Recommended Dosage and Usage of Tranxene (Clorazepate) for Anxiety Disorders and Alcohol Withdrawal
For anxiety disorders, Tranxene (clorazepate) should be administered at 15-60 mg daily in divided doses, with a usual daily dose of 30 mg; for alcohol withdrawal, follow a tapering schedule starting with 30-60 mg on day 1, gradually reducing to 7.5-15 mg before discontinuation. 1
Dosage for Anxiety Disorders
Standard Adult Dosing
- Initial dose: 30 mg daily in divided doses
- Dose range: 15-60 mg daily, adjusted based on patient response
- Alternative single bedtime dosing: 15 mg initially, then adjusted based on response
Special Populations
- Elderly or debilitated patients:
- Start with 7.5-15 mg daily
- Lower doses generally indicated for elderly patients
Administration Considerations
- May be given in divided doses throughout the day or as a single bedtime dose
- Drowsiness may occur at treatment initiation or with dose increases
- Single nighttime dosing (15 mg) has been shown to be effective for short-term anxiety treatment 2
Dosage for Alcohol Withdrawal
Recommended Tapering Schedule
| Time Period | Dosage |
|---|---|
| Day 1 | 30 mg initially, followed by 30-60 mg in divided doses |
| Day 2 | 45-90 mg in divided doses |
| Day 3 | 22.5-45 mg in divided doses |
| Day 4 | 15-30 mg in divided doses |
| Thereafter | Gradually reduce to 7.5-15 mg daily |
Important Considerations
- Maximum recommended total daily dose: 90 mg
- Avoid excessive reductions in daily dose on successive days
- Discontinue as soon as the patient's condition stabilizes 1
- Benzodiazepines are effective for controlling alcohol withdrawal by addressing noradrenergic and hypothalamic-pituitary-adrenocortical overactivity 3
- Medication should be dispensed in small quantities or each dose supervised to reduce misuse risk 4
Adjunctive Treatment Considerations
Psychosocial Support
- Psychosocial support should be routinely offered to alcohol-dependent patients 4
- Where available, consider more structured psychological interventions such as motivational techniques 4
- Encourage engagement with mutual help groups like Alcoholics Anonymous 4
Safety Precautions
- Long-term use can lead to tolerance, addiction, and cognitive impairment
- Paradoxical agitation occurs in approximately 10% of patients treated with benzodiazepines
- Despite clorazepate's long half-life, withdrawal reactions can still occur with abrupt discontinuation 5
- Patients at risk of severe withdrawal or with concurrent serious physical/psychiatric disorders should preferably be managed in an inpatient setting 4
Monitoring and Follow-up
- Regular monitoring for side effects including sedation, cognitive impairment, and falls
- For alcohol withdrawal patients, monitor vital signs and level of sedation
- Withdrawal from benzodiazepines should be undertaken in a planned manner, using a gradually tapering dose over 8-12 weeks 4
- Consider additional psychosocial support during benzodiazepine withdrawal
Clorazepate at 7.5 mg daily has been shown to provide useful anxiolytic effects without excessive sedation 6, which may be particularly important for patients who need to maintain daily functioning while managing anxiety symptoms.