Sep 13th 2023
Benzodiazepines are typically used as a sedative or anxiolytic medication. They are effective at treating sleep and anxiety disorders but can cause unpleasant side effects, withdrawal symptoms, and a risk of dependency, so they are often used short term. Alternative medications and treatments are available that can help manage these conditions.
Benzodiazepines, sometimes referred to as benzos or BZDs, are a class of drugs used for their sedating and calming effects. There are several different benzodiazepines, each with varying uses, depending on how quickly they work and for how long the effects are felt .
Although they can be very effective medications, benzodiazepines can be associated with a risk of abuse or dependence. As such, they are typically not prescribed for long-term use, and there are guidelines for prescribing them safely .
The FDA has approved the use of benzodiazepines in the treatment of several conditions. Due to their risk of addiction, It is advised not to use benzodiazepines long-term, so FDA guidelines suggest they are used for a limited time. Benzodiazepines are approved for use in the following :
Benzodiazepines are often prescribed off-label, meaning they are prescribed for uses not approved by the FDA. This is typically due to increased risks of abuse and dependency or because the effectiveness and safety of their use in treating these conditions have not been determined. This includes conditions such as :
Benzodiazepines affect a neurotransmitter called gamma-aminobutyric acid (GABA). GABA is a neurotransmitter found throughout the body, including the brain, spinal cord, and central nervous system (CNS). It plays a vital role in the regulation of several functions, including cognition, mood, breathing, and blood pressure .
Benzodiazepines are categorized as short-acting, intermediate-acting, and long-acting. This refers to how long the medication stays in the body (half-life) and how long the effects are felt. Short-acting benzodiazepines leave the body faster, so they are commonly used for insomnia as they are less likely to cause ongoing effects the following day.
Long-acting benzodiazepines last for a long time, so they are used as ongoing anxiety treatments. These medications can cause a ‘hangover,’ as the sedating effects continue to be felt the following day or longer. However, they are less likely to cause withdrawal symptoms than short-acting benzodiazepines .
Additionally, the potency of benzodiazepines varies, with higher potency medications often working quicker than lower potency. High-potency benzodiazepines are usually fast acting and often used for acute symptoms.
As such, the type and dosage of benzodiazepine an individual is prescribed will depend on their condition and symptom severity, as this will impact how quickly and for how long the medication needs to be in effect .
There are several benzodiazepines available for prescription in the US. These medications are often available in various forms, including tablets, dispersible tablets, oral liquids, nasal sprays, suppositories, and injectable liquids. Some of the more commonly prescribed benzodiazepines include :
When starting a new medication, it is common to experience some side effects. Generally, these side effects are not severe, but you should consult your doctor if they are persistent or concerning.
If benzodiazepine use is abruptly stopped after being used regularly for an extended time, withdrawal symptoms can occur. Withdrawal symptoms can be unpleasant and even fatal in some cases and can last several days to several months.
Regular benzodiazepine use over several days or weeks can lead to a physical dependence or addiction. This increases the risk of withdrawal symptoms when the medication is stopped and the risk of misuse, such as extended or increased use beyond the prescribed dosage.
Additionally, benzodiazepines are often misused by people for whom the prescription is not intended. Benzodiazepines are often sold as illicit drugs for recreational use to experience a ‘high.’ To try and mitigate this risk, repeat prescriptions are not provided and are written for limited use .
It is advised to keep benzodiazepines locked away or in a safe place to prevent them from being accessed by children or people for whom the prescription is not written.
The risk of benzodiazepine dependence and abuse is higher in those with an alcohol or substance use disorder, so it may not be appropriate for these individuals to be prescribed benzodiazepines .
Benzodiazepines act as a depressant of the central nervous system (CNS), so it is advised to limit or avoid their use alongside other CNS depressant medications or substances. This includes alcohol, illicit drugs, opioid painkillers, sedatives, sedating antihistamines, anxiolytics, and anesthetics. Combined use of CNS depressants can result in breathing difficulties and may be fatal .
Benzodiazepines can also interact with other medications, impacting their effects. This includes oral contraceptives, antibiotics, antifungals, St John’s wort, anticonvulsants, antidepressants, and antipsychotics .
It is advised to inform your doctor of any medications used before starting benzodiazepine treatment.
Inform your doctor if you have breathing problems, sleep apnea, heart, liver, or kidney problems, or a history of drug or alcohol use disorders. It may not be appropriate or safe for you to take benzodiazepines. Alternatively, you may require a reduced dose and careful monitoring throughout the duration of treatment .
There is a risk of fetal harm if benzodiazepines are used during pregnancy. Similarly, the medication can be excreted in breast milk, which can cause side effects or withdrawal symptoms in breastfeeding infants. As such, it is typically not advised to use benzodiazepines while pregnant or breastfeeding .
Your doctor may recommend an alternative medication or treatment to help you manage your condition or will reduce your daily dose to prevent harm to the fetus or newborn.
Many alternative treatments are available to help manage anxiety disorders and insomnia. Often, sleep problems are associated with anxiety symptoms, and many treatment options can improve both conditions .
Medications that can help reduce insomnia and sleep disturbances include:
Engaging in psychotherapy, or talk therapy, can help improve anxiety symptoms. Various types of therapy are available, including cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Improved anxiety symptoms can also help to reduce insomnia .
Sticking to a sleep schedule can also help reduce anxiety symptoms and improve sleep quality. This includes :
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