Oxazepam is in the class of medication called Benzodiazepines. Similar to other Benzodiazepines, Oxazepam exerts its anxiolytic effect s by potentiating the effect of gamma-aminobutyric acid (GABA-A) receptor .Gamma-aminobutyric acid (GABA-A) is the chief inhibitory neurotransmitter of the central nervous system. Benzodizapines are commonly divided into three groups based upon half-life duration. Short- acting (half-life of less than 12 hours), intermediate- acting (half-life between 12-24 hours) and long-acting (half-life greater than 24 hours). Oxazepam is a short acting Benzodiazepine. Generally have few active metabolites do not accumulate with repeated doeses and demonstrate clearance that is largely unaffected by age and liver disease.
Oxazepam is absorbed at a slower rate compared to other benzodiazepines in the GI tract, highly lipophilic and highly protein bound (85-95%). Oxazepam is directly conjugated to an inactive, water-soluble glucronide metabolite that is excreted by the kidney. Therefore, these agents are not susceptible to CYP interactions and are less likely to accumulate in patients with CYP inhibition.
Absorption: almost completely
Protein binding: 86%to 99%
Half –life elimination: 2.8-5.7 hours.
Time to peak, serum: 2-4 hours
Excretion: urine
Administration:
Use treatment of anxiety; management of ethanol withdrawal, use unlabeled anticonvulsant in management of simple partial seizures; hypnotic.
Dosing:
Adult, anxiety: 10-30mg 3-4 times/day; ethanol withdrawal: oral: 15-30 mg 3-4 times/day;
Hypnotic: oral: 15-30mg
Geriatric Oral: anxiety 10mg 2-3 time /day ; increase gradually as needed to a total of 30-45mg/day. Dose titration should be slow to evaluate sensitivity.
Renal impairment Not dialyzed (0% to 5%).
Adverse Reactions Significant Frequency not defined.
Cardiovascular: syncope (rare), edema. Central nervous system: Drowsiness, ataxia, dizziness, vertigo, memory impairment, headache, paradoxical reactions (excitement, stimulation of effect), lethargy, amnesia, euphoria. Dermatology: rash. Endocrine& metabolic: decreased libido, menstrual irregularities. Genitourinary: incontinence. Hematologic: leukopenia, blood dyscrasias.hepatic: jaundice. Ocular: blurred vision, diplopia.
Miscellaneous: drug dependence concerns related to adverse effect:
Anterograde amnesia: benzodiazepines have been associated with anterograde amnesia.
CNS depression: may cause CNS depression, which may impair physical or mental abilities; patients
Must be cautioned about performing tasks which require mental alertness (e.g. operating machinery or driving)hypotension: May cause hypotension (rare):use with caution in patient with cardiovascular or cerebrovascular disease , or in patient who would not tolerate transient decrease in blood pressure.Paradoxical reactions: paradoxical reactions include hyperactive or aggressive behavior; have been reported with benzodiazepines, particularly in adolescent/ pediatric or psychiatric patients.
Disease –related concern:depression : use caution in patient with depression , particularly if suicidal risk may be present.
 Drug abuse: use with caution in patient with a history of drug abuse or acute alcoholism; potential for drug dependency exist .
Concurrent drug therapy issues:  CNS depressant /psychoactive medication: with caution in patients receiving other CNS depressants or psychoactive medication; effects with other sedative drugs or ethanol may be potentiated special population.  Debilitated patient: use with caution in debilitated patient.  Elderly: in older adults, Benzodiazepines increase the risk of cognition, delirium, falls, fractures, and motor vehicle accident. Benzodiazepines have been associated with falls and traumatic injury.
 Pediatric: safety and efficacy in established in pediatric patient <6 years of age: does has not been established between 6-12 years of age.
 Withdrawal: rebound or withdrawal symptoms may occur following abrupt discontinuation or large decreases in dose. Use caution when reducing dose or withdrawing therapy; decrease slowly and monitor withdrawal symptoms. Flumazenil may cause withdrawal in patients receiving long-term benzodiazepine therapy.


Drug interactions:
Alcohol, risk of c; monitor therapy, concomitant with these drugs may enhance CNS depression: Azelastin (nasal) ,Buprenorphine ,Droperidol , Hydroxyzine: Magnesium sulfate ,Methotrimeprazine ,Metyrosine,mirtazapine,paraldehyde, Ropinirol,Rotigotine, Selective serotonin Reuptake Inhibitors, Sodium Oxybate, zolpidem.
Fosphenytoin: may increase the serum concentration of Fosphenytoin.
Olanzapine may enhance the adverse /toxic effect of Clozapine.
Phenytoin: Benzodiazepines may increase the serum concentration of Phenytoin.
Pramipexole: CNS Depressant may enhance the sedative effect of pramipexole
Acetaminophen and acetylsalicylic acid may decrease the excretion rate of oxazepam which could result in a higher serum level.
Theophylline Derivative: may diminish the therapeutic effect of benzodiazepines.
Breast feeding considerations Drowsiness, lethargy, or weight loss in nursing infant have been observed in case reports following maternal use of some Benzodiazepines.