Benzodiazepines

Introduction

These drugs are very addictive and should only ever be prescribed for a few days at a time.

Benzodiazepines work extremely well in calming nerves, inducing sleep and relaxing muscles but it is the fact that they do work so well which makes them attractive and can lead to addiction.

Benzodiazepines gradually start to work less and may seem to cause the very problems for which they were prescribed.

After taking benzodiazepines for longer than two weeks DO NOT STOP ABRUPTLY - gradual tapering is required.

IF YOU ARE TAKING OTHER DRUGS IN ADDITION TO BENZODIAZEPINES ONLY ONE DRUG SHOULD BE WITHDRAWN AT ONCE.

What are they used for?

Benzodiazepines are useful for a variety of conditions such as alcohol dependence, seizures, anxiety, panic, agitation and insomnia. Benzodiazepines are well-tolerated and are generally safe and effective drugs in the short-term (usually 2 to 4 weeks) for a wide range of conditions. They are generally not recommended for elderly patients (over 65 years old).

Side Effects

Drowsiness, dizziness, decreased alertness / concentration, lack of coordination (resulting in ataxia, falls and injuries, particularly in the elderly), decreased libido and erection problems, depression, disinhibition. Personality disorders can sometimes occur.

Low blood pressure and suppressed breathing may be encountered with intravenous use.

Less common side effects include nausea and changes in appetite, blurred vision, confusion, euphoria, depersonalization and nightmares. Cases of liver toxicity have been described but are very rare.

Long-term use

The long term effects of benzodiazepines include drug dependence as well as the possibility of adverse effects on cognitive function, physical, and mental health. There is evidence that reduction or withdrawal from benzodiazepines can lead to a reduction in anxiety symptoms. There are a number of side effects associated with addiction to benzodiazepines such as depression and flu like symptoms. Due to these increasing physical and mental symptoms from long-term use of benzodiazepines withdrawal from benzodiazepines is recommended for many long-term users.

Tolerance can develop to their effects and there is also a risk of dependence and upon discontinuation a withdrawal syndrome may occur. These factors, combined with other possible secondary effects after prolonged use such as psychomotor, cognitive or memory impairments, limit their long term applicability.

Some of the symptoms which may occur as a result of long term use of benzodiazepines include dependence, emotional clouding, nausea, headaches, dizziness, irritability, lethargy, sleep problems, memory impairment, personality changes, aggression, depression, agoraphobia, anxiety and panic attacks, social deterioration as well as employment difficulties. Many of these adverse effects of long term use of benzodiazepines begin to show improvements three to six months after withdrawal of benzodiazepines. This is especially likely to be the case if you have withdrawn gradually with our guidance.

The benefit of any long term use is likely to be far outweighed by the risks (Royal College of Psychiatrists 1987).

They are the most common cause of drug induced dementia, affecting over 10% of patients attending memory clinics, who are frequently mis-diagnosed with Alzheimer's disease.

Withdrawal

Benzodiazepine withdrawal syndrome - often abbreviated to benzo withdrawal - is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug(s) or reduces the dosage too rapidly. Benzodiazepine withdrawal is similar to the alcohol withdrawal syndrome and barbiturate withdrawal syndrome and can in severe cases provoke life threatening withdrawal symptoms such as seizures, but usually only if withdrawal is carried out in too abrupt a manner.

Chronic exposure to benzodiazepines causes physical adaptations in the brain to counteract the drug's effects. This is known as a tolerance and physical dependence. When the drug is removed or dosage reduced in an individual physically dependent on benzodiazepines, numerous withdrawal symptoms both physical and psychological may appear and will remain present until the body reverses the physical dependence by making adaptions to the drug-free environment and thus returning the brain to normal function. Generally the higher the dose and the longer a benzodiazepine is used and the more rapidly a benzodiazepine is discontinued then the more likely severe withdrawal symptoms will occur. However, severe withdrawal symptoms can still occur during gradual dose reduction or from relatively low doses.

In certain selected patient groups the occurrence of withdrawal symptoms is as high as 100%, whereas in unselected patient groups more than 50% of subjects are able to discontinue benzodiazepines with mild or even no withdrawal symptoms at all. Withdrawal symptoms may persist for weeks or months after cessation of benzodiazepines. In a smaller subset of patients withdrawal symptoms may continue at a sub acute level for many months or even a year or more (Protracted Withdrawal Syndrome, Professor H Ashton, Univeristy of Manchester). Long term use of benzodiazepines may lead to withdrawal like symptoms emerging despite a constant therapeutic dose. Correctly attributing previously misdiagnosed withdrawal symptoms such as anxiety to the withdrawal effects of benzodiazepines, individualised taper strategies according to withdrawal severity, the addition of alternative strategies such as reassurance and referral to benzodiazepine withdrawal support groups increase the success rate of withdrawal.

List of names

Drug names:
Alprazolam, Bromazepam, Chlordiazepoxide, Cinolazepam, Clonazepam, Cloxazolam, Clorazepate, Diazepam, Estazolam, Flunitrazepam, Flurazepam, Flutoprazepam, Halazepam, Ketazolam, Loprazolam, Lorazepam, Lormetazepam , Medazepam, Midazolam, Nimetazepam, Nitrazepam, Nordazepam, Oxazepam, Phenazepam, Pinazepam, Prazepam, Premazepam, Quazepam, Temazepam , Tetrazepam, Triazolam

Brand names:
Alodorm, Alopam, Alprox, Anxon, Apozepam, Apzepam, Ativan, Bromam, Centrax, Dalmadorm, Dalmane, Domar, Doral, Dormicum, Dormonid, Dormonoct, Dumolid, Erimin, Euhypnos, Flunipam, Fluscand, Frontal, Gerodorm, Halcion, Hexalid, Hypnovel, Iktorivil, Klonopin, Klopoxid, Lexomil, Lexotan, Lexotanil, Librium, Lorabenz, Loramet, Lysanxia, Madar, Mogadon, Mylostan, Nobrium, Noctamid, Normison, Olcadil, Oxabenz, Oxapax, Oxascand, Pacisyn, Paxipam, Pronoctan, ProSom, Restas, Restoril, Rilamir, Risolid, Rivotril, Rohydorm, Rohypnol, Ronal, Serax, Serenid, Serepax, Seresta, Sobril, Somalium, Stesolid, Stilny, Tafil, Temesta, Tenox, Tranxene, Tropium, Valaxona, Valium, Versed, Vival, Xanax, Xanor.

Interactions

Individual benzodiazepines may have different interactions with certain drugs. Many drugs reduce the rate of elimination of the benzodiazepines in the body, leading to possibly excessive drug accumulation and increased side effects.

Drugs that can have this effect include: oral contraceptives, some antibiotics, antidepressants (including SSRI and SNRI) and antifungal agents.

Conversely some drugs, such as St John's wort, the antibiotic rifampicin and the anticonvulsants carbamazepine and phenytoin, accelerate elimination of many benzodiazepines and decrease their action. This may possibly include other antibiotics and antifugals.

Taking benzodiazepines with alcohol, opioids and other central nervous system depressants amplifies their action. This often results in increased sedation, impaired motor coordination, suppressed breathing and other adverse effects that may potentially be lethal.

Antacids may slow down absorption of some benzodiazepines; however, this effect is worth considering because the proton pump inhibitors such as omeprazole and lansoprazole are so widely prescribed and may affect benzodiazepines.

Benzodiazepines such as lorazepam, oxazepam and temazepam generally have few drug interactions.

The following sites have been used as sources of information:

http://en.wikipedia.org/wiki/Benzodiazipines

http://en.wikipedia.org/wiki/List_of_benzodiazepines

http://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_syndrome

http://en.wikipedia.org/wiki/Long-term_effects_of_benzodiazepines