Benzodiazepines are a class of psychoactive drugs used to treat
anxiety, insomnia, and a range of other conditions. They are one of the
most widely prescribed medications in the U.S., particularly among
elderly patients.
Benzodiazepines possess sedative, hypnotic, anti-anxiety, anticonvulsant, and muscle relaxant properties.
Benzodiazepines work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) - which is responsible for reducing the activity of neurons that cause stress and anxiety.
Short term use of these mediations are generally safe and effective. However, the long term use of benzodiazepines is very controversial, because of the potential of tolerance, dependance, and other adverse effects.
The first benzodiazepine - chlordiazepan - was accidentally developed in 1955 by Leo Sternbach.
When someone feels overly anxious the brain becomes "excited" and over-active, tranquilizing transmitters need to quickly send messages to brain cells to slow down activity in the brain and reduce the symptoms of anxiety.
GABA is the brain's tranquilizing neurotransmitter, and billions of brain cells respond to its signals.
Benzodiazepines work by enhancing the effect of the neurotransmitter GABA. The drugs contain chemicals which add to the calming effect already produced by the human body and essentially keep the brain in a more "tranquilized" state.
List of Benzodiazepines:
A study, published in the BMJ (British Medical Journal), identified an association between prolonged use of benzodiazepines among seniors (over 65s) and an increased risk of dementia. Long-term use of benzodiazepines can also result in physical dependence.
The withdrawal symptoms of benzodiazepines include trouble sleeping, feelings of depression and sweating.
If someone has become dependent on a benzodiazepine it is crucial that they do not suddenly stop therapy cold turkey. Stopping cold turkey can result in life threatening seizures, tremors, and muscle cramps. Therefore, it is important to taper off benzodiazepines very slowly with professional help.
Some drugs, including antidepressants and oral contraceptives can cause excessive drug accumulation and increased side-effects of benzodiazepines.
In contrast, St John's wort, the antibiotic rifampicin, and the anticonvulsants carbamazepine and phenytoin decrease the effectiveness of benzodiazepines.
Most importantly, patients should never mix benzodiazepines with alcohol or opioids, the interaction can be life threatening.
SAMHSA Administrator Pamela S. Hyde, J.D., said that "the misuse of benzodiazepines along with other prescription drugs is fueling the rise of treatment admissions. Prescription drug misuse is dangerous and can even be deadly.
Everyone has a role to play in helping to prevent prescription drug misuse. Simple steps such as locking up medications and proper disposal of unused medications are easy ways people can contribute to reducing the problem."
Benzodiazepines possess sedative, hypnotic, anti-anxiety, anticonvulsant, and muscle relaxant properties.
Benzodiazepines work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) - which is responsible for reducing the activity of neurons that cause stress and anxiety.
Short term use of these mediations are generally safe and effective. However, the long term use of benzodiazepines is very controversial, because of the potential of tolerance, dependance, and other adverse effects.
The first benzodiazepine - chlordiazepan - was accidentally developed in 1955 by Leo Sternbach.
Medical uses of benzodiazepines
- Generalized anxiety disorder (GAD) - Benzodiazepines are often used in the treatment of GAD. The National Institute of Health and Clinical Excellence (NICE) recommends the use of benzodiazepines for short term GAD treatment for no longer than one month. SSRIs are considered to be more effective at treating long-term GAD.
- Insomnia - As Benzodiazepines can lead to dependence, they are normally only used as a short-term treatment for severe insomnia or on a "irregular/as-needed" basis.
- Seizures - Benzodiazepines are powerful anticonvulsants and are very effective at preventing prolonged convulsive epileptic seizures. The first-line hospital choices for treating seizures are either clonazepam, diazepam, or lorazepam.
- Alcohol withdrawal - The most common benzodiazepine prescribed for alcohol withdrawal is chlodiazepoxide, followed by diazepam. The drugs help alcoholics with detoxification and reduce their risk of severe alcohol withdrawal effects. A study conducted at the University of Ioannina School of Medicine in Greece found that people given benzodiazepines were 84 percent less likely to have alcohol withdrawal-related seizures compared to those given placebos
- Panic attacks - Because of their rapid anti-anxiety effects, benzodiazepines are very effective at treating anxiety associated with panic disorder. The American Psychiatric Association says that their use for initial treatment is strongly supported by many different study trials. However, UK based NICE says that long-term use of benzodiazepines for the treatment of panic disorder is not recommended.
Mechanism of benzodiazepines
The human brain contains many different neurotransmitters which are responsible for sending messages between brain cells, these messages have either "tranquilizing" or "excitatory" effects.When someone feels overly anxious the brain becomes "excited" and over-active, tranquilizing transmitters need to quickly send messages to brain cells to slow down activity in the brain and reduce the symptoms of anxiety.
GABA is the brain's tranquilizing neurotransmitter, and billions of brain cells respond to its signals.
Benzodiazepines work by enhancing the effect of the neurotransmitter GABA. The drugs contain chemicals which add to the calming effect already produced by the human body and essentially keep the brain in a more "tranquilized" state.
What are the different types of benzodiazepines?
There are many different benzodiazepines and they all have differences in potency, speed at which they are metabolized, and "half-life" (time required for the quantity of the drug in the bloodstream to decrease to half its value), and therapeutic use.List of Benzodiazepines:
- Alprazolam (Xanax) - FDA approved for the treatment of panic and anxiety disorders. Alprazolam is the most prescribed benzodiazepine in the U.S.
- Bromazepam (Lectopam) - Used as a short-term treatment for anxiety and to alleviate anxiety before surgery.
- Brotizolam (Lendormin) - A very potent anxiolytic, hypnotic, and anticonvulsant drug with fast onset of action. It is used to treat severe insomnia. The drug is not approved in Canada, Britain and the U.S.
- Chlordiazepoxide (Librium) - Used for the management of alcohol withdrawal syndrome.
- Clonazepam (Klonopin) - A high potency sedative, anxiolytic, hypnotic, and anti-convulsant drug. Clonazepam is a long acting benzodiazepine with a half life between 20 to 50 hours. The FDA has approved the drug for treatment of epilepsy and panic disorder.
- Clorazepate (Tranxene) - A hypnotic, sedative, anxiolytic drug used to treat severe insomnia and anxiety disorders.
- Clotiazepam (Clozan) - Used for short term anxiety treatment.
- Cloxazolam (Sepazon) - Prescribed to treat anxiety.
- Diazepam (Valium) - An anxiolytic, hypnotic, sedative, and anticonvulsant drug with rapid onset. It is used to treat panic attacks, insomnia, seizures, restless leg syndrome, and alcohol withdrawal. Diazepam is also used for the treatment of benzodiazepine dependence because of its low potency.
- Estazolam (ProSom) - A sedative, anxiolytic drug prescribed for short term treatment of insomnia
- Etizolam (Etilaam) - Used to treat insomnia
- Flunitrazepam (Rohypnol) - Usually prescribed for short term treatment of chronicly severe insomnia. The drug is sometimes misused as a date rape drug because of its ability to cause amnesia.
- Flurazepam (Dalmane) - A sedative, anxiolytic drug used to treat mild to moderate insomnia.
- Loprazolam (Somnovit) - A sedative, anxiolytic drug used to teat moderately severe insomnia.
- Lorazepam (Ativan) - A very high-potent drug with sedative, anxiolytic, and muscle relaxation properties. It is prescribed for the short-term management of severe anxiety.
- Midazolam (Dormicum) - A high potent drug with anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties. It is used to treat acute seizures and severe insomnia, as well as inducing sedation before surgical procedures.
- Nitrazepam (Alodorm) - A hypnotic drug used to treat severe insomnia.
- Nordazepam (Nordaz) - An anticonvulsant, anxiolytic, muscle relaxant and sedative drug used to treat anxiety.
- Oxazepam (Seresta) - Used to treat anxiety and insomnia and control the symptoms of alcohol withdrawal.
- Temazepam (Restoril) - Approved for the short-term treatment of insomnia.
Side effects and risks associated with benzodiazepines
Side effects of benzodiazepine usage may include:- Drowsiness
- Confusion
- Dizziness
- Trembling
- Impaired coordination
- Vision problems
- Grogginess
- Feelings of depression
- Headache
A study, published in the BMJ (British Medical Journal), identified an association between prolonged use of benzodiazepines among seniors (over 65s) and an increased risk of dementia. Long-term use of benzodiazepines can also result in physical dependence.
The withdrawal symptoms of benzodiazepines include trouble sleeping, feelings of depression and sweating.
If someone has become dependent on a benzodiazepine it is crucial that they do not suddenly stop therapy cold turkey. Stopping cold turkey can result in life threatening seizures, tremors, and muscle cramps. Therefore, it is important to taper off benzodiazepines very slowly with professional help.
Drug interactions
Before beginning treatment with a benzodiazepine it is important to tell your doctor about every medication you are on.Some drugs, including antidepressants and oral contraceptives can cause excessive drug accumulation and increased side-effects of benzodiazepines.
In contrast, St John's wort, the antibiotic rifampicin, and the anticonvulsants carbamazepine and phenytoin decrease the effectiveness of benzodiazepines.
Most importantly, patients should never mix benzodiazepines with alcohol or opioids, the interaction can be life threatening.
Misuse of benzodiazepines
Abuse of Benzodiazepines is becoming a serious public health issue. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), hospital admissions among people over the age of 12 related to the abuse of benzodiazepine drugs rose from 22,400 in 1998 to approximately 60,200 in 2008.SAMHSA Administrator Pamela S. Hyde, J.D., said that "the misuse of benzodiazepines along with other prescription drugs is fueling the rise of treatment admissions. Prescription drug misuse is dangerous and can even be deadly.
Everyone has a role to play in helping to prevent prescription drug misuse. Simple steps such as locking up medications and proper disposal of unused medications are easy ways people can contribute to reducing the problem."
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