The 'rattling' of packages, in my experience, happens only with one brand of etizolam - the Indian Intas ETILAAM, which uses a standard fully aluminium blister for tablets too small to fit snugly. They are also not exactly the best brand I know of.
Etizolam is quite an expensive diazepine - it is approximately eight times more expensive than the same company's diazepam (here I refer to my favoured brand, also from India, Consort ETIZEST, pink, caplet-shaped pills of 1mg which do not rattle at all. Available only in boxes of 50, 5 x 10 tabs.) The most prescribed brands in Europe, Pasaden and Depas, the first named by Bayer, are surprisingly not, IMO, as good as the two best Indian brands, Etilaam and Etizest.
I gather from this discussion that although etizolam is not actually scheduled or even mentioned in the US CSA, the 'analog' act effectively makes it illegal to import, possess or supply. Chemically, I can't actually see what exactly it is an ANALOG (in the dictionary sense) of. It has considerable differences from any other Rx thienodiazepine I know of which IS included in the CSA. Too much to go into in detail here.
In practice though, I have heard of many large shipments from Europe and India which have been opened by US Customs and yet allowed to continue to delivery.
If I may give my opinion based on the BZDs and THDs I am also familiar with in the course of my nearly forty year treatments for severe and chronic GAD and thanatophobic panic disorder, I would say that the closest commonly seen anxiolytics which give the most similar effect, are alprazolam and triazolam (which I have used from time to time not as a sleep induction agent as intended but as an anxiolytic, in dosage of 250-500mcg four times daily - a most effective use for triazolam indeed). Its sedation profile is rather less than either of the triazoloBZDs mentioned but its anxiolytic efficacy is at least equivalent. 1mg etizolam seems to give the equianxiolytic effect as around 750mcg alprazolam.
It does NOT, however, seem to be the best agent for treatment of the thanatophobic aspect of my condition, and I require LYSANXIA 80mg prn or LEXOTAN 32-48mg prn (I know, a very large range, but compare with the range of dosages required by individual patients using hydromorphone HCl for pain - some gain the same analgesia from a single 2.6mg capsule as I do from 13mg, ie FIVE x 2.6mg Palladone IR capsules, high dosage IR Hydromorph being unavailable here in the UK, Palladone SR being preferred but with very few exceptions in Palliative care only). The advantages of using Etizest with adjunctive Lysanxia or Lexotan are the relative lack of sedation or any deleterious effect on cognitive functions. I will never understand why the UK NHS tends to prescribe quite small dosages of diazepam as first line treatment, insufficient to control my problems and heavily over sedating even at lower dosages.
I am currently involved in a study of two drugs which our company believes should be available on the NHS, etizolam and flubromazepam, which displays many of the usual characteristics of fluorinated classical BZDs like fludiazepam! flunitrazepam and flutoprazepam! but with less sedation and a far longer duration of action allowing for an average dosage of 4mg bd and in severe cases, 8mg bd. Next day effect disappears after around four or five days' treatment with flubromazepam.
But to return to etizolam, as in so many countries, I believe that it should be prescribed in preference to most of the currently ost 'popular' benzos. It is particularly well prescribed in Italy and Austria, where doctors have been convinced of its usefulness for many years now. Unfortunately because of the relatively high cost, few Indians are regularly prescribed etizolam and, as in. The UK, diazepam remains the anxiolytic of choice in most cases.
There should be an organised campaign in the USA to have etizolam with all its benefits over things like lorazepam and alprazolam approved by the FDA for prescription. It IS that good and effective.