4.1.2.1 Acute anxiety state

ChoiceDrugDosage
1st choiceNon-drug treatment
2nd choiceDiazepam tablets 2mg, 5mg, 10mg; oral solution 2mg/5ml

Dose:
2mg three times daily increased if necessary to 15-20mg daily in divided doses; elderly (or debilitated) half adult dose

Prescribing Notes

  • Benzodiazepines are indicated for the short-term relief (2-4 weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress. The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate and unsuitable.
  • Benzodiazepine anxiolytics should not be used as sole treatment for chronic anxiety, and they are not appropriate for treating depression or chronic psychosis.
  • Treatment should be limited to the lowest possible dose for the shortest possible time.
  • Diazepam has a medium duration of action and rapid onset. It is the recommended daytime anxiolytic (and issued as pre-medication before surgery and other procedures. See BNF).
  • Beta-blockers (e.g. propranolol) are useful for reducing autonomic symptoms, such as palpitations and tremor in performance anxiety (e.g. public speaking or a musical performance). See BNF.

Cautions

See cautions here.