UK & IRELAND

DrugWatch
Information Sheet
Etizolam
UK & IRELAND
DrugWatch

Version: 1.2
Original version: 17/06/2014 UK & IRELAND
DrugWatch
Revision date: 22/12/2017

Drug overview: Etizolam is a benzodiazepine analogue,

a thienodiazepene. 1 It has gathered some popularity on
the new psychoactive substance (NPS) market in the UK
and Europe.

Chemical name(s): 4-(2-chlorophenyl)-2-ethyl-9-

methyl-6H-thieno[3,2- f][1,2,4]triazolo[4,3-a][1,4]
diazepine. 2

Brand Names: Etilaam, Etizest, Etizola, Sedekopan,

Depas, Pasaden.3

Classification: Depressant.
Image: Wikimedia commons
Background: Etizolam is unlicensed in the UK although
used as a prescribed medication in other countries such
as India, Italy and Japan. 4,5,6 A 1mg tablet is equivalent to
a 10mg diazepam (Valium) tablet. 7

Appearance: Etizolam typically comes in 1mg and 2mg

tablets which are often described by online vendors as
‘pellets’. Its appearance can vary depending on the source
of purchase: tablets can be blue, pink or white and more
increasingly may be sold as ‘street Valium’ and therefore
can appear as light blue tablets with commonly-seen Image: Police Scotland 9
Valium markings. When sold as etizolam, it can be found
in a foil strip packet with the brand name on the foil
such as Etilaam or Etizest. There are other
tablets in circulation which are lighter blue
(similar to blue diazepam colour) and can
display the markings EZ. Tablets from other
vendors may simply come as unmarked
blue, pink or white pills that come loose in
a zip-seal plastic bag.8
It is also possible to purchase in powder
form, which is often white.10 Anecdotal
reports suggest that it is rare for users to
purchase the powder form in the UK.

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 UK & IRELAND
DrugWatch
Information Sheet
Etizolam
UK & IRELAND
DrugWatch

Version: 1.2
Original version: 17/06/2014 UK & IRELAND
DrugWatch
Revision date: 22/12/2017

Cost: Etizolam varies in cost, depending on the form and quantity purchased. They
can range from £1 for single tablets (or in quantities less than 10), to as low as 5p per
tablet at larger quantities. 100 tablets typically cost around £40. The powder form
ranges from approximately £10 for 50mg, to £950 for 20 grams.11

Route of administration: Etizolam is generally consumed orally, by swallowing

tablets or powder placed into gel capsules.8 It can also be taken sublingually (under
the tongue).10 There are reports of snorting and rectal administration although this
appears to be rare on the UK scene.

Legal Status: Etizolam was classified as a Class C drug in the May 2017 amendment
to The Misuse of Drugs Act 1971.23

Dosage (when prescribed): 12

Anxiety disorder 0.25-0.5mg twice daily

Panic disorder 0.5mg twice daily
Insomnia 1-2mg daily
Maximum daily dosage 3mg

Current guidance for prescribing benzodiazepines is that they should not be

prescribed beyond two weeks to prevent dependence.27 A gradual taper strategy
when stopping etizolam is also recommended to ease any withdrawal effects. There
is limited data on etizolam toxicity in the literature.

Recreational oral dose: 8

Light Common Strong Heavy

0.5mg 1-2mg 3-4mg 5mg+

Onset, duration and after effects: Oral doses have an onset of 30-60 minutes and
peak at 3-4 hours. The duration is generally 6-8 hours although higher doses can last
longer. Usual after effects are between 1-5 hours although many users report little
after effects, especially if they have had a 7-8 hour period of uninterrupted sleep
after use.13

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 UK & IRELAND
DrugWatch
Information Sheet
Etizolam
UK & IRELAND
DrugWatch

Version: 1.2
Original version: 17/06/2014 UK & IRELAND
DrugWatch
Revision date: 22/12/2017

In therapeutic doses, the plasma elimination half-life is between 3.4 and 6 hours
(normal daily dosage is up to 2mg/day in divided doses, as per the manufacturer).1,12
However, etizolam has an active main
metabolite, alpha-hydroxyetizolam, with
an elimination half-life of about 8.2 hours. 1

Typical effects and side effects: 8 These

are some of the typical effects and side
effects experienced by people who use
etizolam. Not everyone will experience all
of the effects listed and many can be dose-
dependent. Overall, etizolam is reported to
be “well tolerated with little side effects”
when prescribed. 14

Physical effects

Decrease in energy, decreased heart rate, impaired coordination, sleepiness,

respiratory depression, blurred vision, yawning, constricted pupils, decreased
appetite, nausea and vomiting, muscle relaxation, dry mouth, headache,
involuntary eye closure, rebound insomnia (prolonged use).

Mental effects

Mood enhancement, relaxation, reduced anxiety, lowered inhibitions,

sedative effects, mental confusion, short term memory loss

Comedown effects: Some users report malaise after use but the majority of people
who use on an occasional basis suggest there is little comedown or hangover. Using
on a more frequent basis can lead to rebound anxiety and/or depression, with
difficulty sleeping, problems falling asleep or waking early.

Brain chemistry and pharmacological effects: Etizolam is a full benzodiazepine

receptor agonist and so has a broadly similar pharmacological profile to
benzodiazepine drugs such as diazepam.15 It has the full range of group-specific
benzodiazepine effects: anxiolytic, sedative, hypnotic, anticonvulsant and muscle
relaxant, and is approximately 10 times more potent than diazepam. 7 It differs from
drugs such as diazepam as it has selective and high affinity binding to postsynaptic
GABA-A receptor alpha2 subunit, which results in specific anxiolytic effects. 16

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 UK & IRELAND
DrugWatch
Information Sheet
Etizolam
UK & IRELAND
DrugWatch

Version: 1.2
Original version: 17/06/2014 UK & IRELAND
DrugWatch
Revision date: 22/12/2017

Patterns of use: Patterns of use appear to be similar to other benzodiazepines. Some

users report using etizolam as a comedown aid after using stimulant or psychedelic
drugs.
Etizolam has been a growing feature in drug related deaths. It is not clear from
the statistics whether people have intended to take etizolam or have believed it to
be street Valium. In Scotland in 2016, there were 286 deaths for which NPSs were
implicated in, or potentially contributed to the cause of death. In 277 cases, the
only NPSs present were benzodiazepines (usually etizolam, but sometimes other
unlicensed benzodiazepines such as diclazepam or phenazepam).28

Tolerance, dependence and withdrawal: Benzodiazepines such as etizolam which

are more rapidly eliminated from the body are less likely to accumulate, 17 and there
is evidence to suggest that etizolam
is less likely to induce tolerance and
dependence compared with classical
benzodiazepines. 18
However, dependence may develop
with regular use of benzodiazepines,
even in therapeutic doses for
short periods. If benzodiazepines
are discontinued abruptly after
regular use, withdrawal symptoms
may develop. Administration of
regular doses of benzodiazepines Image: Wikimedia commons
can result in physical dependence,
characterized by a withdrawal syndrome when the drug is discontinued. With larger
doses, the physical dependence develops more rapidly. 19
Withdrawal symptoms include: anxiety, insomnia, headache, dizziness, tinnitus,
anorexia, vomiting, nausea, tremor, weakness, perspiration, irritability, hypersensitivity
to visual and auditory stimuli, palpitations, tachycardia (fast heart rate) and postural
hypotension (drop in blood pressure on standing). In severe and rare cases of
withdrawal from high doses, patients may develop affective disorders or motor
dysfunction: seizures, psychosis, agitation, confusion, and hallucinations. 20, 21
There is also evidence that links benzodiazepine use (in conjunction with alcohol) as
a factor in offending. 22

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 UK & IRELAND
DrugWatch
Information Sheet
Etizolam
UK & IRELAND
DrugWatch

Version: 1.2
Original version: 17/06/2014 UK & IRELAND
DrugWatch
Revision date: 22/12/2017

Long term effects/known harms: Etizolam is entirely metabolised by the liver and so
is contraindicated in those with liver function issues. 25 Loss of hypnotic effects and
increased tolerance may be experienced with long term use. There is also a risk of
dependence and addiction with repeated use.
Benzodiazepines commonly cause drowsiness, ataxia (neurological conditions
which affect balance and coordination), dysarthria (difficulty speaking), nystagmus
(involuntary eye movement) and blepharospasm (involuntary closure of eyelids).
Coma, hypotension (low blood pressure), bradycardia (slow heart beat) and
respiratory depression occasionally occur but are seldom serious if these drugs are
taken alone. Coma usually lasts only a few hours but may be prolonged in elderly
patients.
Benzodiazepine respiratory depressant effects are more serious in patients with
severe chronic obstructive airways disease. Severe effects in overdose also include
rhabdomyolysis (breakdown of muscle tissue) and hypothermia.
Co-ingestion of alcohol and other central nervous system depressants potentiates
the effects of benzodiazepines and can increase toxicity.

Harm reduction advice for clients, if determined to use:

• Try a small test amount (e.g. 0.5mg) and wait at least 1 hour before taking
any more.
• Avoid mixing with alcohol.12
• Etizolam can increase the risk of drowsiness, ataxia (problems with
movement, balance and speech) and disturbances of consciousness
if taken with neuroleptics, antidepressants, antihistamines, analgesics,
antiepileptics or other similar prescribed medications. 12
• Control quantities taken in one session.
• Try not to use alone and tell friends what they are taking.
• Place sleeping people in the recovery position. If going to sleep, sleep on
their side.
• Do not drive or operate machinery.
• Be aware that tolerance and dependency can develop quickly.
• Avoid if they have any history of benzodiazepine addiction.
• Seek help from medical support quickly if they experience any negative
side effects.

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 UK & IRELAND
DrugWatch
Information Sheet
Etizolam
UK & IRELAND
DrugWatch

Version: 1.2
Original version: 17/06/2014 UK & IRELAND
DrugWatch
Revision date: 22/12/2017

Overdose & Emergencies: As unconsciousness or overdose is possible try to make

sure a friend is around who is not using the drug. If a user becomes unconscious
call an ambulance, then place them in the recovery position to prevent choking (see
images below). The recovery position is for someone who is unconscious but breathing
normally. If they are not breathing normally CPR is required, with an emphasis on
giving supplementary oxygen via rescue breaths.

Start by placing Place the other arm Lift up the knee that Turn them on their side
their arm as if they across their chest and is furthest from you. by pulling the knee
are waving. hold their hand against Continue to hold their towards you and down.
their cheek. hand in place.

For further information on Overdose & Emergencies see UK and Ireland DrugWatch
Information Sheet.26

Where to get help: We would advise anyone experiencing issues from

etizolam or other substances to seek medical support via their GP or NHS 24
on 08454 24 24 24 (Scotland) or NHS Direct 111 (England and Wales).
There are a wide range of local drug services throughout the UK, to find out
what is available in your area please use the links below:
Scotland: Scottish Drug Services England: Find Support | Frank
Wales: Dan 24/7 Northern Ireland: Public Health Agency ROI: Drugs.IE

For further advice, medical professionals can use the National Poisons Information
Service 24-hour telephone service on 0344 892 0111 or its online database, TOXBASE.
Any health professional encountering an unusual or unexpected adverse reaction to
the use of etizolam (or any other drug) should report the reaction to RIDR.

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 UK & IRELAND
DrugWatch
Information Sheet
Etizolam
UK & IRELAND
DrugWatch

Version: 1.2
Original version: 17/06/2014 UK & IRELAND
DrugWatch
Revision date: 22/12/2017

If you require more information on this briefing or information about NPS training
please contact staff at SDF on 0141 221 1175 or you can visit the website:
www.sdf.org.uk.

Disclaimer: This information has been collated from a variety of sources including
expert users from UK and Europe, information obtained from users through interviews,
surveys and questionnaires and information from users via relevant websites and
drug forums. This information sheet is to be used as a rough guide only and SDF/
Drugwatch cannot vouch that all information is factual as there is little scientific or
medical evidence available on the substance and much of the information has been
obtained from service users’ reports.

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 UK & IRELAND
DrugWatch
Information Sheet
Etizolam
UK & IRELAND
DrugWatch

Version: 1.2
Original version: 17/06/2014 UK & IRELAND
DrugWatch
Revision date: 22/12/2017

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