Q.7 Benzodiazepines and Abnormal Liver Functions

Q.7. 40 year old male with history of major depression disorder presents for evaluation and management of recent increase in anxiety. 
Laboratory workup revealed abnormal liver function tests, normal TSH, normal renal function test and normal CBC with diff. After detailed evaluation you decided to add benzodiazepine for anxiety management.

Which of the following benzodiazepine should be avoided in this patient ?
(a) Temapepam
(b) Lorazepam
(c) Oxazepam
(d) Clonazepam

This questions is tricky for this will test following two important concepts:-

  • Which benzodiazepines are indicated for anxiety, and

  • Which benzodiazepines should be avoided in patients with abnormal liver functions. 


Answer: –> D (and A)



  • Temazepam is not indicated for treatment of anxiety disorder. Temazepam is indicated for the short-term treatment of insomnia (generally 7 to 10 days). 
  • Benzodiazepines of choice in patients with abnormal liver functions:- OTL (Oxazepam, Temazepam and Lorazepam). The pneumonic used is OTL = Out The Liver.
  • Note that these three benzodiazepines have no active metabolites and half life will not change with underlying liver diseases. 
  • Clonazepam have it’s active metabolites and half life will change (with resultant prolonged duration of effects) with underlying liver diseases. 

Hence based on above information, Clonazepam and Temazepam are not good options; but among these medications Clonazepam is the one to be avoided.


Please do post your questions or comments below. 

Dr. Harvinder Singh, M.D. (Admin)

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