skeletal muscle relaxant properties.
- 1 Indications
- 2 Dosage
- 3 Side effects
- 4 Tolerance, dependence and withdrawal
- 5 Contraindications and special caution
- 6 Pharmacology
- 7 Legal status
- 7.1 United States
- 7.2 United Kingdom
- 7.3 Germany
- 7.4 Poland
- 8 Interactions
- 9 Overdose
- 10 Abuse
- 11 See also
- 12 References
- 13 External links
- Short-term treatment of insomnia
- Short-term treatment of anxiety or panic attacks, if a benzodiazepine is required
- Anxiety disorders associated with depression: 1 mg two to three times a day (maximum 3 mg per day)
- For panic disorder (associated with agoraphobia): 0.5 mg two times per day (maximum 1 mg per day)
- For insomnia: 1–2 mg once daily before bedtime
A 1 mg dose of etizolam is approximately equivalent to a 10 mg dose of diazepam, see List of benzodiazepines.
- Blepharospasms with long term use
- Erythema annulare centrifugum skin lesions
Tolerance, dependence and withdrawal
Abrupt or rapid withdrawal from etizolam, as with benzodiazepines, may result in the appearance of the benzodiazepine withdrawal syndrome, including rebound insomnia. Neuroleptic malignant syndrome, a rare event in benzodiazepine withdrawal, has been documented in a case of abrupt withdrawal from etizolam.
In a study that compared the effectiveness of etizolam, alprazolam, and bromazepam for the treatment of generalized anxiety disorder, all three drugs retained their effectiveness over 2 weeks, but etizolam became more effective from 2 weeks to 4 weeks, a type of reverse tolerance. Administering .5 mg etizolam twice daily did not induce cognitive deficits over 3 weeks when compared to placebo.
When multiple doses of etizolam, or lorazepam, were administered to rat neurons, lorazepam caused downregulation of alpha-1 benzodiazepine binding sites (tolerance/dependence), while etizolam caused an increase in alpha-2 benzodiazepine binding sites (reverse tolerance to anti-anxiety effects). Tolerance to the anticonvulsant effects of lorazepam were observed, but no significant tolerance to the anticonvulsant effects of etizolam were observed. Etizolam therefore has a reduced liability to induce tolerance, and dependence, compared with classic benzodiazepines.
Contraindications and special caution
Etizolam is metabolised by the liver and is contraindicated in those with severely impaired hepatic function. It may impair the ability to drive and operate machinery so caution should be applied. Elderly patients should start on a lower dose as they are more susceptible to the sedative effects of etizolam. It is not recommended to be taken during pregnancy or breastfeeding.
Etizolam can increase the sedative and antidepressant actions of other medication such as neuroleptics, analgesics, anaesthetics, antiepileptics, sedatives and first-generation antihistamines. Co-administration with these medications should be avoided unless instructed by a medical professional. Alcohol should also be avoided.
Drugs inhibiting the enzymes CYP2C19 and CYP3A4, such as fluvoxamine, should not be taken concurrently as etizolam can increase the plasma levels of these enzymes.
Etizolam, a thienodiazepine derivative, is absorbed fairly rapidly, with peak plasma levels achieved between 30 minutes and 2 hours. It has a mean elimination half life of about 3.5 hours. Etizolam possesses potent hypnotic properties, and is comparable with other short-acting benzodiazepines. Etizolam acts as a full agonist at the benzodiazepine receptor to produce its range of therapeutic and adverse effects. Similar to other benzodiazepines, etizolam binds non-selectively to benzodiazepine receptor subtypes.[dubious – discuss]
In addition, etizolam, unlike most other benzodiazepines (some of which can increase levels of estradiol), has prolactogenic effects, leading to an increase in blood levels of prolactin.
According to the Italian P.I. sheet, etizolam belongs to a new class of diazepines, thienotriazolodiazepines. This new class is easily oxidized, rapidly metabolized, and has a lower risk of accumulation, even after prolonged treatment. Etizolam has an anxiolytic action about 6 times greater than that of diazepam. Etizolam produces, especially at higher dosages, a reduction in time taken to fall asleep, an increase in total sleep time, and a reduction in the number of awakenings. During tests, there were not substantial changes in deep sleep; however, it may reduce REM sleep. In EEG tests of healthy volunteers, etizolam showed some characteristics of tricyclic antidepressants.
Etizolam is not authorized for medical use in the U.S. However, it currently remains unscheduled and is legal for research purposes. As it is a thienodiazepine, an analog of benzodiazepines, which are Schedule IV drug under Federal Scheduling Guidelines, it does not fall under the Federal Analog Act, which only applies to Schedule I and II drugs.
Etizolam is a controlled substance in the following states: Alabama, Arkansas and Mississippi.
Unlike other thienodiazepines such as brotizolam and clotiazepam, etizolam is not controlled under the Misuse of Drugs Act 1971 or licensed as a medicine in the United Kingdom.
Etizolam was controlled in Germany in July 2013.
Etizolam may be scheduled under the Act on Counteracting Drug Addiction and the State Sanitary Inspection -Article 27c
Itraconazole and fluvoxamine slow down the rate of elimination of etizolam, leading to accumulation of etizolam, therefore increasing its pharmacological effects. Carbamazepine speeds up the metabolism of etizolam, resulting in reduced pharmacological effects.
Etizolam, similarly to other GABAergic agonists including the benzodiazepines has a strong synergistic effect with ethanol and the consequences of co-ingestion of the two drugs can drastically compound the side effects of either drug.[medical citation needed] This can result in (among other effects) anterograde amnesia (blackouts) and severe respiratory depression which in extreme cases can lead to death.[medical citation needed]
Cases of intentional suicide by overdose using etizolam in combination with GABA antagonists have been reported. Although etizolam has a lower LD50 than certain benzodiazepines, the LD50 is still far beyond the prescribed or recommended dose.
Etizolam is a drug of potential abuse. However, conflicting reports from the World Health Organization, made public in 1991, dispute the abuse claims.
- Benzodiazepine dependence
- Benzodiazepine withdrawal syndrome
- Long-term effects of benzodiazepines
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- WHO Expert Committee on Drug Dependence
- Inchem.org - Etizolam
- Overdose of etizolam: the abuse and rise of a benzodiazepine analog.
- O'Connell CW1, Sadler CA2, Tolia VM2, Ly BT1, Saitman AM3, Fitzgerald RL3.
- Annals of emergency medicine.Ann Emerg Med.2015 Apr;65(4):465-6. doi: 10.1016/j.annemergmed.2014.12.019.
- PMID 25805032
- Lethal poisonings with AH-7921 in combination with other substances.
- Karinen R1, Tuv SS2, Rogde S3, Peres MD4, Johansen U2, Frost J5, Vindenes V2, Øiestad ÅM2.
- Forensic science international.Forensic Sci Int.2014 Nov;244:e21-4. doi: 10.1016/j.forsciint.2014.08.013. Epub 2014 Aug 26.
- AH-7921 is a synthetic μ-opioid agonist, approximately equipotent with morphine. We report the death of two young individuals after ingestion of AH-7921 in combination with other psychoactive drugs. In the first case a young man died shortly after ingesting Internet drugs. Toxicological analysis of
- PMID 25216892
- A case of etizolam dependence.
- Gupta S1, Garg B1.
- Indian journal of pharmacology.Indian J Pharmacol.2014 Nov-Dec;46(6):655-6. doi: 10.4103/0253-7613.144943.
- Etizolam is a thienodiazepine anxiolytic which is said to have lower dependence potential than other benzodiazepines. We report a case of etizolam dependence in a young male with social anxiety disorder and moderate depression. This case report highlights the fact that the same caution be exercised
- PMID 25538342
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