Phenazepam (also known in

Russia Russia, or the Russian Federation, is a country spanning Eastern Europe and North Asia. It is the list of countries and dependencies by area, largest country in the world, and extends across Time in Russia, eleven time zones, sharing Borders ...

as bromdihydrochlorphenylbenzodiazepine) is a

benzodiazepine Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant, depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed t ...

drug, first developed in the

Soviet Union The Union of Soviet Socialist Republics. (USSR), commonly known as the Soviet Union, was a List of former transcontinental countries#Since 1700, transcontinental country that spanned much of Eurasia from 1922 until Dissolution of the Soviet ...

in 1975, and now produced in Russia and several other countries. Phenazepam is used in the treatment of various mental disorders such as psychiatric schizophrenia and anxiety. It can be used as a premedication before surgery as it augments the effects of anesthetics. Recently, phenazepam has gained popularity as a

recreational drug Recreational drug use is the use of one or more psychoactive drugs to induce an altered state of consciousness, either for pleasure or for some other casual purpose or pastime. When a psychoactive drug enters the user's body, it induces an Sub ...

; misuse has been reported in the United Kingdom, Finland, Sweden, and the United States.

Indications

* Neurosis, neurosis-like, psychopathic (personality disorder), psychopathic-like and other conditions accompanied by fear, anxiety, increased irritability, and emotional lability * Brief reactive psychosis and

hypochondriasis Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that th ...

-senestopathic syndrome * Vegetative dysfunction and vegetative lability *

Insomnia Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...

* Alcohol withdrawal syndrome * Temporal lobe epilepsy and myoclonic epilepsy (used only occasionally as better options exist) * Hyperkinesia and tics * Muscle

spasticity Spasticity () is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles. ...

Usually, a course of treatment with phenazepam should not normally exceed 2 weeks (in some cases therapy may be prolonged for up to 2 months) due to the risk of drug

abuse Abuse is the act of improper usage or treatment of a person or thing, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, ...

and dependence. To prevent withdrawal syndrome, it is necessary to reduce the dose gradually.

Chemistry

Phenazepam is a drug of the benzodiazepine class. Benzodiazepine drugs contain a benzene ring fused to a diazepine ring, which is a seven membered ring with the two nitrogen constituents located at R1 and R4. The benzyl ring of phenazepam is substituted at R7 with a bromine group. Like most benzodiazepines, phenazepam has a phenyl ring in R5 which is substituted by chlorine in the R2' group. Phenazepam also contains an oxygen group double bonded to R2 of its diazepine ring to form a ketone. This oxygen substitution at R2 is shared with other benzodiazepine drugs with the suffix -azepam. Like other benzodiazepines, phenazepam (7-bromo-5-(2-chlorophenyl)-1,3-dihydro-1,4-benzodiazepin-2-one) is composed of a benzene ring fused to a seven-membered 1,4-diazepine ring. A 2-chlorophenyl ring is attached at the 5-position and a bromine is attached at the 7-position. Phenazepam has a molecular formula of C₁₅H₁₀BrClN₂O and a molecular weight of 349.6 g/mol.

Side effects

Side effects include hiccups,

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to Balance disorder, disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a ...

, loss of coordination and drowsiness, along with anterograde amnesia which can be quite pronounced at high doses. As with other benzodiazepines, in case of abrupt discontinuation following prolonged use, severe withdrawal symptoms may occur including restlessness,

anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...

insomnia Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...

seizure A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...

convulsion A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term ''convulsion'' is often used as a synony ...

s and

death Death is the end of life; the irreversible cessation of all biological functions that sustain a living organism. Death eventually and inevitably occurs in all organisms. The remains of a former organism normally begin to decompose sh ...

, though because of its intermediate half-life as well as that of its active metabolites, these withdrawal symptoms may take two or more days to manifest.

Contraindications and special caution

Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol or drug-dependent individuals and individuals with comorbid

psychiatric disorders A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

. Phenazepam should not be taken with

alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...

or any other CNS depressants. Phenazepam should not be used therapeutically for periods of longer than one month including tapering on and off the drug as recommended for any benzodiazepine in the British national formulary. Some patients may require longer term treatment. Phenazepam was found to be a component in some "herbal incense" mixtures in Australia and New Zealand in 2011, namely "Kronic". The particular product variety was withdrawn from the market shortly after and replaced with a new formulation.

Synthesis

First, 2-(''o''-chlorobenzoylamino)-5-bromo-2-chlorobenzophenone is prepared by acylation of ''p''-bromoaniline with ''o''-chlorobenzoic acid acyl chloride in the presence of a

zinc chloride Zinc chloride is an Inorganic chemistry, inorganic chemical compound with the chemical formula, formula ZnCl2·''n''H2O, with ''n'' ranging from 0 to 4.5, forming water of hydration, hydrates. Zinc chloride, anhydrous and its hydrates, are colo ...

catalyst. This is hydrolysed with aqueous

sulfuric acid Sulfuric acid (American spelling and the preferred IUPAC name) or sulphuric acid (English in the Commonwealth of Nations, Commonwealth spelling), known in antiquity as oil of vitriol, is a mineral acid composed of the elements sulfur, oxygen, ...

to yield 2-amino-5-bromo-2'-chlorobenzophenone, which is then acylated with hydrochloride of aminoacetic acid acyl chloride in

chloroform Chloroform, or trichloromethane (often abbreviated as TCM), is an organochloride with the formula and a common solvent. It is a volatile, colorless, sweet-smelling, dense liquid produced on a large scale as a precursor to refrigerants and po ...

to form 2-(aminomethylkarbonylamino)-5-bromo-2-chlorobenzophenone hydrochloride, which is converted to a base with aqueous

ammonia Ammonia is an inorganic chemical compound of nitrogen and hydrogen with the chemical formula, formula . A Binary compounds of hydrogen, stable binary hydride and the simplest pnictogen hydride, ammonia is a colourless gas with a distinctive pu ...

and then thermally cyclized to bromodihydrochlorophenylbenzodiazepine (phenazepam). Hydrochloride of aminoacetic acid acyl chloride is prepared by chemical treating glycine with phosphorus pentachloride (PCl₅) in

. This method of Phenazepam synthesis was developed in the 1970s at the Physico-Chemical Institute of the Academy of Sciences of the

Ukrainian SSR The Ukrainian Soviet Socialist Republic, abbreviated as the Ukrainian SSR, UkrSSR, and also known as Soviet Ukraine or just Ukraine, was one of the Republics of the Soviet Union, constituent republics of the Soviet Union from 1922 until 1991. ...

Detection in biological fluids

Phenazepam may be measured in blood or plasma by chromatographic methods. Blood phenazepam concentrations are typically less than 30 μg/L during therapeutic usage, but have frequently been in the 100–600 μg/L range in automotive vehicle operators arrested for impaired driving ability.

Legal status

China

As of October 2015, phenazepam is a controlled substance in China.

United States

Under federal United States law, phenazepam is not currently classified as a controlled substance, as the Federal Analog Act only provides for automatic assumed classification of chemicals "substantially similar" to existing Schedule I or Schedule II drugs, whereas all controlled benzodiazepines under the

Controlled Substances Act The Controlled Substances Act (CSA) is the statute establishing federal government of the United States, federal drug policy of the United States, U.S. drug policy under which the manufacture, importation, possession, use, and distribution of ...

are classified as Schedule IV. Although phenazepam is currently not controlled, sale for human use remains illegal in the United States. Suppliers attempt to circumvent this regulation by placing a "Not for human use" disclaimer on the product's label. Individual states in the United States often ban these analog drugs by name as they appear. Since 2012,

Louisiana Louisiana ( ; ; ) is a state in the Deep South and South Central regions of the United States. It borders Texas to the west, Arkansas to the north, and Mississippi to the east. Of the 50 U.S. states, it ranks 31st in area and 25 ...

has classified phenazepam as a controlled dangerous substance. This ban affects several products, some of which were sold at retail stores under the guise of

air freshener Air fresheners are products designed to reduce unwanted odors in indoor spaces, to introduce pleasant fragrances, or both. They typically emit fragrance to mask odors but may use other methods of action such as absorbing, bonding to, or chemically ...

or similar, containing phenazepam yet claiming not to be for human use. This legislation was introduced after one such product, branded as "Zannie" and marketed as an air freshener rapidly gained publicity as the subject of numerous media reports, attracting the attention of officials. The ensuing investigation effort, led by Senator Fred Mills and Louisiana Poison Center Director Mark Ryan, positively identified the active ingredient of "Zannie" as phenazepam. According to Ryan,

chemical analysis Analytical chemistry studies and uses instruments and methods to separate, identify, and quantify matter. In practice, separation, identification or quantification may constitute the entire analysis or be combined with another method. Separa ...

identified the active ingredient as "100 percent phenazepam". Paul Halverson, director and state health officer for the Arkansas Department of Health, approved an emergency rule to ban the sale and distribution of phenazepam shortly after the Louisiana ban.

Alabama Alabama ( ) is a U.S. state, state in the Southeastern United States, Southeastern and Deep South, Deep Southern regions of the United States. It borders Tennessee to the north, Georgia (U.S. state), Georgia to the east, Florida and the Gu ...

made Phenazepam a schedule I substance on March 18th, 2014.

United Kingdom

Phenazepam is a class C drug in the UK. The UK home office banned importation of phenazepam on Friday 22 July 2011 while it drafted legislation, released in January 2012 to become law at the end of March 2012. The bill was quashed following advice from the ACMD as it included two non-abusable steroids. There was a new discussion about its fate on April 23, 2012, where it was decided that the bill would be rewritten and phenazepam would still be banned. It was eventually banned on June 13, 2012 as a class C, schedule II drug.

Elsewhere

Phenazepam was classified as a narcotic in Finland in July, 2014. Phenazepam is considered a narcotic in Norway, as per a March 23, 2010 Health Department addition to the Regular Narcotic List. In Russia, phenazepam is a controlled substance since March 22, 2021. In Estonia, phenazepam is a Schedule IV substance under the Narcotic Drugs and Psychotropic Substances Act. Schedule IV is the lowest classification of psychoactive substances in Estonia. It includes prescribable drugs, including other benzodiazepines.

UN Single Convention on Narcotic Drugs

On 8 March 2016 at its 59th Session, the Commission on Narcotic Drugs (CND) added Phenazepam to relevant schedules of the Convention on Psychtropic Substances of 1971.

Trade names

RU: * «Феназепам» (Phenazepam) tablets 0.5, 1 and 2.5 mg, solution for intramuscular and intravenous injection 1 mg/mL (0.1%) * «Элзепам» (Elzepam) tablets 0.5 and 1 mg, solution for intramuscular and intravenous injection 1 mg/mL (0.1%) * «Фензитат» (Phenzitat) tablets 0.5 and 1 mg * «Фенорелаксан» (Phenorelaxan) tablets 0.5 and 1 mg, solution for intramuscular and intravenous injection 1 mg/mL (0.1%) * «Транквезипам» (Trankvezipam) tablets 0.5 and 1 mg, solution for intramuscular and intravenous injection 1 mg/mL (0.1%) * «Фезипам» (Phezipam) tablets 0.5 and 1 mg ''(not to be confused with «Фезам» (Phezam) which contains cinnarizine/ piracetam)'' * «Фезанеф» (Phezanef) tablets 1 mg

References

{{GABAAR PAMs Benzodiazepines 2-Chlorophenyl compounds Bromobenzene derivatives Lactams Designer drugs Russian drugs Drugs in the Soviet Union