What are benzodiazepines?

Benzodiazepines are a class of medications that act as sedatives. They work by binding to specific brain receptors to enhance the calming effects of gamma aminobutyric acid (GABA). GABA is a neurotransmitter that helps to manage the speed at which you receive and process information.

By reducing the speed of information you receive, benzodiazepines prevent you from becoming overwhelmed with information.

While benzodiazepines can provide rapid relief, prolonged use may lead to dependence, and you may build up a tolerance to the medication, making it less effective.

Consider speaking with a healthcare professional for short-term options and alternative therapies or medications for the long-term management of your health condition.

What are benzodiazepines?

Doctors commonly prescribe benzodiazepine medications to people with anxiety and sleep disorders. These medications bind to specific receptors in the brain, known as GABA-A receptors, which interact with GABA.

When benzodiazepines interact with GABA, they reduce the activity of neurons and calm the central nervous system. By regulating the activity of GABA, benzodiazepines can effectively reduce anxiety and muscle tension, promoting sedation and sleep.

Benzodiazepines can provide several benefits for people experiencing acute symptoms of anxiety or sleep disturbances. They are known for their rapid onset of action, quickly relieving symptoms and providing relief. These medications can also effectively manage panic attacks, acute anxiety episodes, and insomnia.

Healthcare professionals typically prescribe benzodiazepines for short-term use only because prolonged use can lead to dependence and misuse. Dependence occurs when the body becomes used to the presence of the medication, and withdrawal symptoms may appear when you stop taking them.

Sometimes benzodiazepines can become less effective at managing your symptoms. Your body builds up tolerance to the drug, which means you may need higher doses to achieve the same therapeutic effect.

What are some benzodiazepine uses?

Benzodiazepines have both Food and Drug Administration (FDA) approved uses as well as off-label uses.

FDA-approved uses

Some FDA-approved uses include:

• Anxiety disorders: Benzodiazepines like alprazolam (Xanax) are FDA-approved for the short-term treatment of generalized anxiety disorder, panic disorder, and social anxiety disorder.

• Insomnia: Certain benzodiazepines, such as triazolam (Halcion), have FDA approval for the short-term treatment of insomnia, particularly when you have difficulty falling asleep.
• Seizure disorders: Benzodiazepines like diazepam (Valium) and lorazepam (Ativan) are FDA-approved to manage seizures and prevent prolonged seizures, also called status epilepticus.
• Muscle spasms: Some benzodiazepines, such as diazepam (Valium), are FDA-approved for the relief of acute muscle spasms that occur due to conditions such as spasticity or musculoskeletal injuries.

Off-Label Uses

Off-label use refers to taking or using a medication outside of its FDA-approval indications. While scientific evidence and clinical experience may support these uses, consider speaking with a healthcare professional to assess the possible risks and benefits.

Some off-label uses of benzodiazepines include:

• Alcohol withdrawal: Benzodiazepines such as lorazepam (Ativan) can help manage alcohol withdrawal symptoms by reducing seizures, tremors, and anxiety associated with quitting alcohol.
• Sedation: Doctors may use benzodiazepines like diazepam (Valium) to induce sedation before medical procedures or surgeries. They can help alleviate anxiety, promote relaxation, and have a calming effect.
• Muscle relaxation: Sometimes healthcare professionals prescribe benzodiazepines like clonazepam (Klonopin) off label to help relieve muscle spasms that occur due to conditions like restless leg syndrome.
• Excessive agitation: You may also receive benzodiazepines like lorazepam in emergencies to manage acute agitation or aggression that may occur because of psychiatric conditions or drug toxicity.

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Common and serious side effects

Benzodiazepines, like any medication, can have side effects. Common side effects may include:

• drowsiness
• sedation
• fatigue
• dizziness
• impaired coordination
• memory difficulties
• slurred speech
• nausea
• headache

Common side effects occur during the initial treatment stages and may decrease over time as the body adjusts to the medication. However, consider speaking with a healthcare professional if side effects persist or worsen.

Serious side effects include:

• slow or shallow breathing (respiratory depression)
• severe drowsiness
• low blood pressure
• fainting
• allergic reactions like rash, itching, and swelling
• memory impairment, especially with long term use
• increased risk of falls and accidents, particularly in older adults (ages 65 years and older)
• physical and psychological dependence with prolonged use

If you experience serious side effects, you should consider seeking immediate medical attention.

Withdrawal symptoms

Withdrawal symptoms may occur if you suddenly stop or significantly reduce the dosage of benzodiazepines. They may include:

• seizures
• tremors
• shivering and shaking
• muscle stiffness or pain
• irregular heart rate 
• hallucinations (hearing or seeing things that others can’t see or hear)
• irritability or mood swings
• suicidal thoughts
• increased anxiety, agitation, or hostility 

To minimize the risk and intensity of withdrawal symptoms, healthcare professionals often suggest a gradual reduction of the medication dosage, known as tapering.

Tapering involves slowly decreasing the medication dosage over time under the guidance of a doctor or healthcare professional. By gradually reducing the dosage, the brain and body can adjust to the lower levels of the medication, helping to minimize withdrawal symptoms. 

Do all benzodiazepines cause dependence or use disorder?

Benzodiazepines may cause dependence and increase your risk of substance use disorder (SUD) with prolonged use, but not every person taking these medications will develop these conditions. 

While benzodiazepines carry a risk of dependence or SUD, some factors may increase your risk, including:

• Duration and dosage: Taking benzodiazepines for extended periods, your body may adapt to their presence, increasing the risk of dependence or SUD. 
• History of substance misuse: If you or someone in your family has a history of substance misuse, then you may have a higher risk of developing dependence or SUD. 
• Co-occurring mental health disorders: People with conditions like anxiety or mood disorders may have a higher risk of developing dependence or SUD when taking benzodiazepines. 
• Concurrent use with other substances: Combining benzodiazepines with other substances like alcohol, opioids, or sedatives can lead to heightened sedation and respiratory depression.
• Misuse or noncompliance: Taking benzodiazepines in ways other than prescribed, such as taking higher or more frequent dosing, may lead to dependence or SUD development. 

Common benzodiazepines

Commonly prescribed benzodiazepines include:

• alprazolam (Xanax)
• lorazepam (Ativan)
• diazepam (Valium)
• clonazepam (Klonopin)
• clorazepate dipotassium (Tranxene-T)

Alternatives to benzodiazepines

Sometimes, doctors or healthcare professionals may consider alternative medications to benzodiazepines for the management of anxiety and related conditions.

For generalized anxiety disorder and panic disorder

Doctors commonly prescribe the following medications:

• selective serotonin reuptake inhibitors such as escitalopram (Lexapro) and sertraline (Zoloft)
• serotonin-norepinephrine reuptake inhibitors such as venlafaxine (Effexor), duloxetine (Cymbalta)
• buspirone (Buspar)

For insomnia or sleep disorders

A healthcare professional may prescribe the following:

• melatonin agonists such as ramelteon (Rozerem)
• orexin receptor antagonists such as suvorexant (Belsomra)
• antihistamines such as hydroxyzine (Vistaril) and doxylamine (Unisom)

For muscle relaxation and seizure control

Some common prescription medications include:

• nonbenzodiazepine anticonvulsants like gabapentin (Neurontin)
• baclofen (Lioresal)

When considering alternatives to benzodiazepines, consider speaking with a healthcare professional. They will evaluate your condition and help you choose the most appropriate medication.

Summary

Benzodiazepines are a class of medications commonly prescribed for people with anxiety or sleep disorders. These medications work by enhancing the inhibitory effects of GABA in the brain, providing relief from symptoms such as anxiety, muscle tension, and insomnia. 

While effective, the prolonged use of these medications can lead to dependence and tolerance. Therefore, doctors and healthcare professionals typically only recommend them for short-term use.

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