[9], The elderly are especially susceptible to increased risk of harm from motor impairments and drug accumulation side effects. Test results may vary depending on your age, gender, health history, and other things. A patient taking alprazolam, clonazepam, flurazepam, or lorazepam will not test positive for benzodiazepine metabolites on an Aegis report. Urinary analyses of the metabolite 7-aminoclonazepam (7-AC) can be helpful in monitoring drug abuse and in the context of suspected drug-facilitated sexual assaults (DFSA). Do not stop using clonazepam without asking your doctor. Copyright 1996-2023 Cerner Multum, Inc. 237 0 obj <>stream 8600 Rockville Pike 7-Aminoflunitrazepam. [117], Benzodiazepines, including clonazepam, bind to mouse glial cell membranes with high affinity. Using LC-MS/MS, clonazepam was detected in 297 traffic cases, 92 criminal cases (perpetrators or victims of a crime) and in 140 postmortem cases. Unable to load your collection due to an error, Unable to load your delegates due to an error. Last updated on Dec 13, 2021. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This benzodiazepine was chosen because it forms one major metabolite, 7-aminoclonazepam which is specific for that drug. porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system). As a major metabolite, 7-aminoclonazepam may be used to monitor use of the parent drug, clonazepam. In addition, it is frequently used to treat drug addicts and is itself a popular drug of abuse. Epub 2012 Oct 16. Snyder ML, Fantz CR, Melanson S. Immunoassay-based drug tests are inadequately sensitive for medication compliance monitoring in patients treated for chronic pain. Copyright 2023 Aegis Sciences Corporation, https://www.aegislabs.com/resources/clinical-reference-guide/, Parent drug may not be present in all results; only one marker is required for a positive result, If parent drug is present in urine with no alpha-OH-alprazolam present, please consult the Aegis Clinical Team as multiple clinical factors may be pertinent to result interpretation, and this does not always indicate aberrant patient behavior, Nordiazepam, Temazepam, and/or Oxazepam may be present, Only one marker is required for a positive result, Presence of other benzodiazepine markers may indicate ingestion of other benzodiazepines, Only Temazepam and/or Oxazepam should be present. [75][76] One-third of individuals treated with benzodiazepines for longer than four weeks develop a dependence on the drug and experience a withdrawal syndrome upon dose reduction. It is important to use the correct nomenclature for chemical substances as although experts would understand that 7-aminoclonazolam and 8-aminoclonazolam are actually the same molecule with the amino group in the same position, this difference may cause confusion to lay people such as judges, lawyers and juries. %PDF-1.4 % government site. Please see below for a list of drugs which may cause a false positive for benzodiazepines on POCT.6,11-15 Please refer to the package insert that came with the POCT device being used or contact the manufacturer for more information regarding which drugs may cause false positive results as this information may differ among devices and manufacturers. [22] Clonazepam is mainly prescribed for the acute management of epilepsies. However, negative results do not necessarily indicate the absence of the drug in question. [12][13] It is available as a generic medication. [81][82][83] Sudden withdrawal may also induce the potentially life-threatening condition, status epilepticus. Intentional dilution may occur either with intentional ingestion of copious amounts of water or by adding water to the urine sample from the restroom sink or toilet. CLO was not detected in any of the samples. 7-Aminoclonazepam 100 ug/mL in Acetonitrile | Certified Reference Material This certified Snap-N-Spike solution is suitable for use as a starting material in calibrators and controls for numerous GC/MS or LC/MS applications in forensic analysis, clinical toxicology and urine drug testing. Keep the medication in a place where others cannot get to it. In addition, it is frequently used to treat drug addicts and is itself a popular drug of abuse. Providers should use their independent medical judgment based on the clinical needs of the patient when making determinations of who to test, what medications to test, testing frequency, and the type of testing to conduct. It produces pharmacological effects (depression, amnesia) similar to other compounds from the same therapeutic class, and in combination with alcohol, its CNS-depressant action can be significantly potentiated. 1,2 This product is intended for research and forensic applications. Azole antifungals, such as ketoconazole, may inhibit the metabolism of clonazepam. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2010;67:1344-50.14. Unable to load your collection due to an error, Unable to load your delegates due to an error. Kempf J, Wuske T, Schubert R, Weinmann W. Pre-analytical stability of selected benzodiazepines on a polymeric oral fluid sampling device. We investigated the effects of ACZP on the GABA(A) receptor-mediated currents (I(GABA)) in neurons from the nucleus reticularis thalami (NRT) of the . Please enable it to take advantage of the complete set of features! Disclaimer. Use caution to avoid falling or accidental injury. One hundred samples were presumptive-positive for 7AC and/or CLON. Kirsh KL, Heit HA, Huskey A, et al. The initial test should include the prescribed drug, amphetamines, opioids, cocaine, benzodiazepines, oxycodone, barbiturates, methadone, fentanyl, and marijuana. The assay can be run on miscellaneous pills, powders and liquids to identify a suspected ingested substance that a patient might arrive with at the hospital, and in this case, only the GC/MS assay is performed. National Library of Medicine J Anal Toxicol. [30][31] Bruxism also responds to clonazepam in the short-term. Read the medication guide or patient instructions provided with each medication. 7-Aminoclonazepam | C15H12ClN3O - PubChem Apologies, we are having some trouble retrieving data from our servers. [124][8], Clonazepam is lipid-soluble, rapidly crosses the bloodbrain barrier, and penetrates the placenta. J Anal Toxicol. Store at room temperature away from moisture, heat, and light. Standard curves for CLO (500-4000 pg x mL(-1)) and 7-ACLO (50-2000 pg x mL(-1)) were prepared by spiking aliquots of negative urine. The characterization of human urine for specimen validity determination in workplace drug testing: a review. Do not drink alcohol. Some withdrawal symptoms may last up to 12 months or longer after stopping this medicine suddenly. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use clonazepam only for the indication prescribed. bruising, or feeling dizzy. Clonazepam, sold under the brand names Klonopin and Rivotril, is a medication used to prevent and treat seizures, panic disorder, anxiety disorders, and the movement disorder known as akathisia. 0000001741 00000 n Therapeutic medicine levels Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, or coma. J Anal Toxicol. 7-Aminoclonazepam; Addiction management; Clonazepam; Compliance; Oral fluid. Does the patient have altered gastrointestinal (GI) function or recent GI illness?Some patients have short-gut syndrome due to previous surgeries or GI disease or may have a history of gastric bypass surgery. Clipboard, Search History, and several other advanced features are temporarily unavailable. 215 23 Drugs of abuse in oral fluid collected by two different sample kitsstability testing and validation sing ultra performance tandem mass spectrometry. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures. Bethesda, MD 20894, Web Policies 2012 Oct 10;222(1-3):e33-5. National Library of Medicine 0000008084 00000 n Flunitrazepam is detected as the metabolite 7-aminoflunitrazepam. Clin Chim Acta. 2023 Jan 23:1-13. doi: 10.1007/s40264-022-01269-x. 215 0 obj <> endobj This is not a complete list of side effects and others may occur. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide. J Anal Toxicol. Benzodiazepine metabolism: an analytical perspective. official website and that any information you provide is encrypted Benzodiazepines do not replace GABA, but instead enhance the effect of GABA at the GABAA receptor by increasing the opening frequency of chloride ion channels, which leads to an increase in GABA's inhibitory effects and resultant central nervous system depression. Blank A, Hellstern V, Shuster D, et al. Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. The study examined the number of times the non-medical use of certain drugs was implicated in an ED visit. Please note that the interpretation of benzodiazepine results differs when using presumptive vs. definitive testing methods, and may differ among laboratories. 2023 University of Rochester Medical CenterRochester, NY, Clinical and Translational Sciences Institute, Monroe County Community Health Improvement Plan. [107][108], Benzodiazepines do not have any effect on the levels of GABA in the brain. [21] As a result, clonazepam is sometimes used for certain rare childhood epilepsies; however, it has been found to be ineffective in the control of infantile spasms. [9] In addition, clonazepam decreases the utilization of 5-HT (serotonin) by neurons[111][112] and has been shown to bind tightly to central-type benzodiazepine receptors. Applies only to results expressed in units of measure originally reported by the performing laboratory. Avoid driving or hazardous activity until you know how clonazepam will affect you. It can cause side effects such as drowsiness, problems with coordination, and . It is extensively metabolised into pharmacologically inactive metabolites, with only 2% of the unchanged drug excreted in the urine. Keep the medication in a place where others cannot get to it. Test Result Name. Benzodiazepines such as clonazepam can be very effective in controlling status epilepticus, but, when used for longer periods of time, some potentially serious side-effects may develop, such as interference with cognitive functions and behavior. 2011;3367-77.11. and transmitted securely. Clonazepam has been found to be effective in the acute control of non-convulsive status epilepticus; however, the benefits tended to be transient in many people, and the addition of phenytoin for lasting control was required in these patients. <<5EF21C43C966E948A92DC807C389A0F0>]>> Version 2.73 28073-57-Aminoclonazepam [Mass/volume] in UrineActive Part Description LP28541-8 7-Aminoclonazepam 7-Aminoclonazepam is a metabolite of clonazepam, a benzdiazepine drug used to treat or control seizures, panic attacks, and akathisia. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. The data are also inconclusive on whether benzodiazepines such as clonazepam cause developmental deficits or decreases in IQ in the developing fetus when taken by the mother during pregnancy. Clonazepam in particular is more prone to stability issues. [135], In some countries, clonazepam is used by criminals to subdue their victims. Figure 1. Your child's dose needs may change if the child gains or loses weight. An evaluation of the diagnostic accuracy of liwuid chromatography-tandem mass spectrometry versus immunoassay drug testing in pain patients. Brand names: KlonoPIN, KlonoPIN Wafer Disclaimer. J Anal Toxicol. LP28541-8 7-Aminoclonazepam 7-Aminoclonazepam is a metabolite of clonazepam, a benzdiazepine drug used to treat or control seizures, panic attacks, and akathisia. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Trends in drug use from urine drug testing of addiction treatment clients. 2015:14(2):248.4. Your test results may be different depending on the lab used. As a major metabolite, 7-aminoclonazepam may be used to monitor use of the parent drug, clonazepam. Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. [93][94], Clonazepam is not recommended for patients with chronic schizophrenia. Clonazepam is not approved to treat panic disorder in anyone younger than 18 years old. Such data would be of great importance to law enforcement agencies trying to determine the best time interval for urine collection from a victim of drug-facilitated sexual assault in order to reveal drug use. 6 Table 2 lists commonly ordered. Conclusions: 0000003638 00000 n This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 91 (91.0%) confirmed positive for 7AC (median, range: 4.2, 0.5-316.7 ng/ml) using the ion ratio test, while only 44 of the 100 (44.0%) samples confirmed positive for CLON (median, range: 3.7, 0.5-217.2 ng/ml) using the ion ratio test. [72] Many individuals treated on a long-term basis develop a dependence. Alcohol alone was responsible for over twice as many ED visits as clonazepam in the same study. Application to forensic cases of drug facilitated crimes. Caution is also required if clonazepam is used during breastfeeding. National Library of Medicine 2000 Oct;24(7):614-20. doi: 10.1093/jat/24.7.614. 0000008997 00000 n Because of the complexity of this test, and because the test is not run in a quantitative mode, these sensitivities should only be used in concert with other clinical and historical data to guide clinical interpretation. Ask your healthcare provider what your test results mean for you. Forensic Sci Int. Neonatal withdrawal syndrome associated with benzodiazepines include hypertonia, hyperreflexia, restlessness, irritability, abnormal sleep patterns, inconsolable crying, tremors, or jerking of the extremities, bradycardia, cyanosis, suckling difficulties, apnea, risk of aspiration of feeds, diarrhea and vomiting, and growth retardation. [86], Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, and fainting. A Case Report of Clonazepam Dependence: Utilization of Therapeutic Drug Monitoring During Withdrawal Period. 0000009460 00000 n Detection Times of Diazepam, Clonazepam, and Alprazolam in Oral Fluid Collected From Patients Admitted to Detoxification, After High and Repeated Drug Intake. In some individuals, however, peak blood concentrations were reached at 48 hours. The urine from every subject was still positive for 7-ACLO 14 days after administration of the drug. Patients dependent on clonazepam should be slowly titrated off under the supervision of a qualified healthcare professional to reduce the intensity of withdrawal or rebound symptoms. and phenytoin. The criteria for non-medical use in this study were purposefully broad, and include, for example, drug abuse, accidental or intentional overdose, or adverse reactions resulting from legitimate use of the medication.[134]. [128] Clonazepam plasma levels are very unreliable amongst patients. 4th ed. Acetaminophen (Tylenol) is a non-narcotic analgesic with antipyretic . Curr Drug Metab. Disclaimer. Epub 2006 Jun 30. A recurrence of symptoms of the underlying disease should be separated from withdrawal symptoms. stinging sensation or pain. sharing sensitive information, make sure youre on a federal government site. Clonazepam's mode of action is to decrease abnormal electrical energy in the brain. Afterward, the site may be slightly sore. The .gov means its official. [9][25], The effectiveness of clonazepam in the short-term treatment of panic disorder has been demonstrated in controlled clinical trials. . Analytical Methods Used for the Detection and Quantification of Benzodiazepines. It is typically taken by mouth. Clonazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). Of anticonvulsant drugs, behavioural disturbances occur most frequently with clonazepam and phenobarbital. 2010 Mar 20;196(1-3):14-7. doi: 10.1016/j.forsciint.2009.12.037. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Do not take two doses at one time. Use in very young children may be especially hazardous. may not be accurate if the sample is not handled properly. [89] Clonazepam is generally not recommended for use in elderly people for insomnia due to its high potency relative to other benzodiazepines. Dizziness or drowsiness can cause falls, accidents, or severe injuries. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. The range of concentrations detected was from 73.0 pg x mL(-1) to 183.2 ng x mL(-1). If you use clonazepam during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks. is a metabolite of the drug clonazepam (Klonopin) a central nervous system depressant of the benzodiazepine class. Bookshelf Lund HM, iestad El, Gjerde H, Christophersen AS. A tendency for re-offending in drug-facilitated crime. and transmitted securely. 2007 Mar 2;166(2-3):209-17. doi: 10.1016/j.forsciint.2006.05.040. Negrusz A, Bowen AM, Moore CM, Dowd SM, Strong MJ, Janicak PG. J Anal Toxicol. Swallow the regular tablet whole, with a full glass of water. The benzodiazepine clonazepam is a prescription drug used to treat epilepsy and anxiety. Tell your doctor if you are pregnant or plan to become pregnant. arm. Providers may also consider recent GI illness in the interpretation of unexpected negative results. Cook JD, Caplan YH, LoDico CP, et al. Clonazepam may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Some long-term trials have suggested a benefit of clonazepam for up to three years without the development of tolerance but these trials were not placebo-controlled. These data illustrate the limitations of using a 200 ng/ mL cutoff to monitor clonazepam compliance and suggest that a cutoff of 40 ng/mL or less is needed to reliably monitor use of this drug. If clonazepam is used during pregnancy or breastfeeding, it is recommended that serum levels of clonazepam are monitored and that signs of central nervous system depression and apnea are also checked for. Do not start or stop seizure medication during pregnancy without your doctor's advice. Further information regarding specimen tampering is available in the Aegis Clinical Reference Guide at https://www.aegislabs.com/resources/clinical-reference-guide/. Using molecular similarity to highlight the challenges of routine immunoassay-based drug of abuse/toxicology screening in emergency medicine. [106] It acts by binding to the benzodiazepine site of the GABA receptors, which enhances the electric effect of GABA binding on neurons, resulting in an increased influx of chloride ions into the neurons. 1. Hospitalization/Emergency Department Visit: Patients who arrive at the emergency room with a suspected poisoning or overdose may be given benzodiazepines depending on their presenting symptoms and the source of the toxicity. Results are given in micrograms per milliliter (mcg/mL). The screening immunoassays cutoffs given are the concentrations above which the assay is reported as positive; note that a drug present below the cutoff will be reported as negative on an immunoassay screen even though it is present. Determination of bromazepam, clonazepam and metabolites after a single intake in urine and hair by LC-MS/MS. Before Long-acting benzodiazepines such as clonazepam are not generally recommended for the elderly due to the risk of drug accumulation. Do not give this medicine to a child without medical advice. 1988;10(1):21-6.9. It consists of screening immunoassays for several drugs or drug classes, a quantitative enzymatic assay for ethanol and a gas chromatography-mass spectrometry (GC/MS) assay for a wide variety of therapeutic and abused drugs, as listed below. It differs from other anticonvulsant drugs it was compared to in a study. Pesce A, Rosenthal M, West R, et al. False-positive and false-negative test results in clinical urine drug testing. 7-Aminoclonazepam (CRM) (Item No. Call your doctor for medical advice about side effects. It's often prescribed to adults and 1983;23:369-765. Seizures are often treated with a combination of drugs. [113] Because clonazepam is effective in low milligram doses (0.5mg clonazepam = 10mg diazepam),[114][115] it is said to be among the class of "highly potent" benzodiazepines. Drug class: benzodiazepine anticonvulsants. Diazepam in particular has been noted to be detected longer in the urine of obese patients.4 Period of detection studies in toxicology are often limited, and special populations of patients are often excluded. It can cause side effects such as drowsiness, problems with . [116] The anticonvulsant properties of benzodiazepines are due to the enhancement of synaptic GABA responses, and the inhibition of sustained, high-frequency repetitive firing. A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences", "FDA expands Boxed Warning to improve safe use of benzodiazepine drug", "Get Some Sleep: Beware the sleeping pill hangover", "Recent advances in drug therapy for epilepsy", "The effects of neuroleptics on the GABA-induced Cl- current in rat dorsal root ganglion neurons: differences between some neuroleptics", "Interictal acute psychoses in temporal lobe epilepsy during withdrawal of anticonvulsant therapy", "Clonazepam, Prescription Marketed Drugs", "Sleep and aging: 2. Krasowski MD, Pizon AF, Siam MG, Giannoutsos S, Iyer M, Ekins S. BMC Emerg Med. Eight of the ten volunteers had measurable amounts of the metabolite 21 days after administration. Clonazepam. Abernathy DR, Greenblatt DJ, Divoll M, Shader RI. Pain Physician. [10] The information provided here is intended to assist providers with deciphering benzodiazepine results from Aegis, which have undergone definitive testing by liquid chromatography/tandem mass spectrometry prior to reporting as positive. You may report side effects to FDA at 1-800-FDA-1088. Urinary analyses of the metabolite 7-aminoclonazepam (7-AC) can be helpful in monitoring drug abuse and in the context of suspected drug-facilitated sexual assaults (DFSA). eCollection 2019. [103], Combined use of clonazepam with certain antidepressants, anticonvulsants (such as phenobarbital, phenytoin, and carbamazepine), sedative antihistamines, opiates, and antipsychotics, nonbenzodiazepines (such as zolpidem), and alcohol may result in enhanced sedative effects. Benzodiazepines (BZ) are one class of drugs that can be challenging to detect using OF [7], [9], [10]. BZ are weakly acidic and are therefore excluded from OF, resulting in low OF concentrations [7]. Methods: 2013 Nov;5(22):2803-20. doi: 10.4155/bio.13.244. It's a type of medicine called a Johnson-Davis KL, Sadler AJ, Genzen JR. A retrospective analysis of urine drugs of abuse immunoassay true positive rates at a national reference laboratory. 2016 Mar;95(9):e2881. Simultaneous analysis of 14 benzodiazepines in oral fluid by solid-phase extraction and LC-MS-MS. The immunoassay sensitivities are listed for specific drugs, but each assay can detect related compounds with similar but variable sensitivities (i.e. Follow the directions on your prescription label and read all medication guides. Tell your doctor if you have ongoing anxiety, depression, problems with memory or thinking, trouble sleeping, ringing in your ears, a burning or prickly feeling, or a crawling sensation under your skin. Clonazepam's mode of action is to decrease abnormal electrical energy in the brain. and deuterated internal standard transition ions for -OH alprazolam, 7-aminoclonazepam, desalkylflurazepam, 2-OH ethyl flurazepam, lorazepam, -OH midazolam, nordiazepam, oxazepam, temazepam, and -OH triazolam. might be drooling, sleepiness, lack of muscle coordination, difficulty breathing, Procedural Administration: Abenzodiazepine may be administered as an anxiolytic or sedative prior to medical procedures. PUGVIEW FETCH ERROR: 503 National Center for Biotechnology Information 8600 Rockville Pike, Bethesda, MD, 20894 USA Contact Policies FOIA HHS Vulnerability Disclosure National Library of Medicine National Institutes of Health You don't need to prepare for this test. An official website of the United States government. Forensic Sci Int. The samples were collected using the Orasure Intercept OF sample collection device. treatment. Bookshelf Moeller KE, Lee KC, Kissack JC. Any questions about how to list medications as prescribed on an Aegis laboratory requisition may be directed to the Aegis Client Services department at 1-800-533-7052. [9], Clonazepam was patented in 1960 and went on sale in 1975 in the United States from Roche. Epub 2012 Jul 19. 8600 Rockville Pike J Clin Pharmacol. One volunteer had the highest concentration of 7-ACLO at 3 days, two volunteers at 5 days, and one at 8 days. confusion, paranoia, nightmares, hallucinations; Drowsiness or dizziness may last longer in older adults. Benzodiazepine Multi-Component Mixture-8, 250 g/mL of each component, A-916 / A-916-1ML, A-917 / A-917-1ML, A-924 / A-924-1ML, B-033 / B-033-1ML, C-905 / C-905-1ML, C-906 / C-906-1ML, C-907 / C-907-1ML, F-043 / F-043-1ML, H-113 / H-113-1ML, P-093 / P-093-1ML, read more about ordering regulated substances. 0000003269 00000 n [121] Benzodiazepines inhibit cold-induced thyroid-stimulating hormone (also known as TSH or thyrotropin) release. Use all medications as directed by your doctor. Read and carefully follow any Instructions for Use provided with your medicine. Selling or giving away this medicine is against the law. One volunteer was still positive 28 days after administration. Generic name: clonazepam [kloe-NAZ-e-pam] 2004 Dec;62 Suppl 12:360-3. 2000;24:579-88.6. panic attacks, insomnia, and generalized anxiety. Stability of pain-related medications, metabolites, and illicit substances in urine. 7-aminoclonazepam is superior to clonazepam for detection of clonazepam use in oral fluid by LC-MS/MS [1][135] In August 2021, Roche Australia transferred Rivotril to Pharmaco Australia Ltd.[138], Clonazepam orally disintegrating tablet, 0.25mg. On this Wikipedia the language links are at the top of the page across from the article title. Prolonged excretion of 7-aminoclonazepam in urine after repeated ingestion of clonazepam: a case report. Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. [92], Clonazepam may aggravate hepatic porphyria. It can cause side effects such as . In many cases, non-pharmacological treatments, such as relaxation therapy, psychotherapy, and avoidance of caffeine, can be an effective and safer alternative to the use of benzodiazepines for anxiety in pregnant women. Clonazepam (CLO) is an anticonvulsant benzodiazepine approved by the Food and Drug Administration for use in the treatment of seizures. Federal government websites often end in .gov or .mil. 1B). 0000001552 00000 n Clipboard, Search History, and several other advanced features are temporarily unavailable. Moosmann B, Link LA, Auwarter V. Designer benzodiazepines: a new challenge. Nordal K, iestad EL, Enger A, Christophersen AS, Vindenes V. Ther Drug Monit. Please note that chlordiazepoxide, when administered with clidinium (Librax), is not a controlled substance in many jurisdictions and may not show up on the PDMP in these states. [10] It is a tranquilizer of the benzodiazepine class. Federal government websites often end in .gov or .mil. Alprazolam (Xanax): Metabolizes to alpha-hydroxyalprazolam; reported as Alprazolam Clonazepam (Klonopin): Metabolizes to 7-aminoclonazepam; reported as Clonazepam Flurazepam: Metabolizes to 2-hydroxyethylflurazepam; reported as Flurazepam Lorazepam (Ativan): Metabolizes to lorazepam glucuronide; reported as Lorazepam