UK Clinical Pharmacy Association


Issues for surgery

For insomnia / anxiety – exacerbation of symptoms if omitted.

Risk of withdrawal symptoms if omitted (see Further information).

Increased sedative effect and risk of cumulative central nervous system depression if continued.

Potential for post-operative delirium for elderly patients or those on long-term treatment, if continued (see Further information).

Advice in the perioperative period

Elective and emergency surgery


Inform anaesthetist on day of admission of type and dose of benzodiazepine the patient usually takes so anaesthesia can be adjusted accordingly if necessary.


Discontinuation of benzodiazepines in psychiatric patients with panic disorders should be avoided. Seek advice from Mental Health Team if necessary.

Post-operative advice

Restart post-operatively if appropriate.

If patient cannot resume their usual oral medication post-operatively and is at risk of withdrawal, consider using a suitable intravenous preparation. Consult with a psychiatrist if necessary.

Bear in mind the potential for post-operative confusion and delirium (POD), especially in those patients who are elderly and/or have been taking long-term benzodiazepines (see Further information).

Patients who are discharged on the day of surgery after having received an anaesthetic and who usually take oxazepam should be advised of the potential of enhanced drowsiness and psychomotor effects and counsel against undertaking skilled tasks (e.g. driving).

Interactions with common anaesthetic agents

Central Nervous System (CNS) depression 

Also see Interactions with other common medicines used in the perioperative period.

Oxazepam has CNS depressant effects which may be additive with other medicines that also have CNS depressant effects such as:

  • inhalational and intravenous anaesthetics
  • local anaesthetics
  • opioids
  • other benzodiazepines


Giving oxazepam with opioids during anaesthesia may reduce the dose required of both drugs. The patient should be monitored and adjustments made according to the effect.

If oxazepam is used concomitantly with opioids, possible euphoria may be enhanced; this may lead to increased psychological dependence.

The current recommendation from manufacturers for the prescribing of oxazepam with opioids is that concurrent use should be reserved for patients in whom alternative treatment options are not possible or are inadequate. If the decision is made to prescribe oxazepam with opioids, the lowest effective dose should be used, and the duration of treatment should be as short as possible.

Interactions with other common medicines used in the perioperative period

CNS depression 

Also see Interactions with common anaesthetic agents for information on opioids.

Oxazepam has CNS depressant effects which may be additive with antiemetics that also have CNS depressant effects such as:

  • cyclizine
  • droperidol
  • prochlorperazine

Further information


Sudden discontinuation of benzodiazepines or benzodiazepine-like drugs is associated with withdrawal symptoms including confusion, toxic psychosis, convulsions, delirium and rebound effects. Doses should be reduced gradually.

Withdrawal symptoms can occur within a day after stopping oxazepam.

Post-operative delirium (POD)

POD has been shown to be a predictor of death, increased mortality, and longer duration of stay especially in ventilated patients. Benzodiazepines have been found to increase the frequency of POD. The frequency may be higher in elderly patients and those on long-term benzodiazepines. In addition, if a patient develops POD, consideration should be given to not using benzodiazepines as the first-line agents for treatment.


Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. [Accessed on 29th August 2019

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. [Accessed on 10th July 2019]

Kudoh A, Takase H, Takahira Y. Postoperative confusion increases in elderly long-term benzodiazepine users. Anesthesia & Analgesia. 2004; 99(6):1674

Lepouse C, Lautner CA, Liu A et al. Emergence delirium in adults on the post-anaesthesia care unit. British Journal of Anaesthesia. 2006; 96(6):747-753

Perks A, Cheema S, Mohanraj R. Anaesthesia and epilepsy. BJA: British Journal of Anaesthesia. 2012; 108(4):562-571

Summary of Product Characteristics – Oxazepam Tablets 10mg Tablets. Genus Pharmaceuticals. Accessed via 11/09/2019 [date of revision of the text October 201

Zhang Y, Tany Y, Yang J et al. Perioperative Use of Benzodiazepines: A Reconsideration of Risks and Benefits. J Anaesth Perioper Med. 2018; 5(1):34-40