An Overview of Benzodiazepines

Uses, Types, Side Effects, Benefits, and Risks

Side Effects
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Benzodiazepines are a class of drugs known as central nervous system depressants that are used to treat a variety of mood disorders and other health conditions, including seizures, insomnia, and alcohol withdrawal. While they're effective in treating these conditions for a short time, benzodiazepines may cause frustrating side effects like drowsiness, loss of libido, and lack of coordination. Long-term use can lead to adverse behavioral symptoms and drug dependence.

How They Work

Benzodiazepines, also known as benzos, downers, nerve pills, and tranks, work by enhancing your brain's response to a neurotransmitter called gamma-aminobutyric acid (GABA), which reduces the excitability of nerve signals in your brain and slows it down, leading to the relaxation of certain physiological and emotional responses. This results in a calming, tranquilizing feeling.

Uses

Benzodiazepines have properties that make them useful in treating a number of health conditions. They can act as a muscle relaxant and anticonvulsant and also have sedative (relaxing), hypnotic (sleep-inducing), and anxiolytic (anti-anxiety) effects.

Some of their indications for use include:

  • Alcohol withdrawal symptoms, particularly agitation and anxiety, may sometimes be relieved with a short-term course of benzodiazepines, although the response can vary from person to person. Because of the risk of drug dependence, they are usually prescribed for no longer than a couple of weeks.
  • Certain types of epileptic seizures can sometimes be effectively controlled with Klonopin, Valium, or Ativan. Klonopin offers stronger anticonvulsant action, Valium works faster, and Ativan has a longer duration of action.
  • Generalized anxiety disorder (GAD) and other anxiety disorders can be treated with benzodiazepines, although they are less effective in achieving long-term control. As such, they shouldn't be used for longer than two to four weeks due to the risk of dependence.
  • Insomnia can be alleviated over the short term with benzodiazepines but may result in rebound insomnia if they're overused. Long-term use should be strictly avoided.
  • Panic disorder may be effectively treated with benzodiazepines as they can alleviate anxiety symptoms much faster than antidepressants, an important factor for those who experience severe or debilitating panic attacks

    Other uses include the inducement of calm before surgery or a medical procedure and the treatment of muscle spasms, irritable bowel syndrome (IBS), and abnormal sleep patterns.

    Types

    Benzos come in different formulations. Some are short-acting, some are long-acting, and they vary in potency.

    The most commonly prescribed benzodiazepines and the conditions they're typically prescribed to treat include:

    • Xanax (alprazolam) treats anxiety disorders and panic disorder, and sometimes agoraphobia (fear of open spaces), depression, and premenstrual syndrome.
    • Klonopin (clonazepam) treats panic attacks and seizures.
    • Valium (diazepam) is used to treat anxiety, seizures, muscle spasms, and alcohol withdrawal, as well as IBS and panic attacks.
    • Ativan (lorazepam) is primarily prescribed for anxiety, but may also be used for seizures, IBS, insomnia, alcohol withdrawal, and to help nausea and vomiting in people receiving cancer treatments.
    • Halcion (triazolam) is used as a short-term treatment for insomnia.

    Other benzodiazepines and the conditions they're typically prescribed to treat include:

    • Restoril (temazepam), estazolam, and flurazepam are short-term treatments for insomnia.
    • Versed (midazolam) is typically used in children before medical procedures or surgery.
    • Librium (chlordiazepoxide) treats anxiety and alcohol withdrawal, as well as IBS.
    • Tranxene (clorazepate) is used for anxiety, alcohol withdrawal, and along with other medications to control seizures.
    • Oxazepam treats anxiety, alcohol withdrawal, and IBS.

    Common Side Effects

    Most of the side effects of benzodiazepines are related to the depressant effect the drug has on your central nervous system.

    Common side effects depend on the medication you're using, but in general, they include:

    • Constipation
    • Confusion
    • Depression
    • Diarrhea
    • Drowsiness
    • Dry mouth
    • Erectile dysfunction
    • Fatigue
    • Headache
    • Impaired motor skills and coordination
    • Irritability
    • Loss of appetite or increased appetite
    • Low libido
    • Muscle weakness
    • Short-term memory loss and impaired cognition

    Long-Term Side Effects

    Long-term use of benzodiazepines may trigger a worsening of side effects and, in some cases, paradoxical side effects, meaning that you may experience an opposite response to the drug than you previously had. Some of these side effects can adversely affect your mood and behavior, causing an altered perception of yourself, your environment, or your relationships.

    Long-term side effects may include:

    • Acute anxiety
    • Agoraphobia (the fear of open or public spaces)
    • Anhedonia (the inability to feel pleasure)
    • Depression
    • Inability to think cohesively
    • Loss of libido
    • Social phobias

    Dependence and Withdrawal

    Benzodiazepines are a schedule IV medication due to their risk of physical and psychological addiction. As such, they are usually prescribed for no more than two to four weeks. When they're taken for longer periods, benzodiazepines can lead to tolerance and dependence, meaning that your body will require more of the drug to achieve the same therapeutic effect. This can lead to abuse and/or dependence. Abuse of these drugs is the highest in people who also use heroin or cocaine.

    If you use any of these drugs for too long, you can experience symptoms of withdrawal if you suddenly stop. Don't ever stop taking a benzodiazepine without talking to your doctor first. Your dosage will be gradually tapered off to minimize some of the more profound symptoms of withdrawal, including:

    • Abdominal cramps
    • An altered sense of reality
    • Confusion and disorientation
    • Depression
    • Hallucinations
    • Increased sensitivity to light, pain, and/or sound
    • Insomnia
    • Irritability
    • Muscle cramps
    • Nausea and vomiting
    • Nervousness
    • Paranoia
    • Profuse sweating
    • Seizures and convulsions
    • Tachycardia (rapid heart rate)
    • Tingling, burning, or "skin-crawling" sensations
    • Tremor

    Interactions

    Not only can they cause dependence, there are many substances that can interact with benzodiazepines and cause accidental overdose or even death. Alcohol and opioid pain relievers, both of which also act as central nervous system depressants, can greatly magnify the effect of benzodiazepines. Together, these drugs may slow your respiration and heart function to a point where they may altogether stop. Because of this potentially life-threatening result, benzodiazepines should not be taken with alcohol, opioid drugs, or any other benzodiazepine, unless your doctor has decided that the benefits outweigh the risks in your particular situation.

    Be sure to tell your doctor about all the medications, vitamins, supplements, and herbal products that you're taking before you start on a benzodiazepine. Some of these can also cause serious interactions. Your doctor may need to change your dose or closely monitor you while taking a benzodiazepine.

    Some of the other medications, herbs, and foods that can cause interactions with benzos include:

    • Antidepressants
    • Certain antifungals
    • Certain antibiotics
    • Certain calcium channel blockers
    • Antihistamines
    • Cough medicine
    • Anticonvulsants
    • Other sedatives
    • St. John's wort
    • Grapefruit

    Overdose

    Potential symptoms of a benzodiazepine overdose include:

    • Confusion
    • Drowsiness
    • Slurred speech
    • Coordination problems
    • Losing consciousness (coma)
    • Dizziness
    • Weakness
    • Blurry vision
    • Slowed or difficult breathing
    • Seizures

    If you think someone has overdosed on benzodiazepines, call the poison control helpline at 1-800-222-1222 or visit their website for help. However, if the person has fallen down, is having seizures, can't breathe without difficulty, or is unconscious, call 911 to get emergency help.

    Precautions

    There are circumstances and conditions in which the use of benzodiazepines should be carefully considered or even avoided. Among them include:

    • Respiratory conditions: If you have an underlying respiratory disorder, you shouldn't use benzos as they may impair your breathing, sometimes critically. Examples of respiratory conditions include bronchitis, sleep apnea, myasthenia gravis, and chronic obstructive pulmonary disorder (COPD).
    • Pregnancy: Benzodiazepines are classified as either category D drugs, meaning that they may cause harm to an unborn baby and are contraindicated in pregnancy. Let your doctor know if you're pregnant, plan to become pregnant, or if you get pregnant while taking benzodiazepines.
    • Breastfeeding: Benzodiazepines do cross over into breast milk and can cause symptoms in your baby, so they should be avoided if at all possible when you're breastfeeding.
    • Depression and/or post-traumatic stress disorder (PTSD): If you've been diagnosed with depression or PTSD, you need to be aware that using benzos can create an increased risk of self-harm and suicide, as well as drastic mood changes.
    • Elderly: In anyone aged 65 years or older, benzodiazepines should be used cautiously and in lower doses due to the increased risk of dependence and an increased sensitivity to drug side effects like memory loss, impaired coordination, and loss of cognition.
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