Appendix C - List of Prescription Benzodiazepines

Data To Support Social and Behavioral Research as Used by the Food and Drug Administration

Appendix C - List of Prescription Benzodiazepines

OMB: 0910-0847

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OMB Control No. 0910-0847

Expiration Date: 12/31/2022

Attachment C

Benzodiazepines



Please check all the brand names you recall using during the past 12 months. If you do not recall the brand name, just check the generic name.



Generic Names

Brand Names

Please check if you have used during 12 months prior to beginning treatment

Alprazolam



Xanax


Chlordiazepoxide



Librium


Librax


Clobazam



Onfi


Clonazepam



Klonipin


Clorazepate



Tranxene


Gen-Xene


Diazepam



Valium


Estazolam



Prosom


Flurazepam



Dalmane


Lorazepam



Ativan


Midazolam



Versed


Oxazepam



Serax


Quazepam



Doral


Temazepam



Restoril


Triazolam



Halcion




First Name: _____________ Date/Time of Full Interview with MHA: ______________________

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMark Herring
File Modified0000-00-00
File Created2022-06-06

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