From the Guidelines
Etizolam should not be used as a first-line treatment for anxiety, insomnia, or panic disorders due to its high potential for dependence and abuse, and instead, alternative treatments such as cognitive behavioral therapy for insomnia (CBT-I) or FDA-approved medications like eszopiclone or zolpidem should be considered 1.
Key Points
- Etizolam is a thienodiazepine drug that acts similarly to benzodiazepines, but it is not approved for medical use in the United States.
- It is prescribed in some countries for short-term treatment of anxiety, insomnia, and panic disorders, typically at doses of 0.25-1mg taken 1-3 times daily for no more than 2-4 weeks due to risks of dependence.
- Etizolam works by enhancing the effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, which produces calming effects.
- Users should be aware that etizolam carries significant risks including physical dependence, withdrawal symptoms, respiratory depression (especially when combined with alcohol or opioids), and potential for overdose.
- Abrupt discontinuation after regular use can cause dangerous withdrawal symptoms, so tapering under medical supervision is essential.
- Due to its unregulated status in many regions and potential for abuse, etizolam should not be used without proper medical oversight, and in countries where it's not approved, possession may be illegal.
- Alternative treatments such as CBT-I, stimulus control, relaxation strategies, and sleep restriction should be considered as first-line treatments for insomnia and anxiety disorders 1.
- FDA-approved medications like eszopiclone, zolpidem, and ramelteon may also be considered for the treatment of insomnia, but their use should be carefully monitored due to the risk of dependence and adverse effects 1.
From the Research
Etizolam Overview
- Etizolam is a designer benzodiazepine (BZD) that has raised concern due to its growing non-medical use, liability to tolerance and dependence, and related harms 2.
- It is widely prescribed as an anxiolytic due to its apparently secure toxicological profile, but recent cases of etizolam dependence, intoxications, and fatalities associated with its abuse have been reported 3.
Cognitive Side Effects
- High-dose etizolam use has been shown to cause deficits in working memory, visuospatial memory, and executive function 2.
- Neuropsychological evaluation of etizolam high-dose users found significant cognitive side effects, suggesting that abuse and dependence liability of etizolam should be considered a public health and social problem 2.
Treatment and Discontinuation
- Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown to be effective in facilitating benzodiazepine discontinuation in patients with insomnia and anxiety disorders 4.
- A supervised benzodiazepine taper, combined with CBT, has been found to be effective in assisting chronic users of benzodiazepine medication to discontinue or reduce their use of medication 5.
- The addition of CBT alleviates insomnia, but sleep improvements may become noticeable only after several months of benzodiazepine abstinence 5.
Safety and Dependence
- Etizolam at therapeutic dosages has been found to have negligible influence on psychomotor performances involved in driving, but abuse of etizolam to obtain euphoric effects at high dosages or in combination with other psychoactive substances can be fatal 3.
- Benzodiazepines, including etizolam, have a high potential for addiction and dependence, leading to withdrawal symptoms that can be life-threatening 6.
- Regular use of benzodiazepines has been shown to cause severe, harmful psychological and physical dependence, requiring careful tapering of the medication when prescribed 6.