Benzodiazepines: Risks and Benefits

Drug Class

  • Sedatives
  • Hypnotics
  • Anxiolytics

How common is benzodiazepine use?

Prescribing of hypnotic and anxiolytic drugs is increasing. In 2011-12 more than 16 million prescriptions for these drugs were written in general practice in England.

What medical conditions are treated with benzodiazepines?

Benzodiazepines are prescribed for management of:

  • anxiety disorders
  • panic disorders
  • treatment of seizure
  • treatment of symptoms of alcohol
  • treatment of GHB withdrawal
  • poor sleep
  • prevention of panic attacks prior to dentist visits or diagnostic procedures
  • Muscle relaxation

Because of their addictive potential these medications are prescribed only for a short period of time.

Pharmacology

Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists

Benzodiazepines are commonly divided into three groups based on their half-life in blood:

  • Short-acting
    • half-life less than 12 hours
    • Examples: midazolam and triazolam.
  • Intermediate-acting
    • half-life between 12 and 24 hours
    • Examples: alprazolam, lorazepam, and temazepam.
  • Long-acting
    • half-life greater than 24 hours
    • Examples: diazepam, clonazepam, clorazepate, chlordiazepoxide, and flurazepam.

Adverse Effects

Regular use of benzodiazepins increases the risk of:

  • Seizure
  • Rebound anxiety
  • Tremors
  • Poor memory
  • Depression
  • Psychosis
  • Psychomotor impairments
  • Daytime fatigue
  • Ataxia
  • Falls
  • Pneumonia, and other infections

Who should not use benzodiazepines?

Patients have to avoid using Benzodiazepines if they have any of the following conditions:

  • current or past history of substance abuse
  • are pregnant
  • are being treated with opioids for chronic pain or replacement therapy for narcotic addiction
  • have medical and mental health problems that may be aggravated with benzodiazepines, such as
    • ADHD
    • bipolar disorders
    • depression
    • fibromyalgia/chronic fatigue syndrome
    • impulse disorders
    • somatization disorders
  • asthma or COPD
  • sleep apnea
  • congestive heart failure

Precautions

Regular and long term use of these medications could result in dependence. Taking benzodiazepines with narcotic pain killers, opioids, alcohol and GHP could result in sever respiratory depression and death. Benzodiazepines affect cognitive function and reaction time. Avoid driving or operating machinery if you have been started on benzodiazepines recently.

Warning

Take benzodiazepines if only they are prescribed to your own medical condition.

Take your pills as prescribed. Do now overuse them.

Tell your doctor if you drink alcohol or use other sedative drugs such as heroin, fentnayl, codeine, morphine, oxycodone, percocet, methadone, suboxone, tramadol…

Section

This document is prepared by the “Mental Health for All” team. This document is provided for information purposes only and does not necessarily represent endorsement by or an official position of the Essentials of Medicine. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

References:

  1. Tsimtsiou Z, Ashworth M, Jones R. Variations in anxiolytic and hypnotic prescribing by GPs: a cross-sectional analysis using data from the UK Quality and Outcomes Framework. Br J Gen Pract2009;59:e191-8.
  2. NHS Prescription Services. Central nervous system national charts. NHS Business Services Authority, 2012.
  3. Royal College of General Practitioners and Royal College of Psychiatrists. Addiction to medicines consensus statement 2013. www.rcgp.org.uk/news/2013/january/addiction-to-medicines-consensus-statement.aspx.
  4. Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ2012;345:e8343.
  5. Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ2005;331:1169.
  6. Billioti de Gage S, Begaud B, Bazin F, Verdoux H, Dartigues J-F, Peres K, et al. Benzodiazepine use and risk of dementia: prospective population based study. BMJ2012;345:e6231.
  7. Gallacher J, Elwood P, Pickering J, Bayer A, Fish M, Ben-Shlomo Y. Benzodiazepine use and risk of dementia: evidence from the Caerphilly Prospective Study (CaPS). J Epidemiol Community Health2012;66:869-73.
  8. Wu CS, Ting TT, Wang SC, Chang IS, Lin KM. Effect of benzodiazepine discontinuation on dementia risk. Am J Geriatr Psychiatry2011;19:151-9.
  9. Kripke DF. Chronic hypnotic use: deadly risks, doubtful benefit. Sleep Med Rev2000;4:5-20.
  10. Paterniti S, Dufouil C, Alpérovitch A. Long-term benzodiazepine use and cognitive decline in the elderly: the Epidemiology of Vascular Aging Study. J Clin Psychopharmacol2002;22:285-93.
  11. Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs2004;18:37-48.
  12. Kripke DF. Greater incidence of depression with hypnotic use than with placebo. BMC Psychiatry2007;7:42.
  13. Neutel CI. Risk of traffic accident injury after a prescription for a benzodiazepine. Ann Epidemiol 1995;5:239-44.
  14. Berry SD, Lee Y, Cai S, Dore DD. Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents. JAMA Intern Med2013:1-8.
  15. Kripke DF. Possibility that certain hypnotics might cause cancer in skin. J Sleep Res2008;17:245-50.
  16. Mallon L, Broman JE, Hetta J. Is usage of hypnotics associated with mortality? Sleep Med2009;10:279-86.
error: Content is protected !!