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'''Oxazepam''' (also known as '''Serax''', '''Ceresta''') is a short-to-intermediate-acting benzodiazepine. Oxazepam is used for the treatment of anxiety<ref>Janecek, James; Vestre, Norris D.; Schiele, Burtrum C.; Zimmermann, Robert (1966). "Oxazepam in the treatment of anxiety states: A controlled study". Journal of Psychiatric Research. 4 (3): 199–206. doi:10.1016/0022-3956(66)90007-0. ISSN 0022-3956. PMID 20034170.</ref> and insomnia and in the control of symptoms of alcohol withdrawal syndrome.
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{{headerpanel|{{DepressantOD|benzodiazepines}}}}
{{SummarySheet}}
Oxazepam (also known as Serax) is a [[Depressant|depressant]] substance of the benzodiazepine class. It is used mainly in the treatment of anxiety, insomnia, and [[Alcohol|alcohol]] withdrawals. It's charasteristic effects include [[Sedation|sedation]], [[Anxiety_suppression|anxiety suppression]], [[Disinhibition|disinhibition]], [[Muscle_relaxation|muscle relaxation]] and [[Physical_euphoria|physical euphoria]].


It is a metabolite of diazepam, prazepam, and temazepam,<ref>"Oxazepam (IARC Summary & Evaluation, Volume 66, 1996)". IARC.</ref> and has moderate amnesic, anxiolytic, anticonvulsant, hypnotic, sedative, and skeletal muscle relaxant properties compared to other benzodiazepines.<ref>Mandrioli R, Mercolini L, Raggi MA (October 2008). "Benzodiazepine metabolism: an analytical perspective". Curr. Drug Metab. 9 (8): 827–44. doi:10.2174/138920008786049258. PMID 18855614.</ref> It was patented in 1962 and approved for medical use in 1964.<ref>Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 536. ISBN 9783527607495.</ref>
Oxazepam has the slowest onset action of all of the common benzodiazepines, and a half-life of around 6-9 hours.


'''Medical uses'''
It is sold under the brand names Serax, Ceresta, Novalona when combined with hyoscine and Pausafrent T when combined with alanine.
It is an intermediate-acting benzodiazepine with a slow onset of action,<ref>Galanter, Marc; Kleber, Herbert D. (1 July 2008). The American Psychiatric Publishing Textbook of Substance Abuse Treatment (4th ed.). United States of America: American Psychiatric Publishing Inc. p. 216. ISBN 978-1-58562-276-4.</ref> so it is usually prescribed to individuals who have trouble staying asleep, rather than falling asleep. It is commonly prescribed for anxiety disorders with associated tension, irritability, and agitation. It is also prescribed for drug and alcohol withdrawal, and for anxiety associated with depression. Physicians may use oxazepam outside its approved indications to treat social phobia, post-traumatic stress disorder, insomnia, premenstrual syndrome, and other conditions.


'''Side effects'''
{{SubstanceBox
The side effects of oxazepam are similar to those of other benzodiazepines, and may include dizziness, drowsiness, headache, memory impairment, paradoxical excitement, and anterograde amnesia, but does not affect transient global amnesia. Side effects due to rapid decrease in dose or abrupt withdrawal from oxazepam may include abdominal and muscle cramps, convulsions, depression, inability to fall asleep or stay asleep, sweating, tremors, or vomiting.<ref>"Oxazepam Uses, Side Effects & Warnings - Drugs.com". drugs.com.</ref>


'''Interactions'''
    <!-- Special Parameters -->
As oxazepam is an active metabolite of diazepam, an overlap in possible interactions is likely with other drugs or food, with exception of the pharmacokinetic CYP450 interactions (e.g. with cimetidine). Precautions and following the prescription are required when taking oxazepam (or other benzodiazepines) in combinations with antidepressant medication (SSRIs such as fluoxetine, sertraline, and paroxetine, or multiple reuptake inhibitors such as bupropion, duloxetine, or venlafaxine), potent painkillers (opioids, e.g. morphine, oxycodone or methadone). Concurrent use of these medicines (as well as other benzodiazepines) can interact in a way that is difficult to predict. Drinking alcohol when taking oxazepam is not recommended. Concomitant use of oxazepam and alcohol can lead to increased sedation, severe problems with coordination (ataxia), decreased muscle tone, and in severe cases or in predisposed patients, even to life-threatening intoxications with respiratory depression, coma, and collapse. There is a risk of blood circulation collapse, possibly the same condition as blood circulation syncope, when oxazepam is used in combination with quetiapine, an antipsychotic.
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'''Pharmacology'''
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Oxazepam is an intermediate-acting benzodiazepine of the 3-hydroxy family; it acts on benzodiazepine receptors, resulting in increased effect of GABA to the GABAA receptor which results in inhibitory effects on the central nervous system.<ref>Skerritt JH; Johnston GA. (May 6, 1983). "Enhancement of GABA binding by benzodiazepines and related anxiolytics". Eur J Pharmacol. 89 (3–4): 193–8. doi:10.1016/0014-2999(83)90494-6. PMID 6135616.</ref> The half-life of oxazepam is between 6 and 9 hours.<ref>Sonne, J; Boesgaard, S; Poulsen, H E; Loft, S; Hansen, J M; Døssing, M; Andreasen, F (November 1990). "Pharmacokinetics and pharmacodynamics of oxazepam and metabolism of paracetamol in severe hypothyroidism". British Journal of Clinical Pharmacology. 30 (5): 737–742. doi:10.1111/j.1365-2125.1990.tb03844.x. PMC 1368175. PMID 2271373.</ref> It has been shown to suppress cortisol levels. <ref>Christensen P; Lolk A; Gram LF; Kragh-Sørensen P. (1992). "Benzodiazepine-induced sedation and cortisol suppression. A placebo-controlled comparison of oxazepam and nitrazepam in healthy male volunteers". Psychopharmacology. 106 (4): 511–6. doi:10.1007/BF02244823. PMID 1349754. S2CID 29331503.</ref> Oxazepam is the most slowly absorbed and has the slowest onset of action of all the common benzodiazepines according to one British study. <ref>Serfaty M, Masterton G (1993). "Fatal poisonings attributed to benzodiazepines in Britain during the 1980s". Br J Psychiatry. 163 (3): 386–93. doi:10.1192/bjp.163.3.386. PMID 8104653. S2CID 46001278.</ref>
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Oxazepam is an active metabolite formed during the breakdown of diazepam, nordazepam, and certain similar drugs. It may be safer than many other benzodiazepines in patients with impaired liver function because it does not require hepatic oxidation, but rather, it is simply metabolized by glucuronidation, so oxazepam is less likely to accumulate and cause adverse reactions in the elderly or people with liver disease. Oxazepam is similar to lorazepam in this respect. Preferential storage of oxazepam occurs in some organs, including the heart of the neonate. Absorption by any administered route and the risk of accumulation is significantly increased in the neonate, and withdrawal of oxazepam during pregnancy and breast feeding is recommended, as oxazepam is excreted in breast milk.<ref>Oxazepam is an active metabolite formed during the breakdown of diazepam, nordazepam, and certain similar drugs. It may be safer than many other benzodiazepines in patients with impaired liver function because it does not require hepatic oxidation, but rather, it is simply metabolized by glucuronidation, so oxazepam is less likely to accumulate and cause adverse reactions in the elderly or people with liver disease. Oxazepam is similar to lorazepam in this respect.[30] Preferential storage of oxazepam occurs in some organs, including the heart of the neonate. Absorption by any administered route and the risk of accumulation is significantly increased in the neonate, and withdrawal of oxazepam during pregnancy and breast feeding is recommended, as oxazepam is excreted in breast milk.</ref>
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[[Category:Approval]]
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    <!-- Nomenclature -->
    |NameCommon=[[common name::Oxazepam]], [[common name::Serax]], [[common name::Ceresta]]
    |NameSubstitution=Oxazepam
    |NameSystematic=(RS)-7-Chlor-3-hydroxy-5-phenyl-2,3-dihydro-1H-1,4-benzodiazepin-2
 
    <!-- Class Membership -->
    |EffectClass=[[Depressant]]
    |ChemicalClass=[[Benzodiazepine]]
 
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==Subjective effects==
{{Preamble/SubjectiveEffects}}
{{effects/base
 
|{{effects/physical|
 
*'''[[Effect::Sedation]]''' - In terms of energy level alterations, this drug is considerably unique in that it tends to be notably less sedating and less inebriating than other classical or standard [[benzodiazepines]] such as [[alprazolam]], [[clonazepam]], and [[lorazepam]]. In some sense, it may be seen by many users as more “relaxing” in terms of description rather than being thoroughly “sedating” in average doses (10 - 15mg). However, at sufficient enough doses sedation does become a salient and unavoidable effect at a certain point. Therefore, presumably at stronger doses this causes users to feel extreme somnolence, forcing them to sit down as they tend to generally feel as if they are constantly on the verge of passing out instead of being physically mobile or consciously alert. This component increases proportional to dosage and eventually becomes powerful enough to force a person into complete unconsciousness.
*'''[[Effect::Muscle relaxation]]''' - In comparison to [[alprazolam]] (Xanax), Oxazepam results in a greater degree of muscle relaxation.
*'''[[Effect::Motor control loss]]'''
*'''[[Effect::Respiratory depression]]'''
*'''[[Effect::Dizziness]]''' - This symptom is usually much less prevalent compared to typical, (“heavier”) benzodiazepines like clonazepam or lorazepam.
*'''[[Effect::Seizure suppression]]'''
*'''[[Effect::Physical euphoria]]'''
 
}}
{{effects/visual|
 
*'''[[Effect::Visual acuity suppression]]'''
 
}}
{{effects/paradoxical|
 
Paradoxical reactions to [[benzodiazepines]] such as increased seizures (in epileptics), aggression, increased anxiety, violent behavior, loss of impulse control, irritability and suicidal behavior sometimes occur (although they are rare in the general population, with an incidence rate below 1%).<ref>{{cite journal | vauthors=((Saïas, T.)), ((Gallarda, T.)) | journal=L’Encephale | title=[Paradoxical aggressive reactions to benzodiazepine use: a review] | volume=34 | issue=4 | pages=330–336 | date= September 2008 | issn=0013-7006 | doi=10.1016/j.encep.2007.05.005}}</ref><ref>{{cite journal | vauthors=((Paton, C.)) | journal=Psychiatric Bulletin | title=Benzodiazepines and disinhibition: a review | volume=26 | issue=12 | pages=460–462 | date= December 2002 | url=https://www.cambridge.org/core/journals/psychiatric-bulletin/article/benzodiazepines-and-disinhibition-a-review/421AF197362B55EDF004700452BF3BC6 | issn=0955-6036 | doi=10.1192/pb.26.12.460}}</ref><p></p>
These paradoxical effects occur with greater frequency in recreational abusers, individuals with mental disorders, children, and patients on high-dosage regimes.<ref>{{cite journal | vauthors=((Bond, A. J.)) | journal=CNS Drugs | title=Drug- Induced Behavioural Disinhibition | volume=9 | issue=1 | pages=41–57 | date=1 January 1998 | url=https://doi.org/10.2165/00023210-199809010-00005 | issn=1179-1934 | doi=10.2165/00023210-199809010-00005}}</ref><ref>{{cite journal | vauthors=((Drummer, O. H.)) | journal=Forensic Science Review | title=Benzodiazepines - Effects on Human Performance and Behavior | volume=14 | issue=1–2 | pages=1–14 | date= February 2002 | issn=1042-7201}}</ref>
 
}}
|{{effects/cognitive|
The most prominent of these cognitive effects generally include:
*'''[[Effect::Anxiety suppression]]''' - Less pronounced than with [[alprazolam]], especially in regards to panic attacks but may have an upper-hand on many other benzodiazepines in this department due to a very lightly euphoric and subtle, but not uncommon comfortable sense of well-being that is not usually associated with other benzodiazepines.
*'''[[Effect::Disinhibition]]'''
*'''[[Effect::Delusions|Delusions of sobriety]]''' - This is the false belief that one is perfectly sober despite obvious evidence to the contrary such as severe cognitive impairment and an inability to fully communicate with others. It most commonly occurs at heavy dosages.
*'''[[Effect::Thought deceleration]]'''
*'''[[Effect::Analysis suppression]]'''
*'''[[Effect::Amnesia]]'''
*'''[[Effect::Memory suppression]]''' - Oxazepam primarily suppresses short-term memory, resulting in forgetfulness, and/or disorganized behaviors.
*'''[[Effect::Increased music appreciation]]'''
*'''[[Effect::Compulsive redosing]]'''
*'''[[Effect::Emotion suppression]]'''
*'''[[Effect::Motivation suppression]]'''
*'''[[Effect::Language suppression]]'''
 
}}
{{effects/aftereffects|
 
*'''[[Effect::Anxiety|Rebound anxiety]]''' - Rebound anxiety is a commonly observed effect with [[anxiety suppression|anxiety relieving]] substances like [[benzodiazepines]]. It typically corresponds to the total duration spent under the substance's influence along with the total amount consumed in a given period, an effect which can easily lend itself to cycles of dependence and addiction.
*'''[[Effect::Dream potentiation]]'''<ref>{{cite journal | vauthors=((Goyal, S.)) | journal=Canadian Medical Association Journal | title=Drugs and dreams | volume=102 | issue=5 | pages=524 | date=14 March 1970 | issn=0008-4409}}</ref> or '''[[Effect::Dream suppression]]'''
*'''[[Effect::Sleepiness|Residual sleepiness]]''' - While benzodiazepines can be used as an effective [[hypnotic|sleep-inducing]] aid, their effects may persist into the morning afterward, which may lead users to feeling "groggy" or "dull" for up to a few hours.
*'''[[Effect::Thought deceleration]]'''
*'''[[Effect::Thought disorganization]]'''
*'''[[Effect::Irritability]]'''
*'''[[Effect::Memory impairment]]'''
*'''[[Effect::Headaches]]'''
 
}}
}}
 
==Toxicity and harm potential==
Oxazepam has a [[Toxicity::low toxicity]] relative to dose.  However, it is [[Toxicity::potentially [[respiratory depression|lethal]] when mixed with [[depressants]] like [[alcohol]] or [[opioids]]]].
 
It is strongly recommended that one use [[responsible drug use|harm reduction practices]], such as [[volumetric dosing]], when using this substance to ensure the administration of the intended dose.
===Overdose===
Oxazepam overdose may occur when it is taken in excessively high doses or combined with other depressants.
Symptoms of a benzodiazepine overdose include respiratory depression or arrest, slurred speech, drowsiness, confusion, delirium, vomiting and losing consciousness. Overdose may lead to death or deep coma.
===Tolerance and addiction potential===
Strong Physical and Psychological addiction potential
===Dangerous interactions===
Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be safe in low doses of each but still increase the potential risk of death. [https://www.google.com/ Independent research] should always be done to ensure that a combination of two or more substances is safe before= consumption.
 
*'''[[DangerousInteraction::Depressants|Depressants]]''' (''[[1,4-Butanediol]], [[2-methyl-2-butanol]], [[alcohol]], [[barbiturates]], [[GHB]]/[[GBL]], [[methaqualone]], [[opioids]]'') - This combination can result in dangerous or even fatal levels of [[respiratory depression]]. These substances potentiate the [[muscle relaxation]], [[sedation]] and [[amnesia]] caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the [[recovery position]] or have a friend move them into it.
*'''[[DangerousInteraction::Dissociatives|Dissociatives]]''' - This combination can result in an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the [[recovery position]] or have a friend move them into it.
*'''[[DangerousInteraction::Stimulants|Stimulants]]''' -  It is dangerous to combine benzodiazepines with [[stimulant]]s due to the risk of excessive intoxication. Stimulants decrease the [[sedation|sedative]] effect of benzodiazepines, which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of benzodiazepines will be significantly increased, leading to intensified [[disinhibition]] as well as [[benzodiazepine#Subjective effects|other effects]]. If combined, one should strictly limit themselves to only dosing a certain amount of benzodiazepines per hour. This combination can also potentially result in severe dehydration if hydration is not monitored.
 
==Legal status==
Internationally, oxazpeam is a Schedule IV controlled drug under the Convention on Psychotropic Substances.<ref>International Narcotics Control Board (2003) | http://infoespai.org/wp-content/uploads/2014/12/green.pdf</ref> Bromazepam is regulated in most countries as a prescription drug.
 
==See also==
*[[Responsible use]]
 
==External links==
(List along order below)
* [https://de.wikipedia.org/wiki/Oxazepam (Wikipedia)]
* [https://www.drugs.com/tips/oxazepam-patient-tips (Drugs.com)]
 
==References==
<references />
 
[[Category:Psychoactive substance]][[Category:Proofread]][[Category:Approval]]
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