Benzodiazepines are medications that are frequently
prescribed for the symptomatic treatment of anxiety
and sleep disorders. They produce their effects via
specific receptors involving a neurochemical called
gamma aminobutyric acid (GABA).
Because they are safer and more effective,
benzodiazepines have replaced barbiturates in the
treatment of both anxiety and insomnia.
Benzodiazepines are also used as sedatives before
some surgical and medical procedures, and for the
treatment of seizure disorders and alcohol
The first benzodiazepine developed was
chlordiazepoxide, which is sold under such trade
names as Librium(R)* and Apo-Chlordiazepoxide(R).
Diazepam (e.g. Valium(R)) was the next
benzodiazepine to come on the market and, until the
early 1980s, was the most widely prescribed
benzodiazepine in the world. Now, newer
benzodiazepines, such as lorazepam (e.g., Ativan(R)
), alprazolam (e.g., Xanax(R)), and clonazepam (Rivotril(R)
), account for most benzodiazepine prescriptions.
(Where a name of a medication is capitalized, it is
a registered trade name of the manufacturer.)
There are several different benzodiazepines
currently available . Some are prescribed primarily
for the treatment of anxiety (e.g., lorazepam,
alprazolam and diazepam); others are recommended as
sleeping medications (such as triazolam [e.g.,
Halcion(R) ] and flurazepam [e.g., Dalmane(R)]. They
remain the most commonly prescribed group of
psychoactive (mood-altering) medications.
Even though they are effective, benzodiazepines do
has some limitations and drawbacks. They may produce
physical dependence which results in a
discontinuation or withdrawal syndrome when the
medication is stopped. This syndrome is generally
mild. However, stopping abruptly can produce a wide
range of symptoms including convulsions, especially
if high doses have been used for a prolonged period
of time. Benzodiazepines may also be misused and
The effects of any medication depend on several
* the type and severity of the disorder for which
the medication is prescribed
* the amount taken at one time
* the form in which the medication is taken
* the patient's age
* prior or concurrent use of psychoactive drugs
* the circumstances under which the medication is
taken (i.e., the user's pychological and emotional
state, simultaneous use of alcohol or other drugs,
High doses lead to heavier sedation and can impair
both mental sharpness and physical co-ordination.
Lower doses are recommended for older people and for
those with some chronic diseases, since they may be
more sensitive to medications and may metabolize
them more slowly. It has also been suggested that
benzodiazepines can impair the ability to learn and
remember new information.
Studies show that anti-anxiety agents, even when
correctly prescribed, may interfere with the ability
of some users to perform certain physical,
intellectual and perceptual functions. Most
side-effects usually occur early in treatment and
wane over time.
For these reasons, individuals should assess their
response to benzodiazepines before they operate a
motor vehicle or engage in tasks requiring
concentration and co-ordination. Such activities may
become more dangerous if benzodiazepines are used
together with alcohol and/or other sedativehypnotics
or antihistamines (found in many cold, cough and
Because some benzodiazepines (such as diazepam and
flurazepam) are metabolized and eliminated from the
body quite slowly, the medication can accumulate in
body tissues with long-term use and may heighten
such effects as lethargy in some individuals. Some
users may feel drowsy or "hung over," even
on the day after they take the medication. Seniors,
in particular, may be at increased risk of falls,
fractures and confusion.
There have been very rare reports of unexpected
stimulation resulting from benzodiazepine use, with
cases ranging from agitation to violent behaviour.
Overdoses of benzodiazepines, either accidental or
intentional, do occur. While death rarely results
from benzodiazepine overdose alone, these
medications may be fatal when used in combination
with alcohol and other drugs that depress the
central nervous system.
Tolerance and Dependence
Tolerance is the need to increase the dose of a drug
to maintain the desired effects. Tolerance to the
anxiety-relieving effects of benzodiazepines is
uncommon and most individuals do not increase their
benzodiazepine dose. But tolerance to the sedative
and other effects of benzodiazepines can develop in
some people with regular use.
Risk of physical dependence increases if
benzodiazepines are taken regularly (e.g., daily)
for more than a few months, especially at higher
than normal doses. However, problems have been
reported after shorter periods of use. The user's
body adapts to the presence of the medication and
experiences withdrawal symptoms when use is stopped.
The frequency and severity of these symptoms depend
on the dosage, the duration of use, and whether the
medication is stopped abruptly or tapered off.
Stopping abruptly can bring on such symptoms as
trouble sleeping, gastrointestinal upset, feeling
unwell, loss of appetite, sweating, trembling,
weakness, anxiety, and changes in perception (e.g.
numbness and altered sensitivity to light, sound and
smells ). In rare cases after high doses, psychosis
and convulsions may occur.
The onset and severity of withdrawal are often more
marked for benzodiazepines that are rapidly
eliminated from the body (e.g., triazolam,
alprazolam) than for those that are slowly
eliminated (e.g., diazepam).
While most patients can tolerate such symptoms a
physician may decide to gradually taper the
benzodiazepine dose to minimize discomfort,
especially after long-term use. Gradual
discontinuation of the medication is preferred, but
it may not entirely eliminate withdrawal symptoms.
Diagnostic manuals recognize the occurrence of
psychological or behavioural dependence on
benzodiazepines. The main signs of psychological
dependence on any drug are:
* a strong desire or craving for the drug
* seeking out the drug, often at the expense of
* difficulty Stopping or cutting down
* continued use despite physical or psychological
People who use benzodiazepines on a long-term basis
to treat specific chronic disorders (such as panic
disorder, social phobias or agoraphobia) rarely
exhibit such symptoms or behaviours. On the other
hand, psychological dependence has been clearly
demonstrated among certain groups, such as poly-drug
abusers and methadone-treated heroin addicts.
A woman who is pregnant or thinking about becoming
pregnant should know that benzodiazepines can affect
her baby. Use of benzodiazepines during pregnancy
may lead to withdrawal symptoms in the newborn.
Also, they are passed on through breast milk and
should be used with caution, if at all, while
nursing. However, no one should stop taking the
medication without consulting their physician first.
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