Anxiolytics 💊
Educational reference for common benzodiazepines used in Irish hospitals for anxiety or short-term insomnia: lorazepam, diazepam, alprazolam, and triazolam (Halcion), with dosing notes and SmPC links. Confirm formulary and SmPC before prescribing.
Educational disclaimer
- This table is for education only. It is not a prescribing protocol and does not replace your hospital formulary, pharmacy advice, senior review, or the current Irish SmPC.
- Benzodiazepines are not first-line for anxiety disorders. Use the lowest dose for the shortest time, with a clear indication and review or stop date.
- Check falls risk, respiratory status, hepatic or renal impairment, and other CNS depressants (opioids, z-drugs) before charting.
Anxiolytics
Usual adult reference doses. Confirm SmPC before prescribing.
| Drug | Class | Dose | Frequency | Route | Notes | Hepatic | Renal |
|---|---|---|---|---|---|---|---|
| Lorazepam (Ativan) | Benzodiazepine | 0.5–1 mg | PRN / divided; often max 4 mg/24 h | PO (IM if needed) | Common acute ward choice. Short course only. Sedation, falls, respiratory depression. | Lower dose | Lower dose |
| Diazepam (Anxicalm) | Benzodiazepine | 2–5 mg | TDS–QDS; SmPC anxiety range varies | PO | Longer-acting; hangover and accumulation risk, especially in older adults. | Caution / lower | No routine change |
| Alprazolam (Xanax) | Benzodiazepine | 0.25–0.5 mg | TDS | PO | High dependence potential. Avoid starting a new regular course on call. | Lower dose | Lower dose |
| Triazolam (Halcion) | Benzodiazepine | 0.125–0.25 mg | Nocte; max 0.25 mg | PO | Irish SmPC: short-term severe insomnia (up to 7–10 days), not daytime anxiety. Start 0.125 mg if hypnotic-naive, elderly, or hepatic impairment. | Start 0.125 mg | Usual range |
Lorazepam (Ativan)
BenzodiazepineDose:0.5–1 mg
Route:PO (IM if needed)
Frequency:PRN / divided; often max 4 mg/24 h
Hepatic:Lower dose
Renal:Lower dose
Notes: Common acute ward choice. Short course only. Sedation, falls, respiratory depression.
Diazepam (Anxicalm)
BenzodiazepineDose:2–5 mg
Route:PO
Frequency:TDS–QDS; SmPC anxiety range varies
Hepatic:Caution / lower
Renal:No routine change
Notes: Longer-acting; hangover and accumulation risk, especially in older adults.
Alprazolam (Xanax)
BenzodiazepineDose:0.25–0.5 mg
Route:PO
Frequency:TDS
Hepatic:Lower dose
Renal:Lower dose
Notes: High dependence potential. Avoid starting a new regular course on call.
Triazolam (Halcion)
BenzodiazepineDose:0.125–0.25 mg
Route:PO
Frequency:Nocte; max 0.25 mg
Hepatic:Start 0.125 mg
Renal:Usual range
Notes: Irish SmPC: short-term severe insomnia (up to 7–10 days), not daytime anxiety. Start 0.125 mg if hypnotic-naive, elderly, or hepatic impairment.
⚠️ Educational disclaimer
- This topic is for educational purposes only. It is not a substitute for local hospital formulary, pharmacy advice, senior clinical review, or the current Irish SmPC.
- Doses in the table are usual adult reference ranges for normal renal and hepatic function. Adjust for age, frailty, organ impairment, and co-prescribed CNS depressants.
- Do not use this page as a standalone protocol for starting benzodiazepines.
🧭 Before you prescribe
- See Anxiety (Inpatient) for assessment, medical mimics, and non-drug measures first.
- Benzodiazepines are not first-line for anxiety disorders (HSE MMP / CPsychI). Reserve for a severe, disabling crisis, at the lowest dose, for the shortest time, with a review or stop date.
- Give a one-off dose, or a short PRN course with planned review. Do not start a new regular long course on an overnight call without a day-team plan.
- SSRIs or SNRIs are first-line medicines for diagnosed GAD. Do not start them solely for acute ward distress without a planned diagnosis and follow-up.
⚠️ Safety
- Additive sedation and respiratory depression with opioids, z-drugs, and other CNS depressants.
- Older adults: higher risk of falls, confusion, and prolonged sedation. Use very low doses if a benzodiazepine is unavoidable.
- Hepatic impairment: if a benzodiazepine is essential, lorazepam is often chosen (glucuronidation); still use low doses.
- Alprazolam: high dependence potential. Avoid new regular prescribing from the on-call list.
- Triazolam (Halcion): Irish SmPC indication is short-term severe insomnia (generally up to 7–10 days), not daytime anxiety. Max 0.25 mg at night; start 0.125 mg if hypnotic-naive, elderly, or hepatic impairment. For sleep calls see Night Sedation.
- Document indication, dose, route, maximum daily dose, and review or stop date.
Based on
Related NICE guidance
NICENICE CG113 — Generalised anxiety disorder and panic disorder in adults: management (updated June 2020)
Full guidance on nice.org.uk. BetterCall is not endorsed by NICE.
Educational reference only. Medical disclaimer