Benzodiazepines

Interpretation

  • If there is a question as to a patient's therapeutic compliance, a serum test request for the specific drug of interest may be of help.

Metabolites

  • Benzodiazepines are extensively metabolized, and the parent compounds are not detected in urine.
  • Diazepam is metabolized to nordiazepam, oxazepam, and temazepam; all may be detected after diazepam use.

    Diazepam → Nordiazepam, Oxazepam, and Temazepam

  • Chlordiazepoxide is metabolized to nordiazepam and oxazepam; all may be detected after chlordiazepoxide use.

    Chlordiazepoxide → Nordiazepam and Oxazepam

  • Alprazolam is detected as the metabolite α-hydroxyalprazolam.
  • Triazolam is detected as the metabolite α-hydroxytriazolam
  • Clonazepam is detected as the metabolite 7-aminoclonazepam.
  • Flunitrazepam is detected as the metabolite 7-aminoflunitrazepam.
  • Flurazepam is detected as the metabolite hydroxyethyl-flurazepam.

Confirmation Tests

Approximate Detection Times

Benzodiazepines LOQ (ng/mL) Detection Time* up to
Long-Acting   10 days
Diazepam as metabolites 100  
Nordiazepam 100  
Intermediate-Acting   5 days
Alprazolam as metabolite 100  
Lorazepam 100  
Oxazepam 100  
Temazepam 100  
Chlordiazepoxide as metabolite 100  
Clonazepam as metabolite 100  
Flunitrazepam as metabolite 50  
Short-Acting 2 days
Triazolam as metabolite 100  
Flurazepam as metabolite 100  
*These are approximate detection times for the drug or metabolites in urine. The actual detection time depends on dose, frequency of use, and individual metabolism.