What happens to the brain on benzodiazepines?
They can include:
- Drowsiness, exhaustion, fatigue
- Impaired thinking and memory
- Depression
- Slurred speech, stuttering
- Confusion
- Vertigo
- Tremors
- Respiratory depression
- Nausea, constipation, dry mouth, abdominal discomfort, loss of appetite, vomiting, diarrhea
- Impaired motor coordination
What are benzodiazepines, and are they addictive?
Names & Uses Benzodiazepines belong to the prescription sedative class of drugs. Although benzodiazepines have a calming effect, they are highly addictive, and a person who abuses them faces a host of symptoms. Some of the physical, psychological, and behavioral symptoms of benzodiazepine abuse include:
What drugs are used in hypnosis?
Top 9 Hypnotic Drugs Most Powerful
- (1) Ambien CR: zolpidem is sedative, also called as hypnotic. ...
- (2) Ativan (lorazepam): Ativan belongs to group of drugs known as benzodiazepines. ...
- (3) Estazolam: it’s a ben-zone-dye-AZE-eh-peen. ...
- (4) Edluar (zolpidem): Edluar is a sedative-hypnotic. ...
- (5) Halcion (triazolam): Halcion is a benzodiazepine which is same as valium. ...
Are hypnotics stimulants or depressants?
DEPRESSANTS. Sedative-hypnotic drugs, often referred to as “depressants,” are designed to cause sleep, relieve muscle spasms, reduce anxiety, and prevent seizures. They do this by depressing the brain’s activity, often causing slurred speech, sluggishness, inhibited coordination, memory deficiencies, disorientation, and impaired decision ...
What drugs are considered hypnotics?
Prescription Insomnia Drugs (UPDATED)Ambien (zolpidem)Belsomra (suvorexant)Butisol (butabarbital)Doral (quazepam)Edluar (zolpidem)Estazolam.Flurazepam.Halcion (triazolam)More items...•
Which form of benzodiazepine are used as hypnotics?
Short-acting (eg, triazolam) and intermediate-acting (eg, estazolam, temazepam) benzodiazepine receptor agonists are useful for sleep-onset insomnia. These agents have been the hypnotics of choice for many years because of their relative safety compared with the barbiturates, as well as their low cost.
Are benzodiazepines hypnotics or anxiolytics?
1. The benzodiazepines are among the most frequently prescribed of all drugs and have been used for their anxiolytic, anticonvulsant, and sedative/hypnotic properties.
Is Xanax a hypnotic?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5®) categorizes Xanax addiction as a sedative, hypnotic, or anxiolytic use disorder2. Alprazolam is considered an anxiolytic. Sedatives, hypnotics, and anxiolytics are substances which provide a calming or sleep-inducing effect3.
Is Lorazepam a hypnotic?
Lorazepam is a benzodiazepine medication commonly used as the sedative and anxiolytic of choice in the inpatient setting owing to its fast (1 to 3 minute) onset of action when administered intravenously. Lorazepam is also one of the few sedative-hypnotics with a relatively clean side effect profile.
What is the classification of benzodiazepines?
Benzodiazepines are controlled in Schedule IV of the Controlled Substances Act.
Is clonazepam a hypnotic?
Like other benzodiazepines, clonazepam is a sedative-hypnotic drug under the general class of CNS depressants. Unlike most other benzodiazepines, clonazepam is approved for treatment of seizure disorders (epilepsy) as well as a type of anxiety disorder called panic disorder (with panic attacks).
What is the difference between a hypnotic and a sedative?
A sedative drug decreases activity, moderates excitement, and calms the recipient, whereas a hypnotic drug produces drowsiness and facilitates the onset and maintenance of a state of sleep that resembles natural sleep in its electroencephalographic characteristics and from which the recipient can be aroused easily.
What should be avoided when taking benzodiazepines?
When benzodiazepines are combined with other sedatives, opiates or alcohol, the risk of serious side effects such as profound sedation, respiratory depression, coma, and death may occur.
Is trazodone considered a hypnotic?
Trazodone is not a medication that is primarily designed to produce sleep (a sedative or hypnotic medication). Trazodone was developed as an antidepressant medication.
Is Ambien a hypnotic?
Ambien, the brand name for zolpidem, is a sedative-hypnotic medication commonly prescribed for the short-term treatment of insomnia. While effective, Ambien does have risks, including the potential for next-day drowsiness, misuse and dependence.
Is melatonin a hypnotic?
There are two broad groups of hypnotic medications: benzodiazepines and non-benzodiazepines. Melatonin has also been suggested as a type of hypnotic and appears to be effective for some patients with sleeping difficulties.
What is a hypnotic sedative?
Sedative and hypnotics are the drugs which can reduce anxiety and produce a calming effect by inducing the onset of sleep as well as maintaining sleeping duration [1]. Nowadays, these drugs are extensively used in treatment of different psychiatric disorders including anxiety and insomnia.
Is secobarbital a sedative-hypnotic?
Secobarbital is considered to be an obsolete sedative-hypnotic (sleeping pill), and as a result, it has largely been replaced by the benzodiazepine family.
What are sedatives and hypnotics and its classification?
Anxiolytics, sedatives and hypnotics are medicines that work on the central nervous system to relieve anxiety, aid sleep, or have a calming effect. The benzodiazepines are the main class of drugs that fit into this category.
Are hypnotics and sedatives the same?
At higher doses, sedatives usually cause sleep. Drugs used mainly to cause sleep are called hypnotics. The difference between sedatives and hypnotics, then, is usually the amount of the dose; lower doses have a calming effect and higher doses cause sleep [4].
How long does it take for a benzodiazepine to be eliminated?
A benzodiazepine can be placed into one of three groups by its elimination half-life, or time it takes for the body to eliminate half of the dose. Some benzodiazepines have long-acting active metabolites, such as diazepam and chlordiazepoxide, which are metabolised into desmethyldiazepam. Desmethyldiazepam has a half-life of 36–200 hours, and flurazepam, with the main active metabolite of desalkylflurazepam, with a half-life of 40–250 hours. These long-acting metabolites are partial agonists.
What is the best benzodiazepine for detox?
Chlordiazepoxide is the most commonly used benzodiazepine for alcohol detoxification, but diazepam may be used as an alternative. Both are used in the detoxification of individuals who are motivated to stop drinking, and are prescribed for a short period of time to reduce the risks of developing tolerance and dependence to the benzodiazepine medication itself. The benzodiazepines with a longer half-life make detoxification more tolerable, and dangerous (and potentially lethal) alcohol withdrawal effects are less likely to occur. On the other hand, short-acting benzodiazepines may lead to breakthrough seizures, and are, therefore, not recommended for detoxification in an outpatient setting. Oxazepam and lorazepam are often used in patients at risk of drug accumulation, in particular, the elderly and those with cirrhosis, because they are metabolized differently from other benzodiazepines, through conjugation.
Why are benzodiazepines considered a long term drug?
Long-term use is controversial because of concerns about decreasing effectiveness, physical dependence, benzodiazepine withdrawal syndrome, and an increased risk of dementia and cancer.
How does benzodiazepines affect cognition?
The short-term use of benzodiazepines adversely affects multiple areas of cognition, the most notable one being that it interferes with the formation and consolidation of memories of new material and may induce complete anterograde amnesia. However, researchers hold contrary opinions regarding the effects of long-term administration. One view is that many of the short-term effects continue into the long-term and may even worsen, and are not resolved after stopping benzodiazepine usage. Another view maintains that cognitive deficits in chronic benzodiazepine users occur only for a short period after the dose, or that the anxiety disorder is the cause of these deficits.
What is the best medication for alcohol withdrawal?
Benzodiazepines are the preferred choice in the management of alcohol withdrawal syndrome, in particular, for the prevention and treatment of the dangerous complication of seizures and in subduing severe delirium. Lorazepam is the only benzodiazepine with predictable intramuscular absorption and it is the most effective in preventing and controlling acute seizures.
What are the symptoms of withdrawal from benzodiazepines?
The most frequent symptoms of withdrawal from benzodiazepines are insomnia, gastric problems, tremors, agitation, fearfulness, and muscle spasms.
Which ring system forms the skeleton of many of the most common benzodiazepine pharmaceuticals?
Left: The 1,4-benzodiazepine ring system. Right: 5-phenyl-1 H -benzo [ e] [1,4]diazepin-2 (3 H )-one forms the skeleton of many of the most common benzodiazepine pharmaceuticals, such as diazepam (7-chloro-1-methyl substituted).
What are Anxiolytics, sedatives, and hypnotics?
Anxiolytics, sedatives and hypnotics are medicines that work on the central nervous system to relieve anxiety, aid sleep, or have a calming effect.
How many benzodiazepine derivatives are there?
Although there are more than twenty benzodiazepine derivatives, only certain ones have been approved to treat anxiety (eg, alprazolam, clonazepam, diazepam, and lorazepam), sleeplessness ( insomnia) (eg, estazolam, flurazepam, quazepam, temazepam and triazolam), or panic disorder (eg, alprazolam). Barbiturates are an older class ...
What is the main issue with benzodiazepines?
The main issue with use of benzodiazepines is dependence. Benzodiazepines differ in their propensity to cause sedation and in the length of time they act for. All benzodiazepines are thought to work by enhancing the inhibitory action of γ-aminobutyric acid (GABA).
Which medication is best for anxiety?
Other drug classes that are also considered effective at relieving anxiety include the SSRIs, SNRIs, tricyclic antidepressants and buspirone; other medicines may also be prescribed off-label. These drugs are often preferred over benzodiazepines for anxiety because they are unlikely to cause dependence; however, they may not work as quickly as benzodiazepines. SSRIs typically have a delayed onset-of-action and may initially worsen anxiety.
Can barbiturates cause coma?
Barbiturates are an older class of medicine that used to be used for these indications as well; however, barbiturates have a narrow therapeutic index (window of effectiveness before toxicity occurs), and are more likely to cause respiratory depression, coma and death, and are very rarely used nowadays. The main issue with use of benzodiazepines is ...
Which class of drugs are sedatives?
Other drug classes that have a sedative effective include first-generation antihistamines, agonists of melatonin receptors, anesthetics, eszopiclone, zaleplon, zolpidem, zopiclone, and several others . Many of these drugs also have a hypnotic effect.
What are benzodiazepines?
Benzodiazepines are a class of medications that work in the central nervous system and are used for a variety of medical conditions , such as anxiety, seizures, and for alcohol withdrawal. Benzodiazepines appear to work by blocking excessive activity of nerves in the brain and other areas in the central nervous system.
What is the purpose of Flumazenil?
Flumazenil (Romazicon - brand discontinued) is used to reverse the sedative effect of a benzodiazepine when used for a medical procedure and for treatment in a benzodiazepine overdose. Flumazenil blocks the central effect of benzodiazepines by competitive interaction at the benzodiazepine receptor site.
How do benzodiazepine hypnotics differ from diazepam?
The benzodiazepine hypnotics shorten the time it takes to fall asleep and prolong the sleeping period. The main differences exist in how long they might remain in the body, possibly leading to prolonged side effects. For example, lorazepam has a much shorter duration than diazepam, allowing quicker clearance of the drug and theoretically less side effects. On the other hand, diazepam can remain in the system for days and boost the risk for long-term side effects, especially in the elderly.
Why do benzodiazepines increase in CYP3A4?
If benzodiazepines that are CYP3A4 or CYP2C19 substrates are used with another drug that inhibits (blocks) these enzymes, drug levels of the benzodiazepine may rise due to decreased metabolism and excretion . High drug levels mean a greater risk for side effects.
Which benzodiazepines work better?
Because of this, some benzodiazepines work better than others in the treatment of particular conditions. Common examples of benzodiazepines include alprazolam (brand: Xanax), diazepam (brand: Valium) and lorazepam (brand: Ativan). Common benzodiazepine uses: for sleep.
What is Clobazam used for?
Clobazam (Onfi) is used as an add-on (adjunct) benzodiazepine anticonvulsive treatment with other seizures medications in the treatment of Lennox-Gastaut syndrome. Nayzilam (midazolam) and Valtoco (diazepam) are nasal sprays now approved for the treatment of seizure clusters (also known as acute repetitive seizures).
What is the best treatment for seizures?
For most types of acute or prolonged seizures or status epilepticus, an intravenous (IV) or rectal benzodiazepine would be the treatment of first choice.
What are hynotics used to treat?
Doctors prescribe hypnotics to treat insomnia. Insomnia is a sleep problem that may involve difficulty falling or staying asleep. Inadequate sleep affects mood, energy levels, health, and work performance.
Are hypnotics addictive?
Benzodiazepines are addictive hypnotics and are federally controlled substances. People can develop a physical dependence after several days of taking them, and the risk is higher during long-term use.
Can I drink alcohol if I'm taking a hypnotic drug?
Do not drink alcohol before are after taking a sleep medication because drinking alcohol while using a sleep medication or sedative may lead to severe drowsiness.
What drugs or supplements interact with hypnotics?
Combining sleep medications or using other medications that also cause drowsiness will lead to severe drowsiness. Stimulants such as amphetamines or coffee may reduce the effect of sleep medicines.
Are these drugs safe to take if I am pregnant or breastfeeding?
Researchers have not studied the effects of most hypnotics in pregnant women. Therefore, they should not be used if you are pregnant unless it is absolutely necessary. Pregnant women who have sleep problems should try improving their sleep hygiene, relaxation, and ways to reduce stress.
How many types of hypnotics are there?
Types of hypnotics (hypnotic drugs) The FDA has approved five types of hypnotic medications for the treatment of sleep problems, which include: These medications are all effective for treating sleep problems, but they work in different ways.
What is OTC hypnotics?
OTC (over-the-counter) hypnotics. Natural, herbal hypnotics and hypnotic supplements. Types of hypnotics (hypnotic drugs) List and examples of brand and generic names of hypnotic drugs.
What is a sedative that is taken in larger amounts?
Sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotic, or anxiolytic use.
What is the characteristic withdrawal syndrome?
The characteristic withdrawal syndrome for sedatives, hypnotics, or anxiolytics (refer to Criteria A and B of the criteria set for sedative, hypnotic, or anxiolytic withdrawal ). B. Sedatives, hypnotics, or anxiolytics (or a closely related substance, such as alcohol) are taken to relieve or avoid withdrawal symptoms.
What is a problematic pattern of sedative, hypnotic, or anxiolytic use leading?
A problematic pattern of sedative, hypnotic, or anxiolytic use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12 -month period: Sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended.
What is a hypnotic disorder?
Sedative, Hypnotic, or Anxiolytic Use Disorder is a substance use disorder characterized by repeated use of substances including benzodiazepines, benzodiazepine-like drugs (e.g. - zolpidem, zaleplon), carbamates (e. g. - glutethimide, meprobamate), barbiturates ( e.g. - phenobarbital, secobarbital), and barbiturate-like hypnotics (e.g. - glutethimide, methaqualone) despite significant problems associated with its use. This class also includes all prescription sleeping medications and almost all prescription anti-anxiety medications. Non-benzodiazepine anti-anxiety agents (e.g. - buspirone, gepirone) are not included in this class because they are not associated with significant misuse.
What is sedative hypnotic use?
Sedative, hypnotic, or anxiolytic use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the sedative, hypnotic, or anxiolytic. Tolerance, as defined by either of the following; A.
What is tolerance in a drug?
Tolerance, as defined by either of the following; A. A need for markedly increased amounts of the sedative, hypnotic, or anxiolytic to achieve intoxication or desired effect. B. A markedly diminished effect with continued use of the same amount of the sedative, hypnotic, or anxiolytic.
What is the term for a desire to use a sedative?
A great deal of time is spent in activities necessary to obtain the sedative, hypnotic, or anxiolytic; use the sedative, hypnotic, or anxiolytic; or recover from its effects. Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic. Recurrent sedative, hypnotic, or anxiolytic use resulting in a failure to fulfill major role ...
What are barbiturates used for?
They suppress central nervous system activity and are effective anxiolytics, antiepileptics, sedatives and hypnotics. Barbiturates act as positive allosteric modulators of GABA A receptors to enhance the action of neuroinhibitory GABA. They are classified according to their duration of action; short-, medium- or long-acting. As they have the tendency to cause tolerance and psychological and physical dependence, they are now rarely used as anxiolytics. Barbiturates are currently used principally for their hypnotic actions (in anaesthesia) and in rare cases as antiepileptics. The use of barbiturates as sedatives has been superceded by safer and more effective benzodiazepine drugs in routine clinical practice.
How do benzodiazepines affect the neurotransmitter GABA?
Benzodiazepines enhance response to the inhibitory neurotransmitter GABA, by opening GABA-activated chloride channels, thereby rendering neurons resistant to excitation. Benzodiazepine family drugs are similar in pharmacological action but vary in potency and clinical efficacy in treatment of particular conditions.
Why should benzodiazepines be avoided in elderly people?
Benzodiazepines and the Z–drugs (see below) should be avoided in the elderly, because they are at greater risk of becoming ataxic and confused, potentially leading to increased falls and injury.
What is the job of a prescriber?
The job of the prescriber is to identify the drug which offers the best therapeutic outcome for their patient. Benzodiazepine class drugs are the most commonly used anxiolytics and hypnotics. They act selectively on gamma-aminobutyric acid-A (GABA A) receptors in the brain.
How long does it take for buspirone to work?
Buspirone hydrochloride is thought to act at serotonin 5-HT 1A receptors. Response to treatment may take up to 2 weeks. The dependence and abuse potential of buspirone hydrochloride is low. Although it is licensed only for short-term use, specialists occasionally use it for several months.
Is thiopental sodium a hypnotic?
The very short-acting barbiturate thiopental sodium is used in anaesthesia. Older non-benzodiazepine drugs such as meprobamate and the barbiturates are not recommended as hypnotics as they have more side-effects and interactions (especially with alcohol) than benzodiazepines and are much more dangerous in overdose.
Can you prescribe benzodiazepines for anxiety?
It is considered inappropriate to prescribe benzodiazepines for short-term ‘mild’ anxiety. Benzodiazepine use to treat insomnia should only be considered when the insomnia is severe, disabling, or is causing extreme distress.
What medication did a 16 year old man take for anxiety?
He wanted something to help him sleep that was not going to give him a hangover the next day. Current medication was erythromycin for acne.
What is melatonin hypnotic?
Once melatonin enters the brain, it acts on melatonin receptor MT1 to promote sleep and on MT 2 to move the circadian sleep phase forward. It is an effective hypnotic for sleep onset. 5 A modified-release formulation of melatonin has been licensed for the management of insomnia in people over 55 years of age for up to 13 weeks. It is taken after food 1–2 hours before sleeping. Adverse effects include dyspepsia and dry mouth. 3 See Table 3 for the use of BZDs and hypnotics in vulnerable groups.
What BZDs are used for insomnia?
BZDs currently licensed in the UK for the treatment of insomnia are temazepam, loprazolam, lormetazepam (short-acting), diazepam (for insomnia associated with anxiety), flurazepam, nitrazepam (long-acting) and lorazepam. These should be used only for insomnia that is severe, disabling or causing extreme distress and prescribed for no longer than 2–4 weeks.3 Lorazepam is also licensed for use in anxiety. Chlordiazepoxide and diazepam are used for the management of anxiety and alcohol withdrawal.
What is insomnia hypnotics?
Non-pharmacological strategies to manage insomnia should be considered first, alongside good sleep hygiene. Hypnotics are sleep-inducing drugs and include benzodiazepines (BZDs), ‘Z’ drugs and melatonin. The National Institute for Health and Care Excellence advocates the use of drugs with the lowest purchase cost as there is no difference in efficacy between the ‘Z’ drugs and shorter acting BZDs.1 However, caution is required as sedative hypnotics are associated with increased mortality, although the mechanism of effect remains unclear. 2 Certain factors must be considered before prescribing hypnotics for insomnia ( Table 1 ).
Is Zopiclone a BZD?
Zopiclone, zolpidem and zaleplon are structurally unrelated non-BZD hypnotics that were developed in an attempt to overcome some of the disadvantages of BZDs, such as hangover effects and dependence.1 It is advised that a patient who has not responded to one of the ‘Z’ drugs should not be switched to any of the others. ‘Z’ drugs also potentiate GABA activity by acting on the BZD receptor site of the GABAA receptor complex, but are more selective in their binding than BZDs. 5 ‘Z’ drugs can cause amnesia and dependence. Zolpidem has a rapid onset of action with minimal hangover effects. Zopiclone has a slower onset and medium duration of action. Zopiclone, zaleplon and zolpidem are metabolized by hepatic enzymes, so inducers or inhibitors of these enzymes can decrease or increase the serum concentrations of these drugs (see interactions in Table 2 ).
Can BZDs cause cognitive impairment?
BZDs may cause cognitive impairment, occasional ‘paradoxical’ reactions such as disinhibition (more common with short-acting hypnotics4), next-day ‘hangover’ effects (more common with long-acting hypnotics), tolerance and dependence with prolonged use, and withdrawal, and can adversely affect driving performance. They are contraindicated in respiratory depression. BZD-induced respiratory depression is reversed by flumazenil, a BZD antagonist. As flumazenil has a short half-life, additional doses may be needed. BZDs do not induce or inhibit microsomal enzymes so do not usually cause pharmacokinetic interactions with any other drugs.4 (See Table 2 for interactions.)
Overview
Medical uses
Benzodiazepines possess psycholeptic, sedative, hypnotic, anxiolytic, anticonvulsant, muscle relaxant, and amnesic actions, which are useful in a variety of indications such as alcohol dependence, seizures, anxiety disorders, panic, agitation, and insomnia. Most are administered orally; however, they can also be given intravenously, intramuscularly, or rectally. In general, benzodiazep…
Contraindications
Because of their muscle relaxant action, benzodiazepines may cause respiratory depression in susceptible individuals. For that reason, they are contraindicated in people with myasthenia gravis, sleep apnea, bronchitis, and COPD. Caution is required when benzodiazepines are used in people with personality disorders or intellectual disability because of frequent paradoxical reactions. In major depression, they may precipitate suicidal tendencies and are sometimes used for suicidal …
Adverse effects
The most common side-effects of benzodiazepines are related to their sedating and muscle-relaxing action. They include drowsiness, dizziness, and decreased alertness and concentration. Lack of coordination may result in falls and injuries, in particular, in the elderly. Another result is impairment of driving skills and increased likelihood of road traffic accidents. Decreased libido and erection pr…
Overdose
Although benzodiazepines are much safer in overdose than their predecessors, the barbiturates, they can still cause problems in overdose. Taken alone, they rarely cause severe complications in overdose; statistics in England showed that benzodiazepines were responsible for 3.8% of all deaths by poisoning from a single drug. However, combining these drugs with alcohol, opiates or tricyclic an…
Interactions
Individual benzodiazepines may have different interactions with certain drugs. Depending on their metabolism pathway, benzodiazepines can be divided roughly into two groups. The largest group consists of those that are metabolized by cytochrome P450 (CYP450) enzymes and possess significant potential for interactions with other drugs. The other group comprises those that are metabolized through glucuronidation, such as lorazepam, oxazepam, and temazepam, and, in gen…
Pharmacology
Benzodiazepines work by increasing the effectiveness of the endogenous chemical, GABA, to decrease the excitability of neurons. This reduces the communication between neurons and, therefore, has a calming effect on many of the functions of the brain.
GABA controls the excitability of neurons by binding to the GABAA receptor. Th…
Chemistry
Benzodiazepines share a similar chemical structure, and their effects in humans are mainly produced by the allosteric modification of a specific kind of neurotransmitter receptor, the GABAA receptor, which increases the overall conductance of these inhibitory channels; this results in the various therapeutic effects as well as adverse effects of benzodiazepines. Other less important m…
Overview
- Anxiolytics, sedatives and hypnotics are medicines that work on the central nervous system to relieve anxiety, aid sleep, or have a calming effect. Other drug classes that are also considered effective at relieving anxiety include the SSRIs, SNRIs, tricyclic antidepressants and buspirone; other medicines may also be prescribed off-label. These drug...
Introduction
Prevention
Prognosis
- Benzodiazepines are a class of medications that work in the central nervous system and are used for a variety of medical conditions, such as anxiety, seizures, and for alcohol withdrawal. Benzodiazepines appear to work by blocking excessive activity of nerves in the brain and other areas in the central nervous system. As a class, benzodiazepines are similar in how they work in …
Mechanism of action
- 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.
Signs and symptoms
- 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 ...
Treatment
- *The half-life is the amount of time it takes for half of the drug to be eliminated from the body. The shorter the half-life, the quicker the drug is eliminated, and the faster any bothersome side effects can subside.
Epidemiology
- Benzodiazepines work in the central nervous system, selectively occupying certain protein areas in the brain called GABA-A receptors. There are three types of GABA (gamma-aminobutyric) receptors in the brain: GABA-A, GABA-B, and GABA-C. GABA is the main inhibitory neurotransmitter in the brain (a chemical that help to block a nerve action). GABA helps to regul…
Medical uses
- Alcohol withdrawal is diagnosed in a patient with a history of heavy and prolonged alcohol use and a sudden reduction or complete abstinence from alcohol. Alcohol withdrawal produces changes in the body, such as:
Effects
- Medications such as benzodiazepines are a first-line treatment for acute alcohol withdrawal. Benzodiazepines reduce withdrawal symptoms and may be life-saving for the patient. Commonly used medicines in this group include: chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan). Lorazepam (Ativan) or oxazepam (Serax) may be preferred in patients with l…
Side effects
- Anxiety and worry is a common problem in adults; however, when chronic, unwarranted worry lasts for a period of six months or longer and interferes with normal daily activities, this may be diagnosed as Generalized Anxiety Disorder (GAD). GAD is the most frequent anxiety disorder, affecting 6.8 million adults or about 3% of the U.S. population, but more than half remain untreat…
Contraindications
- Antidepressants (SSRIs/SNRIs) are considered first-line therapy for most patients, and benzodiazepines may play an adjunctive role in the treatment of GAD to address acute symptoms while the antidepressant takes effect. Only short-term use of low-dose benzodiazepines (2 to 6 weeks) is recommended, with a slow, gradual tapering once the antidepressant effect takes hol…
Interactions
- The patient may remain awake but sedated, and usually there is no recollection of the procedure. Most patients can respond to verbal cues or tactile commands. This type of sedation allows the patient to recover more quickly from anesthesia, but they will need someone to drive them home and are usually drowsy until the next day, so will need to take a full day off of work. There is nor…
Examples
- 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. Unusual sleep behaviors and anterograde amnesia may occur with traditional benzodiaz…
Adverse effects
- In the elderly, benzodiazepines and nonbenzodiazepine agents should be avoided, as recommended by the Beers Criteria, an expert opinion-developed guideline addressing safe drug use in the elderly. In general, benzodiazepines should NOT be used in pregnancy.