Benzodiazepines (BZD, BZs), sometimes called “Benzos”
These drugs are a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring … In 1977 benzodiazepines were globally the most prescribed medications. They are in the family of drugs commonly known as minor tranquilizers. ~ Wikipedia
Benzodiazepines are a large drug class and have a long history of development, starting with the first FDA-approvals in the 1960s, chloridiazepoxide (Librium) and diazepam (Valium). There are many options available within the class, and most benzodiazepines are now available generically, making them very affordable.
All benzodiazepines are listed as DEA schedule IV controlled substances. As controlled substances, all benzodiazepines have the potential for abuse, addiction and diversion.
In the past, benzodiazepines, especially when used as a sedative-hypnotic for sleep, were touted as safer alternatives to the older barbiturates, which could lead to fatal overdose, particularly when combined with alcohol.
Traditional benzodiazepines taken alone are rarely associated with lethal overdoses, but when combined with other sedatives or alcohol, the risk greatly increases.
Are Benzodiazepines safe?
When prescribed by a doctor and used for short periods of time, such as the day of surgery or for less than two weeks to aid sleep, benzodiazepines are safe to take.
Problems start to arise when benzodiazepines are taken at higher dosages than recommended, or when they are taken for more than two to four weeks. Benzodiazepines are potentially addictive and the risk of becoming emotionally and physically dependent on them increases the more you take. In addition, tolerance can develop with their use. This is when the same dose no longer gives the same effect, and a dosage increase is needed to ease symptoms again.
Overall, benzodiazepines should be used short-term as they can lead to tolerance, dependence (addiction) and abuse. Potent benzodiazepines with shorter elimination half-lives (triazolam, alprazolam, lorazepam) may be the most prone to causing problems with tolerance and dependence.
Withdrawal reactions can also occur if the drug is stopped suddenly, especially those that are shorter-acting. Sudden discontinuation can also lead to rebound insomnia, making sleep difficult, and perpetuating continued use and higher doses of benzodiazepines.
Discontinuation of a benzodiazepine should be done gradually under a doctor’s direction.
Benzodiazepines are Extremely Dangerous!
What are the side effects of Benzodiazepines?
Drowsiness, sleepiness, or dizziness are the most common side effects reported. This can make it dangerous for people taking benzodiazepines to drive or operate machinery or perform other hazardous tasks. Alcohol may enhance these effects.
Other commonly reported side effects include:
- amnesia (forgetfulness)
- sexual dysfunction
- unsteadiness when walking or standing
- unusually slow and shallow breathing
- vision problems (blurred or double vision).
Withdrawal symptoms may occur with abrupt discontinuation – symptoms may include convulsions, cramps, insomnia, sweating, tremors, and vomiting.
Some people develop a paradoxical reaction to benzodiazepines – this is the opposite reaction to what you would expect. They may become agitated or very anxious, develop hallucinations, have difficulty sleeping or exhibit bizarre behavior such as taking off their clothes in public or taking unnecessary risks.
What are the risks of Benzodiazepine use?
- You may become dependent on a benzodiazepine. This may happen if you use benzodiazepines every day, or 2 or 3 times a day for weeks or months. Use of benzodiazepines at the same time as alcohol, marijuana, or cocaine may be life-threatening. Benzodiazepines may cause sleepiness. You may be at higher risk for falling or becoming confused. You may have increased aggression or hostility. Benzodiazepines may also cause you to be more impulsive, excited, or irritable.
- Benzodiazepines can cause long-term medical problems for your baby. They can be life-threatening. If you are pregnant and use benzodiazepines, your baby may become dependent on the medicine. When the baby is born, he will have signs and symptoms of withdrawal. If you breastfeed your baby, he can get the medicine through your breast milk.
What are the signs and symptoms of withdrawal?
If you have used benzodiazepines for a long time, do not suddenly stop taking them. A sudden stop could cause withdrawal symptoms. You must decrease the amount of medicine and the frequency slowly over time to avoid withdrawal symptoms. Signs and symptoms may begin hours to days after you stop taking benzodiazepines. They may continue for a month or longer. You may have any of the following:
- Nausea or vomiting
- Increased sweating, or a fast heartbeat
- Seeing, feeling, or hearing things that are not there
- Shaky hands
- Trouble falling or staying asleep
- Repeated behaviors, such as pacing or wringing your hands
- Anxiety or nervousness
Types of Benziodiazepines
All benzodiazepines are listed as DEA scheduled IV controlled substances. As controlled substances, all benzodiazepines have the potential for abuse, addiction and diversion.
- alprazolam Niravam, Xanax, Xanax XR anxiety, panic disorders 6-26h (short-acting)
- chlordiazepoxide Librax anxiety, alcohol withdrawal 30-100h (long-acting)
- clobazam Onfi Lennox-Gastaut syndrome, adjunct (seizures) 71-82h (long-acting)
- clonazepam Klonopin seizure disorder, panic disorder, neuralgia (nerve pain) 20-50h (long-acting)
- clorazepate Tranxene T-Tab anxiety, alcohol withdrawal, partial seizures 20-100h (long-acting)
- diazepam Valium anxiety, sedation, alcohol withdrawal, muscle spasm, seizure disorders 20-100h (long-acting)
- estazolam ProSom insomnia (short-term use) 10-24h (medium-acting)
- flurazepam Dalmane insomnia (short-term use) 40-100h (long-acting)
- lorazepam Ativan anxiety, insomnia (short-term use), seizures, sedation 10-20h (medium-acting)
- midazolam Versed sedation, preoperative; general anesthesia induction; seizures 2.5h (short-acting)
- oxazepam Serax anxiety, alcohol withdrawal 5-15h (short-acting)
- temazepam Restoril insomnia (short-term use) 10-20h (medium-acting)
- triazolam Halcion insomnia (short-term use) 2-5h (short-acting)