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HEALTH GUIDE / Prescription Drugs / Benzodiazepines

Benzodiazepines

About

About benzodiazepines

Benzodiazepines are a type of central nervous system (CNS) depressant used to reduce anxiety. In some cases, these medications are also used to treat insomnia, although they are only effective for this purpose over the course of a few weeks. Certain benzodiazepines are commonly used in hospital settings to lessen patients’ anxiety before medical or surgical procedures and to provide sedation for these procedures.

Benzodiazepines work on certain neurotransmitters in the brain to minimize the excitement of nerve cells and produce a calming effect. Benzodiazepines became popular in the 1960s as a safer alternative to earlier anti-anxiety medications such as barbiturates. Benzodiazepines produce less drowsiness, respiratory depression and impairment of motor function than barbiturates. In addition, they are less likely to result in fatal toxic doses.

In some patients, benzodiazepines can relieve anxiety within as little as 30 to 90 minutes. These drugs are usually prescribed only for short periods of time because there is a risk that patients may develop psychological and physical dependence on them. However, benzodiazepines may be used for up to six months to treat panic disorder.

Benzodiazepines are available as oral pills or solutions, or in some cases as injections or rectal gels.

Types

Types and differences of benzodiazepines

All benzodiazepines have similar effects, but differ in how quickly they work, how quickly they are metabolized, their potency and the duration of their actions, which is related to their half-lives (time required for a medication level to fall to half its initial concentration in the body). Examples of benzodiazepines include:


Generic Name Brand Name

alprazolam

Xanax

chlordiazepoxide

Librium

clonazepam

Klonopin

clorazepate

Tranxene

diazepam

Valium

flurazepam

Dalmane

lorazepam

Ativan

midazolam

Versed

oxazepam

Serax

prazepam

Centrax

temazepam

Restoril

triazolam

Halcion

Conditions

Indications for benzodiazepines

Benzodiazepines are used primarily to treat cases of significant anxiety. They should not be used to treat the type of stress, nervousness or tension that a person encounters in everyday life. Several anxiety disorders are commonly treated with benzodiazepines, including:

Phobias

Extremely strong, persistent irrational fears of things, places, experiences or situations. Patients may react with extreme panic when they come into contact with the stimulus that they fear. Social anxiety disorder, or social phobia, is commonly treated with benzodiazepines.

Panic disorder

Condition in which a person regularly experiences panic attacks sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes. These episodes can cause symptoms such as racing heartbeat, heavy perspiration and shortness of breath.

Generalized anxiety disorder

Condition in which a person worries excessively about all types of life issues, including health, family, money and work. Patients with this disorder may find themselves unable to relax even when there is no indication of trouble in their lives.

It appears that these disorders may at times be treated more effectively with antidepressant medications, which have the advantage of not being associated with the development of psychological dependence.

In some cases, benzodiazepines are used to treat insomnia, although they are typically effective for only a few weeks. In addition, certain benzodiazepines are commonly used in hospital settings to lessen patients’ anxiety before medical or surgical procedures.

Other anxiety disorders, such as obsessive-compulsive disorder and post-traumatic stress disorder, are usually treated with other classes of drugs, such as antidepressants.

Specific benzodiazepines are sometimes used to treat various conditions. For example:


ConditionBenzodiazepine(s) Used

Muscle tension and spasms

diazepam

Alcohol withdrawal

chlordiazepoxide
clorazepate
diazepam
oxazepam

Panic disorder

alprazolam
clonazepam

Seizure disorders

clobazam
clonazepam
clorazepate
diazepam
lorazepam


Contraindications for benzodiazepines

Patients with a history of substance abuse may be more susceptible to developing a psychological dependence on benzodiazepines. In addition, patients with damage to their kidneys or liver may maintain higher levels of benzodiazepines in their bloodstream, increasing the risk of side effects.

Individuals with brain disease are likely to suffer higher incidences of central nervous system (CNS) depression. Starting or stopping use of benzodiazepines too suddenly can trigger seizures in these patients if they have used benzodiazepines for more than a few weeks continuously.

Before taking benzodiazepines, patients should tell their physician if they have ever had an allergic reaction to this type of medication, or to substances such as foods, preservatives or dyes.

Benzodiazepines also can worsen some medical conditions, including:


  • Depression and other mental illnesses
  • Emphysema, asthma, bronchitis or other lung disorders
  • Glaucoma (eye disorder characterized by increased pressure in the eyeball)
  • Hyperactivity
  • Myasthenia gravis (disease marked by weakness of the skeletal muscles)
  • Porphyria (metabolic abnormality that causes abdominal pains and mental confusion)
  • Sleep apnea (temporary cessation of breathing during sleep)
  • Swallowing difficulties
Side effects

Potential side effects

Common side effects of benzodiazepines include marked drowsiness (which may be a therapeutic effect when used for insomnia) and impaired motor function.

Less common side effects include:


  • Increased anxiety
  • Confusion
  • Fast, pounding or irregular heartbeat
  • Memory lapses after the drug is taken
  • Depression

In some patients, use of benzodiazepines may cause psychological or physical dependence if taken for a long time or in high doses. This risk is very low when benzodiazepines are taken for short periods of time under close physician supervision.

Signs that a patient may be dependent on benzodiazepines include a strong desire or need to take the drug, or a need to increase the dosage level to get the same medicinal effect. Patients who are dependent on these drugs also may exhibit withdrawal symptoms, including irritability, nervousness, insomnia, abdominal or stomach cramps, and trembling or shaking after ceasing use of the medication. Patients who exhibit signs of dependence should not stop taking their medication, but should visit a physician for correct intervention. Improper cessation of the medication can lead to severe withdrawal symptoms and even death. In addition to the symptoms listed above, other signs of withdrawal include:


  • Tachycardia (rapid heartbeat)
  • Increased blood pressure
  • Muscle cramps
  • Anxiety
  • Panic attacks
  • Impairment of memory and concentration
  • Perceptual disturbances

Withdrawal symptoms can begin as early as one day after stopping use of the medication and may continue for weeks or months.

Some anti-anxiety drugs, including benzodiazepines, can build up in the system and cause toxicity if not monitored carefully. The risk is especially high for people who have conditions, such as kidney or liver diseases, that reduce the body’s ability to metabolize the drugs. Therefore, physicians monitor the use of benzodiazepines for potentially toxic build-up in the body.

Interactions

Drug or other interactions

Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Of particular concern to individuals taking benzodiazepines are:


  • Central nervous system (CNS) depressants. These medications cause drowsiness that may be increased when taken with benzodiazepines. Examples of CNS depressants include antihistamines, cold and hay fever medications, sedatives and tranquilizers, prescription pain medications, barbiturates, medicines for seizures, muscle relaxants, and anesthetics.
  • Alcohol. Alcohol also serves as a CNS depressant. Use of alcohol with benzodiazepines can affect the heart and breathing and may increase drowsiness.
  • Fluvoxamine or nefazodone. These antidepressant drugs may cause higher levels of benzodiazepines to remain in the system, thus increasing the hypnotic effects of the benzodiazepine and the risk of side effects.
  • Itraconazole or ketoconazole. These antifungal drugs should not be used with benzodiazepines.
  • Opioids. Benzodiazepines can interfere with the pain-killing effects of these medications.
Lifestyle

Lifestyle considerations with benzodiazepines

Because benzodiazepine use frequently causes marked drowsiness, patients who take this medication should not drive, engage in dangerous physical activities or use hazardous machinery during the initial stages of treatment. Activities can be adjusted once patients become aware of their reaction to the medication.

How to use

Pregnancy use issues

Certain benzodiazepines – such as chlordiazepoxide and diazepam – have been shown to raise the risk of birth defects in children when used during the first three months of pregnancy. Although birth defects have not been linked to other benzodiazepines, similar problems are possible, as all benzodiazepines are related. Some benzodiazepines have been shown to cause birth defects or other serious problems in animal testing.

Excessive use of benzodiazepines during pregnancy has been linked to dependency in the baby after birth. Use of benzodiazepines during the last few weeks of pregnancy may cause various problems in newborn infants, including body temperature problems, breathing problems, feeding difficulties, drowsiness and muscle weakness. High doses of benzodiazepines given to a woman within 15 hours of delivery also can cause these symptoms.

Benzodiazepines have been shown to pass into breast milk and to cause drowsiness and difficulty in feeding. Weight loss may occur in both mothers and nursing infants.


Child use issues

Side effects associated with benzodiazepines are more likely to occur in children, especially very young children. There is evidence to suggest that using the benzodiazepine clonazepam may cause deficiencies in physical and mental growth of children. In many cases, these effects may not become evident until years later. For this reason, great care must be exercised in deciding whether to give benzodiazepines to children.


Pregnancy use issues

Side effects associated with benzodiazepines are more likely to occur in the elderly. In addition, benzodiazepines that are taken for insomnia are more likely to cause daytime drowsiness in older patients. The use of benzodiazepines appears to be associated with increased rates of falls and related injuries, most notably hip fractures, in the elderly.

Symptoms of benzodiazepine overdose

Symptoms of benzodiazepine overdose can be similar to the medication’s side effects, but are usually more severe. Combining benzodiazepines with alcohol or other central nervous system (CNS) depressants can cause loss of consciousness and can even be fatal. Patients exhibiting any of these symptoms should contact their physician immediately:


  • Continuing slurred speech or confusion
  • Severe drowsiness or weakness
  • Staggering

Questions for your doctor

Patients may wish to ask their doctor the following questions about benzodiazepines:
    • Are benzodiazepines appropriate for treating my anxiety?
    • How are the various types of benzodiazepines different from one another?
    • Which benzodiazepine is best for my condition?
    • What are the side effects associated with this drug?
    • What side effects indicate the need for medical attention?
    • How quickly will I see improvement in my condition?
    • How long will I be on this drug?
    • If my condition does not improve, will you try a different type of benzodiazepine?
    • How will I know if I’m becoming dependent on the drug?
    • If I become dependent, does that mean I can never use benzodiazepines in the future?
    • Will any of the drugs I’m currently taking interact poorly with benzodiazepines?
    • Can I drink alcohol while taking benzodiazepines?

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