Benzodiazepines


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Benzodiazepines

 

Definition

Benzodiazepines are medicines that help relieve nervousness, tension, and other symptoms by slowing the central nervous system.

Purpose

Benzodiazepines are a type of antianxiety drugs. While anxiety is a normal response to stressful situations, some people have unusually high levels of anxiety that can interfere with everyday life. For these people, benzodiazepines can help bring their feelings under control. The medicine can also relieve troubling symptoms of anxiety, such as pounding heartbeat, breathing problems, irritability, nausea, and faintness.
Physicians may sometimes prescribe these drugs for other conditions, such as muscle spasms, epilepsy and other seizure disorders, phobias, panic disorder, withdrawal from alcohol, and sleeping problems. However, this medicine should not be used every day for sleep problems that last more than a few days. If used this way, the drug loses its effectiveness within a few weeks.

Description

The family of antianxiety drugs known as benzodiazepines includes alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan). These medicines take effect fairly quickly, starting to work within an hour after they are taken. Benzodiazepines are available only with a physician's prescription and are available in tablet, capsule, liquid, or injectable forms.

Recommended dosage

The recommended dosage depends on the type of benzodiazepine, its strength, and the condition for which it is being taken. Doses may be different for different people. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage.
Always take benzodiazepines exactly as directed. Never take larger or more frequent doses, and do not take the drug for longer than directed. If the medicine does not seem to be working, check with the physician who prescribed it. Do not increase the dose or stop taking the medicine unless the physician says to do so. Stopping the drug suddenly may cause withdrawal symptoms, especially if it has been taken in large doses or over a long period. People who are taking the medicine for seizure disorders may have seizures if they stop taking it suddenly. If it is necessary to stop taking the medicine, check with a physician for directions on how to stop. The physician may recommend tapering down gradually to reduce the chance of withdrawal symptoms or other problems.

Precautions

Seeing a physician regularly while taking benzodiazepines is important, especially during the first few months of treatment. The physician will check to make sure the medicine is working as it should and will note unwanted side effects.
People who take benzodiazepines to relieve nervousness, tension, or symptoms of panic disorder should check with their physicians every two to three months to make sure they still need to keep taking the medicine.
Patients who are taking benzodiazepines for sleep problems should check with their physicians if they are not sleeping better within 7-10 days. Sleep problems that last longer than this may be a sign of another medical problem.
People who take this medicine to help them sleep may have trouble sleeping when they stop taking the medicine. This effect should last only a few nights.
Some people, especially older people, feel drowsy, dizzy, lightheaded, or less alert when using benzodiazepines. The drugs may also cause clumsiness or unsteadiness. When the medicine is taken at bedtime, these effects may even occur the next morning. Anyone who takes these drugs should not drive, use machines or do anything else that might be dangerous until they have found out how the drugs affect them.
Benzodiazepines may also cause behavior changes in some people, similar to those seen in people who act differently when they drink alcohol. More extreme changes, such as confusion, agitation, and hallucinations, also are possible. Anyone who starts having strange or unusual thoughts or behavior while taking this medicine should get in touch with his or her physician.

Key terms

Anxiety — Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions, such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.
Asthma — A disease in which the air passages of the lungs become inflamed and narrowed.
Bronchitis — Inflammation of the air passages of the lungs.
Central nervous system — The brain and spinal cord.
Chronic — A word used to describe a long-lasting condition. Chronic conditions often develop gradually and involve slow changes.
Emphysema — An irreversible lung disease in which breathing becomes increasingly difficult.
Epilepsy — A brain disorder with symptoms that include seizures.
Glaucoma — A condition in which pressure in the eye is abnormally high. If not treated, glaucoma may lead to blindness.
Myasthenia gravis — A chronic disease with symptoms that include muscle weakness and sometimes paralysis.
Panic disorder — A disorder in which people have sudden and intense attacks of anxiety in certain situations. Symptoms such as shortness of breath, sweating, dizziness, chest pain, and extreme fear often accompany the attacks.
Phobia — An intense, abnormal, or illogical fear of something specific, such as heights or open spaces.
Porphyria — A disorder in which porphyrins build up in the blood and urine.
Porphyrin — A type of pigment found in living things.
Seizure — A sudden attack, spasm, or convulsion.
Sleep apnea — A condition in which a person temporarily stops breathing during sleep.
Withdrawal symptoms — A group of physical or mental symptoms that may occur when a person suddenly stops using a drug to which he or she has become dependent.
Because benzodiazepines work on the central nervous system, they may add to the effects of alcohol and other drugs that slow down the central nervous system, such as antihistamines, cold medicine, allergy medicine, sleep aids, medicine for seizures, tranquilizers, some pain relievers, and muscle relaxants. They may also add to the effects of anesthetics, including those used for dental procedures. These effects may last several days after treatment with benzodiazepines ends. The combined effects of benzodiazepines and alcohol or other CNS depressants (drugs that slow the central nervous system) can be very dangerous, leading to unconsciousness or, rarely, even death. Anyone taking benzodiazepines should not drink alcohol and should check with his or her physician before using any CNS depressants. Taking an overdose of benzodiazepines can also cause unconsciousness and possibly death. Anyone who shows signs of an overdose or of the effects of combining benzodiazepines with alcohol or other drugs should get immediate emergency help. Warning signs include slurred speech or confusion, severe drowsiness, staggering, and profound weakness.
Some benzodiazepines may change the results of certain medical tests. Before having medical tests, anyone taking this medicine should alert the health care professional in charge.
Children are generally more sensitive than adults to the effects of benzodiazepines. This sensitivity may increase the chance of side effects.
Older people are more sensitive than younger adults to the effects of this medicine and may be at greater risk for side effects. Older people who take these drugs to help them sleep may be drowsy during the day. Older people also increase their risk of falling and injuring themselves when they take these drugs.

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they take benzodiazepines. Before taking these drugs, be sure to let the physician know about any of these conditions:
ALLERGIES. Anyone who has had unusual reactions to benzodiazepines or other mood-altering drugs in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.
PREGNANCY. Some benzodiazepines increase the likelihood of birth defects. Using these medicines during pregnancy may also cause the baby to become dependent on them and to have withdrawal symptoms after birth. When taken late in pregnancy or around the time of labor and delivery, these drugs can cause other problems in the newborn baby, such as weakness, breathing problems, slow heartbeat, and body temperature problems.
BREASTFEEDING. Benzodiazepines may pass into breast milk and cause problems in babies whose mothers taken the medicine. These problems include drowsiness, breathing problems, and slow heartbeat. Women who are breastfeeding their babies should not use this medicine without checking with their physicians.
OTHER MEDICAL CONDITIONS. Before using benzodiazepines, people with any of these medical problems should make sure their physicians are aware of their conditions:
  • current or past drug or alcohol abuse
  • depression
  • severe mental illness
  • epilepsy or other seizure disorders
  • swallowing problems
  • chronic lung disease such as emphysema, asthma, or chronic bronchitis
  • kidney disease
  • liver disease
  • brain disease
  • glaucoma
  • hyperactivity
  • myasthenia gravis
  • porphyria
  • sleep apnea
USE OF CERTAIN MEDICINES. Taking benzodiazepines with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

The most common side effects are dizziness, light-headedness, drowsiness, clumsiness, unsteadiness, and slurred speech. These problems usually go away as the body adjusts to the drug and do not require medical treatment unless they persist or they interfere with normal activities.
More serious side effects are not common, but may occur. If any of the following side effects occur, check with the physician who prescribed the medicine as soon as possible:
  • behavior changes
  • memory problems
  • difficulty concentrating
  • confusion
  • depression
  • seizures (convulsions)
  • hallucinations
  • sleep problems
  • increased nervousness, excitability, or irritability
  • involuntary movements of the body, including the eyes
  • low blood pressure
  • unusual weakness or tiredness
  • skin rash or itching
  • unusual bleeding or bruising
  • yellow skin or eyes
  • sore throat
  • sores in the mouth or throat
  • fever and chills
Patients who take benzodiazepines for a long time or at high doses may notice side effects for several weeks after they stop taking the drug. They should check with their physicians if these or other trouble-some symptoms occur:
  • irritability
  • nervousness
  • sleep problems
Other rare side effects may occur. Anyone who has unusual symptoms during or after treatment with benzodiazepines should get in touch with his or her physician.

Interactions

Benzodiazepines may interact with a variety of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes benzodiazepines should let the physician know all other medicines he or she is taking. Among the drugs that may interact with benzodiazepines are:
  • Central nervous system (CNS) depressants such as medicine for allergies, colds, hay fever, and asthma; sedatives; tranquilizers; prescription pain medicine; muscle relaxants; medicine for seizures; sleep aids; barbiturates; and anesthetics.
Medicines other than those listed above may interact with benzodiazepines. Be sure to check with a physician or pharmacist before combining benzodiazepines with any other prescription or nonprescription (over-the-counter) medicine.

Resources

Other

"Medications." National Institute of Mental Health Page. 1995. http://www.nimh.nih.gov.
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