How Oxazepam (Serax) Is Used for Anxiety

The medication oxazepam (which is sold under the brand name Serax, among others) is used for short-term relief of anxiety, tension, agitation, and irritability. It's also used to treat anxiety associated with depression and alcohol withdrawal, and cocaine withdrawal.

Oxazepam is an older medication that was first marketed in 1965. Since it's been around so long, it's available almost exclusively as a generic drug—brand name versions like Serax are difficult or impossible to find. However, the generic versions of the medication should work as well as the prescription versions. Oxazepam works slowly compared to other benzodiazepine drugs.

How Oxazepam Works

Like other benzodiazepines, oxazepam affects gamma-aminobutyric acid (GABA) receptors in the brain. The result of this is reduced excitability of the central nervous system. This induces feelings of relaxation and reduced anxiety.

These medications are fast-acting, which is why they are used to treat acute anxiety symptoms.

Oxazepam Side Effects

As with all prescription drugs, oxazepam has potential side effects, some of which may be serious.

If this is too big a problem or lasts for more than a few days, talk to your doctor about reducing your dosage (which almost always solves the problem).

Less common side effects of oxazepam include:

• Headache
• Tremor
• Swelling
• Dizziness or lightheadedness
• Vertigo (trouble with balance or the sensation that the room is spinning)
• Slurred speech
• Nausea
• Changes in your sex drive

Oxazepam Precautions

When starting oxazepam, you shouldn't drive or perform any other potentially hazardous activities until you know how you will react to the medication (and even then you should practice caution).

Combining oxazepam with alcohol, opioid medications, or other substances that depress the central nervous system could result in serious complications, even death due to suppression of the breathing center in the brain.

People with a history of psychosis should not be prescribed oxazepam. Likewise, the medication should be avoided in anyone with a history of addictive behavior. An exception, of course, is when the medication is used for alcohol withdrawal symptoms.

Benzodiazepines, including oxazepam, should also be avoided entirely in the elderly and in people with dementia.

Safety Compared to Other Benzodiazepines

Oxazepam is significantly safer in terms of toxicity than either Librium (chlordiazepoxide) or Valium (diazepam), two other benzodiazepines.

Commonly used doses of oxazepam are less likely than equivalent doses of other benzodiazepines to cause dangerous side effects.

During Pregnancy and Nursing

Benzodiazepines are associated with pregnancy outcomes, including decreased gestational age and birth weight. Let your doctor know if you are pregnant, planning to become pregnant, or are breastfeeding.

Oxazepam will pass through into your breast milk. Nursing mothers should not use this medication unless you and your doctor decide the expected benefit of the drug outweighs the risk to the baby.

Dependence and Addiction

Benzodiazepines are categorized as a Schedule IV medication, which means that they have the potential to cause psychological and physical dependence. Because of this, benzodiazepines such as oxazepam are usually only prescribed for around two to four weeks. 

Taking oxazepam for longer periods increases the risk of dependence. People can also develop a tolerance to the medication, which means that they need to take more in order to achieve the same effects.

Oxazepam Withdrawal

Abrupt discontinuation of oxazepam or any other benzodiazepine, especially after extended therapy, can cause mild to severe withdrawal effects. Symptoms of withdrawal include:

• Confusion
• Hallucinations
• Sensitivity to light and sound
• Insomnia
• Irritability
• Muscle cramps
• Nausea and vomiting
• Increased anxiety 
• Sweating
• Rapid heart rate
• Tremors
• Seizures

For those who have been using oxazepam for some time, withdrawal can be severe and even fatal.

Because of this problem, you should try to use the medication for as little time as possible and discuss with your doctor how to taper your dosage off gradually. Never discontinue the drug suddenly.

Summary

Oxazepam can be a useful medication for the acute treatment of anxiety or alcohol withdrawal, and since it may have fewer side effects than some of the other benzodiazepines, may be a good choice in certain circumstances.

At the same time, it's essential to understand that benzodiazepines are strong medications with a potential for abuse and serious side effects, both due to the side effects of the drug alone or in combination with other drugs, and due to withdrawal side effects when it is discontinued.