In some patients, severe allergies like anaphylaxis and angioedema have been reported with benzodiazepines. There are many other side effects of benzodiazepines; check with your physician or pharmacist for specific questions. Overall, benzodiazepines should be used short-term as they can lead to tolerance, dependence (addiction) and abuse. Potent benzodiazepines with shorter elimination half-lives (triazolam, alprazolam, lorazepam) may be the most prone to causing problems with tolerance and dependence. Withdrawal reactions can also occur if the drug soon is stopped suddenly, especially those that are shorter-acting. Sudden discontinuation can also lead to rebound insomnia, making sleep difficult, and perpetuating continued use and higher doses of benzodiazepines. Discontinuation of a benzodiazepine should be done gradually under a doctor's direction. Intravenous (IV) benzodiazepines can be associated with cardiac and/or respiratory arrest if they are given too rapidly. Other reactions due to iv administration may include: hypotension cardiac arrhythmias slow heart rate apnea respiratory depression nausea/vomiting blurred vision or double vision skin rash injection site reactions In the elderly, benzodiazepines should be avoided. The 2012 beers Criteria, an expert opinion-developed guideline addressing safe drug use in the elderly, specific states that benzodiazepine use should be avoided in the elderly. Older adults have increased sensitivity and lowered metabolism of this class. If there is a documented need, low doses and drugs with shorter durations (half-lives) will help to minimize side effects like dizziness, weakness, and falls that may lead to hip fractures. Under the care of a clinician, there may be appropriate uses for benzodiazepines in the elderly, such as for seizure disorders, certain sleep disorders, benzodiazepine or alcohol withdrawal, severe gad, procedural anesthesia, and end-of-life care. Drug and Herbal Interactions with Benzodiazepines Important: Many drug interactions can occur with benzodiazepines; therefore, a drug interaction screen completed by a healthcare provider is an important step each time a new drug is added or discontinued in any treatment regimen.


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Clonazepam is the benzodiazepine most frequently used for long-term control and prevention of chronic seizure disorders; however, in general benzodiazepines are not usually the first choice for seizure prevention. Benzodiazepines are not appropriate for the long-term control of epilepsy because of the development of tolerance in a high proportion of patients. More traditional types of seizure treatments (for example: carbamazepine, oxcarbazepine, levetiracetam, phenytoin, valproic acid, topiramate, lamotrigine) might be used first line, dependent upon patient characteristics and specific epilepsy diagnosis. Lennox-Gastaut syndrome is a severe form of epilepsy that usually begins in early childhood. This form of epilepsy may involve seizures of multiple types, mental impairment, and a particular brain wave pattern. Clobazam is used as an additional (adjunct) benzodiazepine anticonvulsive treatment with other seizures medications in the treatment of Lennox-Gastaut syndrome. Adverse Effects of Benzodiazepines Unusual sleep behaviors and anterograde amnesia may occur with traditional benzodiazepines; this effect is especially a risk with triazolam use. Next day drowsiness and "hangover effect" is a concern with benzodiazepines that have long duration, for example, with diazepam or flurazepam. The sedative side effects can carry into the next day and impair driving and other daily activities; this is a particularly concerning risk in the elderly. More recent research is focusing on the possible adverse effects on cognition (thinking and reasoning ability) in patients using benzodiazepines for long periods of time.


In conscious sedation, most patients can respond to verbal cues or tactile commands. Conscious 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. There is normally no need to aid breathing in conscious sedation; however, a deeper level of sedation may rarely occur, therefore respiratory and resuscitative equipment should be available to healthcare providers. Contraindications to conscious sedation include: Pregnancy Known allergy to any of the medication Alcohol intoxication or other substance abuse cns depression Some instances of glaucoma seizures Benzodiazepines are often used in the treatment of seizures; examples include: Clobazam Clonazepam Clorazepate diazepam Lorazepam Midazolam For most. Status epilepticus is considered a medical emergency in which there is either more than 30 minutes of continuous seizure activity; or there are two or more sequential seizures without recovery of full consciousness between two seizures. Intravenous lorazepam is considered to be the first treatment of choice by many clinicians; diazepam is available as a rectal gel for patients without access to an iv line. Buccolam is a specific form of midazolam available in the. It is available as an oromucosal solution (a solution given in the side of the mouth, into the space between the gum and the cheek) in prefilled syringes. Buccolam is used for the treatment of prolonged, acute, convulsive seizures in infants, toddlers, children and adolescents (from three months to less than 18 years). Buccolam is not available in the.

Benzodiazepines, drug Class: Side

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Behavioral therapy and treatment with the antidepressants such as selective serotonin-reuptake inhibitors (ssris serotonin-norepinephrine reuptake inhibitors (snris and/or behavioral therapy are first-line treatments. The older tricyclic antidepressants, such as nortriptyline (Aventyl, pamelor) and imipramine (Tofranil) are effective, too, but may be hindered by side effects. In patients without comorbid conditions such as depression benzodiazepines may be used cautiously for a short period. Benzodiazepines may be used at the beginning of zachtboard therapy to lessen symptoms while the antidepressants take effect, which may take 4 to 6 weeks. Benzodiazepines such as clonazepam (Klonopin lorazepam (Ativan diazepam (Valium) and alprazolam (Xanax) are useful for panic attacks. They are safe when used as directed and often bring quick relief from panic symptoms. When discontinued, benzodiazepines should be slowly tapered to help avoid withdrawal symptoms like rebound insomnia and anxiety. Conscious Sedation Conscious sedation is the use of a combination of medications to help the patient relax (a sedative) and to block pain nachtpflege (an anesthetic) during a medical or dental procedure. A combination of a benzodiazepine and an opiate analgesic for pain relief is typically used. This method of sedation is often used for patients receiving an outpatient surgery or procedure that allows the patient to return home the same day, for example, endoscopy or colonoscopy procedures, wisdom tooth extractions, biopsies, and uncomplicated surgical procedures lasting less than one hour. The benzodiazepines most commonly used for conscious sedation are classified by their length of action: diazepam is considered the longest acting, lorazepam is the intermediate acting and midazolam is short acting.

The benzodiazepines that were initially fda-approved for insomnia, such as temazepam (Restoril) or triazolam (Halcion are not used as frequently today due to the availability of the newer nonbenzodiazepine drugs, such as eszopiclone ( Lunesta zolpidem ( Ambien or zaleplon ( Sonata ). All of the nonbenzodiazepine agents are approved only for treatment of insomnia. Muscle relaxant The skeletal muscle relaxant class, which includes agents such as baclofen, carisoprodol, methocarbamol, metaxalone, and cyclobenzaprine, are typically used first-line when a muscle relaxing therapeutic effect is needed. Benzodiazepines such as diazepam may be used short-term as muscle relaxants reducing the tone of skeletal muscle. These are generally used to relieve painful skeletal muscle spasms. Panic Disorders Panic disorder is a specific type of anxiety disorder. A person with panic disorder has panic attacks which are repeated episodes of intense fear which may be expected or unexpected. These symptoms may be accompanied by physical symptoms that are similar to the body's normal response to danger - the fight or flight phenomenon. Panic attacks may accompany other mood, anxiety or substance abuse conditions. The symptoms that a person may experience include: Rapid heart rate Trembling or tingling sensation Flushing, redness and sweating Shortness of breath fear and heightened awareness of surroundings, even if no danger is present Worry about death or losing control avoidance of crowds or other.

Benzodiazepines should be used with extreme caution in the elderly due to the risk for excessive sedation, confusion, and risk for falls and fractures. Mirtazapine and buspirone are also effective in gad for patients who do not respond to at least two trials of ssris or snris. Long-term use of benzodiazepines for gad should be avoided, when possible. Insomnia 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, triazolam 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 especially in the elderly, this can boost the risk for long-term side effects. Benzodiazepines should be used for a short period of time (usually 2-4 weeks) for insomnia. In general, patients should reassess their sleep habits - avoiding caffeine late in the day, limit electronics (tv, computer, tablets) in the bedroom, and avoiding alcohol late in the evening. Exercise early in the can often help to promote a more restful sleep.

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However, when different benzodiazepines were compared among themselves for effectiveness, results never reached statistical significance; however, chlordiazepoxide showed a trend toward better performance. The authors concluded that benzodiazepines showed a protective benefit against alcohol withdrawal symptoms, especially seizures, when compared to placebo and a potentially protective benefit for many outcomes when compared with other drugs. However, the studies were varied with different interventions and outcomes, and the authors could not reach definite conclusions about the overall safety or efficacy of benzodiazepines. Anxiety Anxiety and worry is a common problem in adults; however, when chronic, unwarranted worry lasts for a period of six badzout 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 about 5 of adults in the primary care setting. The occurrence of three out of six symptoms listed below constitutes a diagnosis of gad. Excessive anxiety for at least six months not due to another mental condition, medication, or substance abuse Sleep disturbances, insomnia fatigue restlessness Difficulty concentrating Irritability muscle tension Drug treatment will depend upon the level of anxiety, patient characteristics such as age and organ function, and. For patients who do not want to use medications, cognitive behavioral therapy and relaxation therapy have been shown to be effective. 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. Short-term use of benzodiazepines(2-6 weeks) is recommended. Common benzodiazepines used for gad include alprazolam, diazepam, and lorazepam. benzodiazepines

Benzodiazepines that target specific subunits of neustussenschot the gaba receptors have more selective pharmacologic actions. Common Uses for Benzodiazepines Alcohol Withdrawal 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: Shakes, Sleeping difficulties Confusion Anxiety hallucination seizures Delirium tremens ml The use of medications such as benzodiazepines is a first-line treatment for alcohol withdrawal. Benzodiazepines reduce symptoms and may be life-saving for the patient. Commonly used medicines in this group include chlordiazepoxide (Librium diazepam (Valium and lorazepam (Ativan). Lorazepam may be preferred in patients with liver impairment. Chlordiazepoxide, diazepam, and lorazepam can be given orally, intravenously, or intramuscularly. Oxazepam (Serax) may be useful but is only available orally. A 2010 Cochrane review (Amato, et al) from sixty-four randomised controlled trials compared benzodiazepine use versus other drugs for alcohol withdrawal. In the review, there was a trend in favor of benzodiazepines for seizure and delirium control, severe life-threatening side effects, dropouts, dropouts due to side effects and patient's global assessment score.

Benzodiazepines, drug Class: Side Effects, types uses

Generic Name Brand Name common Uses Half-life* alprazolam, niravam, xanax, xanax xr anxiety, panic disorders half-life 6-26h (short-acting) chlordiazepoxide. Librax anxiety, alcohol withdrawal half-life 30-100h (long-acting) clobazam, onfi, lennox-Gastaut syndrome, adjunct (seizures) half-life 71-82h (long-acting) clonazepam, klonopin seizure disorder, panic disorder, neuralgia (nerve pain) half-life 20-50h (long-acting) clorazepate Tranxene t-tab anxiety, alcohol withdrawal, partial seizures half-life 20-100h (long-acting) diazepam Valium anxiety, sedation, alcohol withdrawal. The shorter the half-life, the quicker the drug is eliminated. How do benzodiazepines Work? Gaba is the main inhibitory neurotransmitter in the brain. There are three types of gaba (gamma-aminobutyric) receptors in the brain: gaba-a, gaba-b, and gaba-c. Benzodiazepines work in the central nervous system, selectively occupying certain protein areas in the brain called gaba-a receptors. Benzodiazepines enhance responses to filler the inhibitory neurotransmitter gaba by opening gaba-activated chloride channels and allowing chloride ions to enter the neuron. This action allows the neuron to become negatively charged and resistant to excitation, which leads to the various anti-anxiety, sedative, or anti-seizure activity seen with these drugs. The a2 subunit of gaba-a appears to be responsible for the anti-anxiety effects of benzodiazepines; other subunits modulate the amnesic and sedative properties of benzodiazepines.


Traditional benzodiazepines taken alone are hals rarely associated with lethal overdoses, but when combined with other sedatives or alcohol, the risk greatly increases. Flumazenil is a benzodiazepine antagonist antidote that can be given intravenously in the emergency setting to reverse the effects of a benzodiazepine overdose, although some controversy exists over its use. Table 1 lists. Generic and brand name benzodiazepines, their common uses and duration of action. Many of the brand name products have been discontinued by their manufacturers; however, equivalent, lower-cost generics are available for these brands. Some benzodiazepines (diazepam, chlordiazepoxide) have active metabolites that remain in the system (long acting and this can be problematic for patients - especially older patients. Elderly patients may have liver impairment and trouble eliminating the drugs from their system. Side effects, such as dizziness, confusion or unsteadiness may persist in the elderly who are prescribed long-acting benzodiazepines. On the other hand, short-acting benzodiazepines are often preferred for insomnia because they theoretically produce less next-day drowsiness, although many patients still experience these effects. Table 1: Common Benzodiazepines available in the.

Benzodiazepines : Uses, side Effects, Interactions warnings

Benzodiazepines are a class of medications that work in the central nervous system and are used for a variety of medical conditions. As a class, benzodiazepines are similar in how they work in the brain but have different potencies, durations of actions, and receptor site affinities. Because of this, some benzodiazepines work better than others in the treatment of particular conditions. Benzodiazepine Uses: Sedative-hypnotics for sleep, adjuncts to anesthesia to induce prikkelende relaxation and amnesia (procedural memory loss). To reduce anxiety (anxiolytic panic disorders, to treat or prevent seizures. For alcohol withdrawal, muscle relaxant, benzodiazepines are a large drug class (see table 1) 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. All benzodiazepines are listed as dea schedule iv controlled substances. As controlled substances, all benzodiazepines have the potential for abuse, addiction and diversion. 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.

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Sometimes, people taking benzodiazepines may feel drowsy or dizzy. This side effect can be more pronounced with increased doses. High doses of benzodiazepines can produce more serious side effects. Signs and symptoms of acute toxicity or overdose may include the following: Drowsiness.

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The drug is usually added to alcohol-containing drinks or even soft drinks in powder or liquid forms and can be hard to taste. Benzodiazepine Abuse causes, although some people may have a genetic tendency to become addicted to drugs, there is little doubt that environmental factors also play a significant role. Some of the more common environmental influences are low socioeconomic status, unemployment, and peer pressure. Benzodiazepine Abuse symptoms, at normal or regular doses, benzodiazepines relieve anxiety and insomnia. They are usually well tolerated.

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The combination of benzodiazepines and alcohol can be dangerous - and even lethal. Benzodiazepines have also been used as a "date rape" drug because they can markedly impair and even abolish functions that normally allow a person to resist or even want to resist sexual aggression or assault. In recent years, the detection and conviction of people involved in this has increased dramatically.

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They are usually classified by how long their effects last. Benzodiazepines are commonly abused. This abuse is partially related to the toxic effects that they produce and also to their widespread availability. They can be chronically abused or, as seen more commonly in hospital emergency departments, intentionally or accidentally taken in overdose. Death and serious illness rarely result from benzodiazepine abuse alone; however, they are frequently taken with either alcohol or other medications.

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Doctors may prescribe a benzodiazepine for the following legitimate medical conditions: Anxiety, insomnia, alcohol withdrawal, seizure control, muscle relaxation, inducing amnesia for uncomfortable procedures. Given before an anesthetic (such as before surgery). Benzodiazepines act on the central nervous system, produce sedation and muscle relaxation, and lower anxiety levels. Although more than 2,000 different benzodiazepines have been produced, only about 15 are currently fda-approved in the United States.

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Benzodiazepine Abuse overview, benzodiazepines are a type of medication known as tranquilizers. Familiar names include, valium and. They are some of the most commonly prescribed medications in the United States. When people without prescriptions obtain and take these drugs for their sedating effects, use turns into abuse.

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