4.1.2.1 Acute anxiety state

ChoiceDrugDosage
1st choiceNon-drug treatment
2nd choiceDiazepam tablets 2mg, 5mgDose:
2mg three times daily increased if necessary to 15-20mg daily in divided doses; elderly (or debilitated) half adult dose

Prescribing Notes

  • The most appropriate first-line treatments for anxiety are self-help strategies, counselling and CBT. See resources e.g. ‘Good relaxation guide’ on the Patient Zone and the Choice and Medication website
  • 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)
  • New patients should not be put on a repeat prescription system and existing patients receiving an anxiolytic should be reviewed and offered the chance to stop. See 4.10c  and resources on the primary care intranet
  • Buspirone has little efficacy as an acute anxiolytic as clinical effect typically takes 2-4 weeks to achieve. However, it is only licensed for short term use, making its place in therapy unclear

Cautions

See cautions here.