From the Guidelines
Etizolam is a potent anxiolytic and hypnotic agent that should be used with caution due to its high potential for dependence and addiction. Etizolam is a thienodiazepine derivative that acts similarly to benzodiazepines, though it's not classified as one. It's not FDA-approved in the United States but is used medically in some countries like Japan, Italy, and India for treating anxiety disorders, insomnia, and panic attacks. Etizolam works by enhancing the effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, which reduces neuronal excitability and produces calming effects. The "tab" form simply refers to tablet formulation.
Key Points to Consider
- Research suggests etizolam is effective for short-term anxiety relief and sleep disorders, with some studies indicating it may cause less sedation and have a shorter duration of action compared to traditional benzodiazepines 1.
- However, etizolam is definitely habit-forming and carries significant risks for dependence and addiction, as noted in guidelines that advise against the use of benzodiazepines for chronic insomnia due to their harms outweighing benefits 1.
- Regular use can lead to tolerance, withdrawal symptoms upon discontinuation, and potential for abuse. Physical dependence can develop in as little as 2-4 weeks of regular use.
- Due to these risks and its legal status in many countries, etizolam should only be used under proper medical supervision where it's legally prescribed, and not for recreational purposes or self-medication.
Recommendations for Use
- Etizolam should be prescribed at the lowest effective dose and for the shortest possible duration to minimize the risk of dependence and other adverse effects 1.
- Patients should be counseled on the potential risks of etizolam, including dependence, withdrawal symptoms, and the potential for abuse.
- Alternative treatments for anxiety and insomnia should be considered, especially for long-term management, due to the significant risks associated with etizolam and other benzodiazepine-like substances.
From the Research
What is Etizolam
- Etizolam is a benzodiazepine (BZD) with a unique structure, where a thiophene replaces the benzene ring and a triazole ring is fused to the diazepine ring 2.
- It has a pharmacological profile similar to other BZDs, but with some differences in its potency and effects 3.
Uses of Etizolam
- Etizolam is used to treat anxiety and panic disorders, reduce depressive and somatization symptoms, and induce muscle relaxation 2.
- It is also used recreationally due to its reinforcing and sedative effects 2.
- Etizolam has been shown to be effective in the treatment of generalized anxiety disorder, with a progressive increase in anxiolytic activity over 4 weeks of treatment 4.
Mechanism of Action
- Etizolam has a high affinity for the benzodiazepine site of GABAA receptors, which is responsible for its anxiolytic and sedative effects 3.
- It is a thienodiazepine derivative, which distinguishes it from other BZDs 3.
Effectiveness and Habit Formation
- Etizolam has been shown to be effective in the treatment of anxiety and panic disorders, with a higher potency as an anxiolytic compared to diazepam 3.
- However, its use can be associated with harms, particularly when used in illicitly manufactured pills or combined with other substances 3.
- The risk of habit formation and dependence on etizolam is a concern, particularly with long-term use or in high doses 5, 6.
- A meta-analytic review found that benzodiazepines, including etizolam, are moderately effective in the treatment of generalized anxiety disorder, with a higher effect size compared to selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) 5.
- Another study found that SSRIs cause more adverse events than benzodiazepines in short-term panic disorder treatment, although both classes of drugs have their own unique side effect profiles 6.