What is the first-line pharmacologic treatment for an acute panic attack?

• A. Clonazepam
• B. Lorazepam
• C. Diazepam
• D. Alprazolam

Answer: (A)

When a panic attack hits, the priority is rapid relief of intense fear and autonomic symptoms. Benzodiazepines act quickly by enhancing GABA-A inhibition, which dampens the amygdala-driven surge that fuels panic. A medication with a fast onset and manageable duration is preferred so relief comes promptly without prolonged sedation. Lorazepam is typically favored here because it begins working relatively quickly and has a moderate duration, offering swift relief without excessive carryover effects. Alprazolam can also provide rapid relief, but its shorter half-life raises the risk of rebound symptoms if dosing isn’t maintained. Clonazepam, on the other hand, has a slower onset and a much longer half-life, which makes it less suitable for immediate crisis control and more appropriate for longer-term maintenance of panic symptoms. For an acute panic attack, a fast-acting benzodiazepine with quick relief is preferred over clonazepam, which is better suited for ongoing prevention and chronic management.