Short answer: Clorazepate (Tranxene) is a long-acting benzodiazepine used for anxiety, as an add-on treatment for partial seizures, and for alcohol withdrawal. It is a Schedule IV prescription medicine. It is converted in the stomach to desmethyldiazepam, which lasts for days.
Key takeaways
- What it is: Clorazepate is a long-acting benzodiazepine (prodrug) and a Schedule IV controlled substance in the US.
- Main uses: Anxiety; seizures (adjunct); alcohol withdrawal.
- Timing: effects start in within 1 hour and last long; active metabolite lasts days.
- Most dangerous mix: Opioids (oxycodone, hydrocodone, fentanyl, heroin), which can cause profound sedation, slowed breathing, coma, death.
- Naloxone: it does not reverse this drug, but give it whenever opioids could be involved.
- Dependence risk: High.
- Legal route: only with a prescription from a DEA-registered clinician, filled by a licensed pharmacy.
What is clorazepate?
Clorazepate treats anxiety, adds to other antiseizure medicines for partial seizures, and eases acute alcohol withdrawal.
It is a prodrug: stomach acid converts it into desmethyldiazepam, the same long-lasting metabolite produced by diazepam.
Quick facts
| Fact | Clorazepate |
|---|---|
| Generic name | Clorazepate dipotassium |
| Brand names | Tranxene T-Tab |
| Drug class | Long-acting benzodiazepine (prodrug) |
| US legal status | Schedule IV, prescription only |
| Approved uses | Anxiety disorders; add-on therapy for partial seizures; acute alcohol withdrawal |
| Forms | Tablets (3.75, 7.5, 15 mg) |
| Onset | Within 1 hour |
| Active metabolite | Desmethyldiazepam (nordiazepam), half-life 40 to 50 hours or more |
How long does clorazepate last?
- Starts working: Within 1 hour
- Effects last: Long; active metabolite lasts days
Its metabolite can be detected for a week or more after regular use.
Timing varies with the dose, the form, how it is taken, liver and kidney function, age, and other drugs taken at the same time.
What are the biggest risks of clorazepate?
The FDA requires boxed warnings, its strongest, on clorazepate products, including:
- Use with opioids can cause profound sedation, slowed breathing, coma, and death.
- Abuse, misuse, and addiction, which can lead to overdose and death, especially with alcohol, opioids, or other drugs.
- Physical dependence: stopping suddenly or reducing the dose quickly can cause life-threatening withdrawal reactions, including seizures.
Common side effects include drowsiness, dizziness, and stomach upset.
Seizures on stopping: in people with epilepsy, stopping suddenly can trigger frequent seizures or status epilepticus.
What should you never mix with clorazepate?
| Combined with | What happens | Label guidance |
|---|---|---|
| Opioids (oxycodone, hydrocodone, fentanyl, heroin) | Profound sedation, slowed breathing, coma, death | Boxed warning; avoid unless no alternative |
| Alcohol | Deeper sedation, blackouts, slowed breathing | Avoid |
| Other sedatives (sleep medicines, gabapentinoids, muscle relaxants, antihistamines) | Additive drowsiness and impaired coordination | Use caution |
| Other antiseizure medicines | Additive sedation | Monitor |
Check any combination with the DoseUses combination checker or ask a pharmacist.
What are the signs of a clorazepate overdose, and what should you do?
Clorazepate overdose causes deep drowsiness, confusion, poor coordination, slowed reflexes, and coma. With opioids or alcohol, breathing can stop.
If someone may have overdosed
- Call 911 if the person is unresponsive, hard to wake, or breathing slowly.
- For advice when the person is awake and stable, call Poison Help at 1-800-222-1222 (US, free, 24 hours).
- If opioids could be involved, including pills not from a pharmacy, give naloxone if you have it. Naloxone does not reverse clorazepate, but it will not harm the person.
- Stay with the person and place them on their side if they are drowsy or vomiting.
What is clorazepate withdrawal like, and how long does it last?
People who take clorazepate regularly, even as prescribed, can become physically dependent within weeks. Its long-lasting metabolite means withdrawal often begins several days after the last dose.
- Days 2 to 7Symptoms beginRebound anxiety, insomnia, restlessness, sweating, and tremor.
- Weeks 1 to 4Acute withdrawalPanic, irritability, muscle pain, nausea, sensitivity to light and sound, and in severe cases seizures or delirium.
- MonthsProtracted symptoms in some peopleA minority have lingering anxiety, poor sleep, low mood, or tingling that can last weeks to more than 12 months.
See the withdrawal timelines and the full clorazepate withdrawal guide.
Is clorazepate legal?
In the United States, clorazepate is a Schedule IV controlled substance. The only legal way to get it is with a prescription from a clinician registered with the Drug Enforcement Administration (DEA), filled by a licensed pharmacy. Depending on state law, that can be a physician, nurse practitioner, or physician assistant.
- Refills: a Schedule IV prescription can be refilled up to five times within six months of the date it was written. After that, a new prescription is needed.
- Telehealth: federal flexibilities let DEA-registered clinicians prescribe Schedule II to V medicines after a telemedicine visit, without a prior in-person exam, through December 31, 2026. A permanent DEA rule was under final review in late 2026. State rules can be stricter.
- Monitoring: prescribers and pharmacists in most states check a prescription drug monitoring program, a database of controlled-substance prescriptions, before prescribing or dispensing.
Outside the United States
| Country | Status |
|---|---|
| United Kingdom | Class C; prescription only |
| Canada | Schedule IV of the Controlled Drugs and Substances Act |
| Australia | Schedule 4 prescription medicine |
| International | Schedule IV of the 1971 Convention on Psychotropic Substances |
Frequently asked questions about clorazepate
Is clorazepate the same as diazepam?
No, but both are converted to the same long-lasting metabolite, desmethyldiazepam.
Is clorazepate used for seizures?
Yes, as an add-on treatment for partial seizures.
How long does clorazepate stay in your system?
Its metabolite can be detected for a week or more after regular use.
Is clorazepate addictive?
It can cause dependence and addiction like other benzodiazepines.
Can clorazepate be stopped suddenly?
No. It should be tapered, especially in people with epilepsy.
Sources
- Tranxene (clorazepate) prescription information, DailyMed, US National Library of Medicine.
- FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines, US Food and Drug Administration, 2016.
- FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class, US Food and Drug Administration, 2020.
- Joint Clinical Practice Guideline on Benzodiazepine Tapering, American Society of Addiction Medicine, 2025.
- Controlled Substance Schedules, DEA Diversion Control Division.
- 21 CFR 1306.22, Refilling of prescriptions (Schedules III and IV), Electronic Code of Federal Regulations.
- Prescribing controlled substances via telehealth, US Department of Health and Human Services.
- BeSafeRx: Your Source for Online Pharmacy Information, US Food and Drug Administration.
This guide summarizes the sourced DoseUses Clorazepate profile, written from FDA labels, DEA rules, and federal health agencies. It is educational and is not medical advice. Last updated October 5, 2026.
