Benzodiazepines Metabolism by the Liver
Benzodiazepine Metabolism by the Liver
Take Home Points
- ALL benzodiazepines are metabolized by the liver. Some are just metabolized by different pathways that are less dependent on global liver function.
The ‘LOT’ drugs are those metabolized mostly by conjugation.
- L – Lorazepam
- O – Oxazepam
- T – Temazepam
The ‘LOT’ drugs do not have active metabolites after hepatic conjugation, and therefore have minimally affected half-lives in patients with liver disease.
Non-LOT Benzodiazepine Medications
These benzodiazepines may have prolonged effects in patients with marked liver disease.
- Primarily metabolized via hepatic CYP-mediated oxidation.
- Examples: Drugs with active metabolites include -
Some practitioners like to take advantage of the longer duration of action and active metabolites.
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- Mihic SJ, Harris RA. Chapter 17. Hypnotics and Sedatives. In: Chabner BA, Knollmann BC, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12nd ed. New York: McGraw-Hill; 2011. Accessed November 7, 2013.
- Lee DC, Ferguson KL. Chapter 74. Sedative-Hypnotics. In: Lee DC, Ferguson KL, eds.Goldfrank’s Toxicologic Emergencies. 9th ed. New York: McGraw-Hill; 2011. Accessed November 7, 2013.