Etizolam

Etizolam is a thienodiazepine, closely related to benzodiazepines but differing by a sulfur-containing thiophene ring in place of the benzene ring. It is a prescription medication for anxiety and insomnia in a handful of countries such as Japan, Italy and India, but it has never been approved for medical use in the United States. It has appeared widely in the unregulated designer-benzodiazepine and research-chemical market, often sold as powders, pellets or on blotter, and is sometimes misrepresented as pharmaceutical alprazolam. Its effects and risks closely track those of prescription benzodiazepines.

Like benzodiazepines, etizolam is a positive allosteric modulator at the GABA-A receptor, enhancing the effect of the brain's main inhibitory neurotransmitter, GABA. This increases inhibitory signaling, producing sedation, reduced anxiety, muscle relaxation and anticonvulsant effects. It is considered relatively potent and comparatively fast in onset, and it produces the same core hazards as classical benzodiazepines: tolerance, dependence and dangerous additive depression when combined with other CNS depressants.

Effects mirror benzodiazepines: reduced anxiety, calm, drowsiness and muscle relaxation, and at higher exposures heavy sedation, slurred speech, unsteadiness and memory impairment (anterograde amnesia). Because unregulated products vary enormously in potency, and may be far stronger or weaker than assumed or may not be etizolam at all, effects are unpredictable. Blackouts and disinhibited behavior can occur, and the amnesia can obscure how much has been taken.

Etizolam carries the full benzodiazepine-class risk set: rapid development of tolerance, physical dependence, and a potentially dangerous withdrawal syndrome, including rebound anxiety, insomnia, tremor and, after heavy or prolonged use, seizures, that generally requires medically supervised tapering rather than abrupt cessation. The gravest acute danger is combining it with other central nervous system depressants: opioids, alcohol or other sedatives stack with etizolam to suppress breathing, and this combination is a leading contributor to fatal overdoses. Because etizolam is overwhelmingly sold through unregulated channels, contamination is a serious hazard: illicit products and counterfeit benzodiazepine pills have been found adulterated with fentanyl or other potent opioids, which can cause fatal respiratory depression in someone who believed they were taking only a sedative. Potency is inconsistent between batches, so an amount that seemed tolerable once can be far stronger the next time. Naloxone reverses opioids but not benzodiazepines, so it will not undo etizolam's own effects, though it should still be given if an opioid may be involved. If someone is unresponsive or breathing slowly, call 911 immediately. This page has not yet been medically reviewed.