Methylnaltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Drug reference
Oxazepam
Short-acting benzodiazepine (no active metabolites) · Anxiolytic
START
10–15 mg PO 3 times daily (elderly: 10 mg BID–TID)
TYPICAL MAX
120 mg/day (alcohol withdrawal); 60 mg/day anxiety
STOP IF
Dependence signs, falls, or significant sedation
WATCH
Falls, cognition (elderly), respiratory status, taper plan
CDSCO approvedATC N05BA04
KDIGO 2024 + manufacturer label
- ONSET
- 45min · absorption
- PEAK
- 2.5h · Tmax
- t½
- 10h · t½
- DURATION
- 5h · per dose
EXCRETION
Renal — glucuronide conjugate
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Avoid (cleft palate, neonatal withdrawal).
FDA category + note
Top interactionssee all 12 →
- MethylnaltrexoneSevereTextbookG&G 14e
- NalmefeneSevereTextbookG&G 14e
- NaloxoneSevereTextbookG&G 14e
- NaltrexoneSevereTextbookG&G 14e
Mechanism
Allosteric agonist at GABA-A receptor benzodiazepine site, potentiating chloride conductance; metabolised purely by glucuronidation (no oxidative metabolism), with no active metabolites — favoured in elderly and hepatic impairment.
Indications
Anxiety disorders (short-term)Anxiety associated with depression (short-term adjunct)Alcohol withdrawal (in elderly / hepatic impairment)
Dosing
- Adult
- 10–30 mg PO 3–4 times daily; alcohol withdrawal up to 120 mg/day. Short-term use only.
- Pediatric
- Not generally recommended.
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- Preferred benzodiazepine (no active metabolites); usual dose.
- Geriatric
- Preferred over long-acting BZDs; start 10 mg twice–thrice daily.
- Max dose
- 120 mg/day (alcohol withdrawal); 60 mg/day chronic anxiety (short-term)
Pharmacokinetics
Onset
~30–60 min (oral)
Peak effect
~2–3 h
Duration
~4–6 h (per dose)
Half-life
~5–15 h (no active metabolites)
Bioavailability
Well absorbed orally
Protein binding
~87%
Metabolism
Hepatic glucuronidation only (Phase II)
Excretion
Renal (glucuronide)
Contraindications
- Severe respiratory insufficiency / sleep apnoea
- Acute angle-closure glaucoma
- Myasthenia gravis
- Pregnancy/breastfeeding
- Hypersensitivity
Side effects
Common
DrowsinessDizzinessFatigueConfusion (elderly)
Serious
- Dependence/withdrawal
- Falls/fractures (elderly)
- Respiratory depression (with opioids/alcohol)
- Paradoxical agitation
Pregnancy & lactation
Pregnancy
Avoid (cleft palate, neonatal withdrawal).
Lactation
Avoid (low milk levels but cumulative effect).
Drug interactions
Nalmefene
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naloxone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Other Cns Depressants
Severe
Textbook
Typically fatal if combined in overdose.
Use with extreme caution; avoid if possible.
Source: G&G 14e
Alfentanil
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Benzhydrocodone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Buprenorphine
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Codeine
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Dextropropoxyphene
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Ask House about Oxazepam
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20