Benzodiazepines increase gamma-aminobutyric acid (GABA), which is a neurotransmitter (or chemical messenger) in the brain. This slows down the nervous system and has a relaxing, sedative effect that works to relieve anxiety. While effective, they can come with potentially serious side effects and require some precautions when taking them. Midazolam, in particular, is one of the most lipophilic benzodiazepines, meaning it rapidly crosses the blood-brain barrier (to enter your CNS).
Benzodiazepines: Uses, Dangers, and Clinical Considerations
Prescribing interventions, substitution, psychotherapies and pharmacotherapies all contribute to the management of benzodiazepine dependence. There is therefore a need to develop a better evidence base and treatment paradigm for these patients. Urine drug screening is complicated by the presence of benzodiazepine metabolites. Care should be taken in interpreting the results as some metabolites are themselves parent compounds. For example, temazepam and oxazepam are metabolites of diazepam, which may lead the practitioner to conclude that the patient had been taking other benzodiazepines during diazepam treatment. Urine drug screening should be used as a tool to engage the patient rather than as a punitive measure.
Benzodiazepines Uses, Indications, and Side Effects
- The experimental group in this study had a weekly 1/10-dose reduction after a 2 week stabilization period [72].
- Gastrointestinal reactions may include retching, nausea and vomiting, and excess salivation.
- According to certain 2019 recommendations, people with severe anxiety or panic attack disorder should be prescribed the lowest effective dose of benzodiazepines for no more than 2 to 4 weeks.
- CNS and neuromuscular adverse effects may include euphoria, hallucination, ataxia, dizziness, seizure-like activity, and paresthesia.
The primary difference between these drugs is the length of time they stay active in the body. However, benzodiazepines can cause physical dependence and withdrawal even when they are taken as directed. Although benzodiazepines can effectively treat anxiety and insomnia, they’re addictive and can cause lethal interactions with other drugs such as opioids.
4. Special Populations and Withdrawal
- Catatonia presents in populations suffering from bipolar disorder, schizophrenia, or a variety of medical conditions.
- When prescribed by a doctor and used for short periods of time, such as the day of surgery or for less than two weeks (but not every night) to aid sleep, benzodiazepines are safe to take.
- However, no set schedule for a taper has been validated in the current literature.
- For example, midazolam is given by injection and often used alongside anesthesia medications because it works quickly to cause sleepiness.
- Talk with a healthcare professional if you have any concerns about safely taking benzodiazepines.
- Benzodiazepines have properties that make them useful in treating a number of health conditions.
Withdrawal symptoms may be worse for short-acting benzodiazepines because your body has less time to adjust to being without them. Your doctor may change your prescription to a long-acting benzodiazepine such as clonazepam and slowly lower the dosage. During the previous year, 12.6 percent of people ages 18 and older, or more than 1 in 8, used benzodiazepines.
Alcohol withdrawal
In some patients, severe allergies like anaphylaxis and angioedema have been reported with benzodiazepines. Next day drowsiness and “hangover effect” is a concern with benzodiazepines that have long duration, for example, with diazepam or flurazepam. The sedative side effects can carry into the next day and impair driving and other daily activities; this is a particularly concerning risk in the elderly. Benzodiazepines may be used at the beginning of therapy to lessen symptoms while the antidepressants take effect, which may take 4 to 6 weeks. Benzodiazepines such as clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium) and alprazolam (Xanax) are useful for panic attacks.
Stabilisation and maintenance therapy
The principles of management of dependence with ‘z-drugs’ such as zolpidem and zopiclone are the same as the management of benzodiazepine dependence. Any patient who has taken a benzodiazepine for longer than 3–4 weeks is likely to have withdrawal symptoms if the drug is ceased abruptly. The risk of inducing dependence can be reduced by issuing prescriptions limited to 1–2 weeks supply. Descriptions of studies performed on specific treatments of benzodiazepine dependence and withdrawal symptoms. Some studies in the past have shown that there is a correlation between chronic BZD use and a decline in cognitive function, including the development of dementia and dementia-like diseases.
When To Call the Doctor
They found significant changes in sleep microstructure in chronic insomnia with high dosage abuse of BZD, but sleep architecture changes were not significant. Long-term use of BZD leads to negative changes in sleep microstructure in patients with insomnia [35]. Overall, benzodiazepines should be used short-term as they can lead to tolerance, abuse, dependence (addiction), withdrawal and possible fatal overdose when combined with opioids. Drowsiness, sleepiness, or dizziness are the most commonly reported side effects with this drug class. Driving or operating machinery or perform other hazardous tasks can be dangerous while using these drugs. Drinking alcohol in combination with benzodiazepines may heighten these effects.
BZDs act on the CNS to exert anxiolytic and sedative effects and, together with electroconvulsive therapy, are the mainstay therapy for catatonia [13]. Benzodiazepines are often coingested with other substances, such as opioids and alcohol, in overdose. When discontinued, benzodiazepines should be slowly tapered to help avoid withdrawal symptoms like rebound insomnia and anxiety. The severe benzodiazepine withdrawal syndrome primary disadvantage of benzodiazepines is the risk of abuse, dependence, and overdose (especially with opiates). Selection of drug therapy should be based on issues with dosing, possible side effects or drug interactions, and cost. In general, the optimal treatment of these conditions in primary care is non-pharmacological, particularly psychological and behavioural, therapies.
- This slows down the nervous system and has a relaxing, sedative effect that works to relieve anxiety.
- Urine drug screening is complicated by the presence of benzodiazepine metabolites.
- Some of these side effects can adversely affect your mood and behavior, causing an altered perception of yourself, your environment, or your relationships.
- Lennox-Gastaut syndrome is a severe form of epilepsy that usually begins in early childhood and also causes developmental and behavior problems..
- Withdrawal, like with alcohol since they exert their effects on similar receptors, can be life threatening.
- Respiratory depression represents a critical concern, necessitating prompt medical intervention.
The dependence on BZDs generally leads to withdrawal symptoms, which necessitates careful tapering of the medication when prescribed [26]. Still, due to the severe potential for dependence and deadly withdrawal sequelae, guidelines for recommended use are no longer than a few weeks. Despite this, numerous studies report usage extending for months into years or even decades in many users [9]. Additionally, according to several studies, BZD use increases with age, with long-term usage most prevalent in the 65 and older population [16].