Oxazepam and related benzodiazepine drugs are used in the treatment of anxiety. All benzodiazepines currently in use share a number of effects, including sedation, hypnosis, decreased anxiety, muscle relaxation, amnesia, and anticonvulsant activity. Oxazepam and four other benzodiazepines (chlordiazepoxide, chlorazepate, diazepam, and flurazepam) were nominated for study by the Food and Drug Administration (FDA) and by the NIEHS based on their widespread use, use by pregnant women, and the lack of adequate rodent carcinogenicity studies. Oxazepam was evaluated in 14-week and 2-year studies by the NTP, and Technical Report No. 443 contains the results of the studies performed with the Swiss-Webster and B6C3F1 strains of mice. Studies with rats were not initiated at the same time as the mouse studies because adequate carcinogenicity studies of oxazepam with the Sprague-Dawley rat strain had been submitted to the FDA. Subsequently, because of the marked neoplastic responses found in the two mouse strains, the NTP initiated 2-year studies of oxazepam with the F344/N rat. Groups of male and female F344/N rats were exposed to oxazepam (greater than 99% pure) in feed for 2 years. Genetic toxicology studies were conducted in Salmonella typhimurium and cultured Chinese hamster ovary cells, and mouse peripheral blood samples were analyzed for the frequency of micronucleated normochromatic erythrocytes.
Groups of 50 male and 50 female F344/N rats were fed diets containing 0, 625, 2,500, or 5,000 ppm oxazepam for up to 105 weeks. A stop-exposure group of 50 males and 50 females received 10,000 ppm oxazepam in feed for 26 weeks, after which animals received undosed feed for the remainder of the 2-year study. The continuous-exposure concentrations resulted in average daily doses of 25, 100, or 250 mg oxazepam/kg body weight to males and 25, 110, or 220 mg/kg to females. Stop- exposure males and females received an average daily dose of 630 mg/kg during the exposure period.
Survival, body weights, and clinical findings
All 5,000 ppm continuous-exposure and 10,000 ppm stop-exposure males died before the end of the study. Survival of 2,500 ppm continuous-exposure males and females was significantly less than that of the controls. The mean body weight gains of 2,500 and 5,000 ppm males and females were less than those of the controls throughout the study. The mean body weights of 10,000 ppm stop-exposure males were generally less than those of the controls throughout the study; those of 10,000 ppm stop-exposure females were less than those of the controls during the exposure portion of the study but increased steadily after the cessation of dosing at week 27. Feed consumption by exposed groups was similar to that by the controls after week 1 of the study. Treatment-related eye/nasal discharge, hyperactivity when handled, and/or ataxia were observed in exposed male and female rats on or about day 2 of exposure but were no longer apparent after day 7.
Plasma oxazepam determinations
Plasma oxazepam concentrations were measured at the end of the study. The concentrations ranged from approximately 0.5 (625 ppm males) to 2.8 µg/mL (5,000 ppm females).
In the standard histopathologic evaluation, the incidence of renal tubule adenoma was slightly increased in male rats exposed to 2,500 ppm and was at the upper limit of the historical control range for this neoplasm in 2-year NTP feed studies. In an extended evaluation (step section) of the kidneys of male rats, the incidences of renal tubule adenoma occurred with a positive trend in exposed groups. In standard and step sections (combined), male rats exposed to 2,500 or 5,000 ppm showed a significant increase in the incidences of renal tubule adenoma and hyperplasia. In addition, the incidences of renal tubule adenoma and hyperplasia were significantly increased in the 10,000 ppm stop-exposure group. The incidences of nephropathy in continuously exposed female rats were significantly greater than in the controls, and the severity of nephropathy increased with increasing exposure concentration in males.
The incidences of epithelial hyperplasia and chronic inflammation of the forestomach in males exposed to 2,500 and 5,000 ppm and of ulcers in 2,500 ppm males were significantly greater than in the controls. Incidences of mineralization of the glandular stomach in 5,000 ppm and 10,000 ppm (stop-exposure) males and of erosion of the duodenum in 5,000 ppm males were significantly greater than in the controls. Female rats exposed to 2,500 ppm had greater incidences of epithelial hyperplasia, chronic inflammation, and ulcers of the forestomach and of erosion in the glandular stomach.
Centrilobular hepatocyte hypertrophy occurred more frequently in 2,500 and 5,000 ppm males and females than in the controls.
Oxazepam was not mutagenic in any of several strains of S. typhimurium, nor did it induce sister chromatid exchanges or chromosomal aberrations in cultured Chinese hamster ovary cells. These in vitro tests were performed with and without S9 metabolic activation. Results from an in vivo mouse peripheral blood micronucleus test performed on B6C3F1 mice used in a 14-week study were also negative.
In summary, under the conditions of these 2-year dosed-feed studies, there was equivocal evidence of carcinogenic activity in male F344/N rats, based on small increases in the incidences of renal tubule adenomas in exposed groups also exhibiting significantly enhanced nephropathy. There was no evidence of carcinogenic activity of oxazepam in female F344/N rats exposed to feed containing 625, 2,500, or 5,000 ppm for 2 years or 10,000 ppm for 6 months.
Administration of oxazepam to rats resulted in nonneoplastic lesions in the forestomach, glandular stomach, and small intestine as well as centrilobular hypertrophy of hepatocytes in the liver. In addition, nephropathy was increased in incidence in female rats and was markedly increased in severity in male rats, resulting in early mortality at the higher exposure concentrations.