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What are Benzodiazepines (Benzos)?

what are benzodiazepines graphic

Benzodiazepines are a class of prescription medication used to treat conditions that cause excessive nerve activity in the brain. They work by affecting the brain’s gamma-aminobutyric acid (GABA) production, producing mild to severe depression of the central nervous system and sedation.  This sedates and calms the patient. These medications are effective at reducing brain activity, which may be required to treat certain conditions. Prolonged use may cause physical dependency. Itis essential that those who are prescribed them follow their doctors’ instructions carefully to avoid future problems with abuse.

Which drugs are benzodiazepines?

Among the more common drugs classified as benzodiazepines are diazepam (Valium, Diastat), estazolam (Prosom), alprazolam (Xanax, Xanax KR, Niravam), quazepam (Doral), chlordiazepoxide (Librium), clorazepate (Tranxene), clonazepam (Klonopin), oxazepam (Serax), lorazepam (Ativan), triazolam (Halcion), and flurazepam (Dalmane).

What Do They Treat?

Adults are commonly prescribed this class of drug for a wide variety of physiological and psychological disorders. Psychological conditions treated with benzodiazepines include panic attacks, anxiety disorders, sleepiness, and excessive nervousness. Physical problems such as seizures, muscle spasms, alcoholism, and status epilepticus can also be treated with benzodiazepines.

Treatment for Anxiety Disorders

Several types of anxiety disorders are treated with these medications. These include generalized anxiety disorder, social anxiety disorder, and panic disorder, although benzodiazepines are usually prescribed for social anxiety and panic disorders if antidepressants have already been proven ineffective. Psychiatrists recognize that this class of prescription drugs lend themselves to abuse and are often hesitant to prescribe them for a prolonged period. Part of the reason that patients may end up abusing these drugs is that long-term use may lead to the development of a tolerance, which leads to the prescription of higher doses. Since these drugs have a direct impact on cognitive function, they are sometimes found to be a drug of abuse in certain patients.

Other Uses

In addition to treating anxiety and other psychological problems, benzodiazepines are also used as a sedation drug during surgeries and can be used to treat alcohol withdrawal.

Common Side Effects

Patients who have been prescribed this medication may wind up suffering from certain physical and cognitive side effects. Common physical side effects include nausea, vomiting, constipation, changes in appetite, weight gain, dry mouth, fatigue, and reduced libido. Commonly reported cognitive side effects include lightheadedness, drowsiness, confusion, sedation, and memory impairment. While most side effects are mild, some patients may experience more severe reactions to these medications, including respiratory depression, jaundice, seizures, slow heart rate, low blood pressure, akathisia, increased heart rate, fainting, and suicide. Anyone experiencing these more severe symptoms should consult his or her physician immediately.  Patients may also develop a dependence and experience withdrawal symptoms after taking benzodiazepines. A study published by the BMJ suggest people over 65 who are taking benzodiazepines may be at higher risk of dementia.

Drug Interactions

Some medications can cause negative interactions with benzodiazepines, so it’s essential that patients disclose all medications, supplements, and substances they are using to their physicians before treatment with these drugs.  It is never safe to take drugs that depress the central nervous system, including alcohol, at the same time as these drugs. Doing so can lead to respiratory depression and restrict the supply of oxygen to the body. Drinking while taking benzodiazepines can also enhance the effects of alcohol, making it easier to experience alcohol poisoning. Opioid pain medications such as morphine, fentanyl, oxycodone, and hydrocodone should be avoided as they also cause respiratory depression. Sedatives and prescription sleep aids such as zolpidem, intermezzo, zaleplon, eszopiclone, and phenobarbital should also be avoided.

Adverse Effects of Benzodiazepine Abuse

Abusing benzodiazepine can lead to a number of adverse effects, including disturbing dreams, irritability, hostility, and amnesia. Patients who are using these drugs should look out for signs that they are becoming addicted, even if they are using them as prescribed. These signs include diarrhea, vomiting, nausea, goosebumps, bone and muscle pain, uncontrolled leg movements, and sleeping problems. Hospital admissions for benzodiazepine misuse have tripled since 1998. This class of medications is sold on the streets to drug addicts under the names “benzos” and “downers,” but they may cause addiction even if taken under the supervision of a physician. It can be difficult to recover from addiction. Benzodiazepines work by changing the chemistry of the user’s brain. Quitting cold turkey can be dangerous due to withdrawal symptoms. Most doctors suggest contacting an addiction specialist and tapering off of these drugs to reduce the severity of these unpleasant symptoms and increase the chances of successfully beating addiction.

Signs of Overdose

An overdose on these medications is life-threatening. Symptoms of an overdose include a rapid and weak pulse, shallow breathing, coma, and death. Less serious symptoms of benzodiazepine overdose include clammy skin and dilated pupils.

Withdrawal Symptoms

It’s always best to detox off these medications under the supervision of a physician. If addiction or abuse have become a problem, the help of an addiction specialist is an option. Those who stop taking their medication abruptly without tapering off of it may experience increased anxiety and insomnia, irritability, difficulty concentrating, panic attacks, tremors and palpitations, headaches, muscle pain and stiffness, and changes in perception. These symptoms range from mild to deadly. If someone is addicted to benzos, it is critically important that they seek medical assistance to taper off slowly and that they not stop cold turkey. Stopping cold turkey can be life-threatening.

Contraindications for Pregnancy

Benzodiazepines are categorized by the FDA as pregnancy category D. This classification is given to drugs that can potentially cause harm to a fetus if they are prescribed to or taken by women who are pregnant or may become pregnant while taking these drugs. These long-acting medications are also able to enter a woman’s breast milk, causing weight loss and lethargy in newborn infants. However, under certain extenuating circumstances, doctors may prescribe these medications to pregnant or breastfeeding women who have already been adequately informed of the associated risks.

The Take-Away

Benzodiazepines are used to treat a variety of physical, physiological, and mental disorders. They should only be taken under the supervision of the prescribing physician. Patients should review side effects, dosage, drug interactions, and risks and benefits with their doctors before taking these medications. It is important to be aware that they can be habit forming and addictive even at prescribed doses. Anyone who has been prescribed benzodiazepines should watch for symptoms of dependency. However, one should not abruptly stop taking them without their doctors’ approval. An abrupt stop is life-threatening as it can lead to potentially serious withdrawal symptoms. References: