Which benzodiazepine is safest in patients with liver disease and requires NO hepatic metabolism?

• A Diazepam
• B Clonazepam
• C Flurazepam
• D Oxazepam ✓

Explanation

Most benzodiazepines (diazepam, chlordiazepoxide, clonazepam, flurazepam) undergo hepatic oxidative metabolism through CYP3A4 and form active metabolites; these accumulate dangerously in liver failure. Oxazepam, temazepam, and lorazepam — the 'LOT' drugs — undergo only phase II glucuronidation (conjugation) in the liver, which is relatively preserved even in advanced cirrhosis, and they have no active metabolites. Oxazepam is therefore the preferred benzodiazepine in hepatic failure (and in the elderly).

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.