Alternatives To Benzodiazepines

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Paul Coelho, MD

For sleep, anxiety, and panic attack.

MODIFIED FROM TIP 54 SAMHSA: BENZODIAZEPINE ALTERNATIVES

Alternatives to Benzodiazepines for Sleep
1. Trazodone: 50mg – 100mg po QHS
2. Mirtazapine: 15mg po QHS
3. Amitriptyline: 10mg po QHS
4. Nortriptyline: 25mg po QHS
5. Trimipramine 25mg po QHS
6. Doxepin: 10mg – 25mg po QHS
7. Cyclobenzaprine: 10mg po QHS
8. Benadryl: 50mg po QHS
9. Melatonin: 5mg po QHS
10. Hydroxyzine: 2550mg po QHS
11. Tizanidine: 4mg po QHS
Alternatives to Benzodiazepines for Anxiety
1. Citalopram: 20mg po QD
2. Pregabalin: Escalating dose over 8wks to 450mg po QD.
3. Gabapentin: Escalating dose over 8wks to 2700mg po QD.
4. Lamotrigine: (PTSD) Escalating dose over 8wks to 500mg po QD
5. Buspirone: 7.5mg po BID increase by 5mg Q 3D, to 15mg po BID. Maximum daily dose 60mg.
6. Clonidine 0.1mg po can repeat x 1 (Caution with BP)
7. Hydroxyzine: 2550mg po
8. Sertraline: 25mg QD escalating to 50po QD after 1wk
Alternatives to Benzodiazepines for Panic Attacks
Acute: Clonidine 0.1mg po can repeat x 1 (Caution with BP)
Acute : Propranolol 10mg can repeat x 1 (Caution with BP)
Acute: Atenolol 25mg po x 1 (Caution with BP)
Valproic Acid: 500mg to 2000mg Escalating dose over 8wks.

Prophylaxis for Panic Attacks
Propranolol 10mg po TID.  (Caution with BP)
Atenolol 25mg po BID (Caution with BP)

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