Benzodiazepines are a group of anxiety medications that are used to treat a range of conditions, including anxiety. They have a calming effect by enhancing the work of GABA, a neurotransmitter in the brain. Benzodiazepines can be effective medications, but they do come with risks. If you are taking benzodiazepines, you should be aware of potential side effects, risks, and drug interactions.
What Are Benzodiazepines & How Do They Work?
Benzodiazepines, or sometimes called benzos for short, are a class of medications that are most commonly used to treat anxiety disorders.1 In addition to treating anxiety, they may be prescribed for insomnia, epilepsy, and alcohol withdrawal. Benzodiazepines can induce feelings of calm and relaxation. They work by increasing the efficiency of the neurotransmitter GABA in the brain.
There are many different benzodiazepines available, including alprazolam (Xanax) and clonazepam (Klonopin).1 These medications are very effective at decreasing anxiety. However, they can also cause a range of side effects and risks, including tolerance, dependence, withdrawal, and addiction. Because of these risks, benzodiazepines are usually only prescribed for short periods of time, rather than as a long-term treatment.
Benzodiazepine Uses
Benzodiazepines are prescribed to treat a range of conditions and symptoms.1 The most common reason for prescribing benzodiazepines is to treat anxiety symptoms. Benzodiazepines are effective at reducing symptoms during a panic attack and panic disorder. They are more effective and safe treating bursts of anxiety than they are for more steady and constant anxiety symptoms. They can also help promote muscle relaxation and sleep in people dealing with insomnia.
Benzodiazepines also have anticonvulsant and sedative effects.1 Certain benzodiazepines are prescribed for epilepsy and alcohol withdrawal. They are sometimes used as an anaesthetic for people undergoing minor operations, like oral surgery.
Benzodiazepines are often prescribed to treat the following conditions:1
- Anxiety
- Panic attack
- Insomnia
- Epilepsy
- Alcohol withdrawal
- Muscle spasms
- Anaesthesia during surgery
Benzodiazepine Off-Label Uses
Benzodiazepines are intended to treat the conditions listed above and are approved by the Food and Drug Administration (FDA) for these purposes.2 Sometimes medical professionals will prescribe medications for other purposes, which is called off-label use. However, this is not recommended with benzodiazepines as it may be harmful.
Off-label uses for benzodiazepines include:3
- Depression
- Posttraumatic stress disorder (PTSD)
- Chronic insomnia or anxiety
Types of Benzodiazepines
There are several medications that fall into the category of benzodiazepines.1 These medications are similar in how they influence GABA in the brain. However, they differ in potency and how quickly they exert their effects and are eliminated from the body.4
Benzodiazepines are typically classified by two categories: potency (high and low) and duration of action (short-, intermediate-, and long-acting).4 Duration of action is determined by each medication’s half-life, which refers to how long it takes for half of the medication to be processed and eliminated from the body.
Short-acting benzodiazepines have a half life of between one and 12 hours, intermediate-acting benzodiazepines have a half-life of between 12 and 40 hours, and long-acting benzodiazepines have a half-life of between 40 and 250 hours. High potency benzodiazepines work more quickly, but can also cause more significant side effects. Benzodiazepines with a shorter half-life can cause more rapid withdrawal symptoms.1
Here are commonly benzodiazepines and what they’re typically used for:1,4
| Generic (Brand Drug Name) | Uses | Half-life | Potency |
|---|---|---|---|
| alprazolam (Xanax) | Anxiety, panic attacks | Short | High |
| lorazepam (Ativan) | Anxiety, seizures, insomnia, anaesthesia | Short | High |
| temazepam (Restoril) | Insomnia, anaesthesia | Short | Low |
| clonazepam (Klonopin) | Anxiety, seizures | Intermediate | High |
| diazepam (Valium) | Anxiety, insomnia, muscle spasms, alcohol withdrawal, seizures, anaesthesia | Long | Medium |
| chlordiazepoxide (Librium) | Anxiety, alcohol withdrawal | Long | Low |
How Long Does it Take For Benzodiazepines to Work?
Benzodiazepines vary in how quickly they take to work. Generally, a person may experience decreased anxiety within a few minutes or up to an hour.1,4 The exact amount of time it takes to feel relief depends on the specific medication, its potency, and half-life. A short-acting, high potency benzo like Xanax will work very quickly, while a long-acting, low potency medication like Librium will take longer.
Are Benzodiazepines Safe?
Benzodiazepines can be safe when taken as prescribed and closely monitored by a medical professional. However, benzodiazepines can lead to addiction, dependence, and may be problematic if combined with alcohol or other drugs.5 The safety of taking benzodiazepines during pregnancy is controversial. Pregnant women should talk to their providers about the costs and benefits of these medications and also consider alternatives.
Benzodiazepine Addiction
Long-term use of benzodiazepines can lead to addiction, especially if they’re not taken as prescribed.5 Benzodiazepines can cause effects similar to alcohol. Because these effects are pleasurable, people who take benzodiazepines may be tempted to misuse them by taking more than prescribed or taking them without a prescription. These all increase the risk of addiction.
Benzodiazepines can also cause dependence, which often goes with addiction. Dependence happens when a person’s body becomes accustomed to a medication and requires more of it to feel the same effects.
Benzodiazepines & Alcohol
Benzodiazepines and alcohol should not be mixed. Drinking alcohol while taking benzodiazepines increases the risk of abuse, addiction, and overdose.2 A large portion of benzo overdoses involve alcohol. If you are prescribed benzodiazepines, it is important to abstain from alcohol while on medication. The chemical effects on the brain of alcohol and benzodiazepines are very similar. Therefore, combining these substances can be quite dangerous.
Benzodiazepines & Pregnancy
The use of anxiety medications during pregnancy is controversial.6 Research has found a slight increase in risk of cleft palate when benzodiazepines are taken during the first trimester of pregnancy. Babies born to mothers who take benzodiazepines during pregnancy may also develop withdrawal symptoms like irritability, sleeping problems, and in rare cases, seizures.
Anytime medication is considered during pregnancy, it is important to weigh the risks and benefits with a professional. Mental health conditions are also associated with pregnancy complications, so it’s important to talk through the decision with a prescriber who has experience treating pregnant women.
Benzodiazepines Side Effects
Anxiety medications like benzodiazepines can cause a range of side effects, including trouble breathing or loss of consciousness.4,7 Some side effects are mild, but others can be dangerous. Benzodiazepines can cause people to feel drowsy and disoriented, so it’s important to avoid driving or any other activities that could lead to an accident or injury.
If you or someone you know experiences any serious side effects, be sure to seek medical attention right away.
Common benzo side effects may include:4,7
- Drowsiness
- Dizziness
- Confusion
- Headache
- Low energy
- Stomach problems, like nausea, vomiting, and diarrhoea
- Slurred speech
- Blurry vision
- Changes in mood
More serious side effects of benzodiazepines can include:7
- Difficulty breathing
- Loss of consciousness
Symptoms of Overdose
If you or someone you know is experiencing signs of an overdose, call 9-1-1 and seek medical attention immediately. Symptoms include loss of consciousness, confusion, and difficulty breathing. A benzo overdose is dangerous, but may be treatable if medical attention is sought as quickly as possible.
A benzodiazepine overdose can happen if a person takes more benzodiazepines than their body can handle.8
The risk of an overdose is higher if a person misuses the medication or mixes benzodiazepines with alcohol, opioids, or other sedatives. When benzodiazepines are mixed with these substances, the risk of a fatal overdose increases significantly.
Symptoms of benzodiazepine overdose include:8
- Loss of consciousness
- Confusion
- Difficulty breathing
- Slurred speech
- Poor balance and coordination
Benzodiazepine Drug Interactions
Benzodiazepines can interact with certain medications, including some oral contraceptives, antifungals, and antibiotics. These may affect how they work. Because benzodiazepines are metabolised in the liver by specific enzymes, medications that work with these enzymes can impact how benzodiazepines are eliminated from the body.4
Medications that may interact with benzodiazepines include:
- Certain oral contraceptive pills
- Antifungals
- Certain antibiotics
- Carbamazepine (Tegretol)
- Rifampin
- Phenytoin
- St. John’s Wort
Taking benzodiazepines with alcohol, opioids, and other sedatives should always be avoided.4,5 Mixing these substances together can increase the risk of dangerous side effects and overdose. Before taking any benzodiazepines, be sure to disclose any medications you are taking to your doctor and don’t hesitate to ask for more information about drug interactions.
Benzodiazepine Withdrawal
When a person takes benzodiazepines for a prolonged period of time, their body can become dependent on the medication.1 If the person stops taking benzodiazepines or reduces the amount, they can experience withdrawal symptoms. Benzo withdrawal includes psychological symptoms like anxiety and depression, as well as physical symptoms like low energy, aches and pains, and stomach problems.
Severe symptoms of withdrawal include hallucinations (i.e., seeing or hearing things that are not there) and seizures. In rare cases benzo withdrawal can even cause death.9 To avoid dependence and withdrawal, medical professionals suggest limiting benzo use to two to four weeks.1
If a person has been on benzodiazepines for an extended period of time, they should not stop cold turkey. Instead, it is important to work with a medical provider on developing a taper. This allows a person to gradually reduce their dose over several weeks and sometimes months, which can help prevent dangerous withdrawal symptoms.
Some medical providers also recommend switching to a benzo with a longer half-life, like diazepam, and then gradually decreasing the dose to help manage withdrawal.
Symptoms of benzo withdrawal include:1,10
- Anxiety
- Depression
- Irritability
- Poor memory and concentration
- Headache
- Fatigue
- Sweating
- Muscle pain and weakness
- Changes in appetite
- Dry mouth
- Metallic-like taste
- Palpitations
- Hypersensitivity
- Skin rash
- Upset stomach
- Sleeping problems
- Hallucinations
- Seizures
Misuse of Benzodiazepines
Because benzodiazepines are effective at alleviating anxiety, there is a potential for them to be misused. People may misuse benzodiazepines by taking more than prescribed, mixing benzodiazepines with other substances or medications to enhance its effects, or taking them without a prescription. Benzo misuse is harmful because it can lead to dependence and addiction and increase the risk of an overdose.8
To prevent benzo misuse, it is important to only take benzodiazepines as prescribed. Discuss any concerns with your healthcare provider and do not take more benzodiazepines or stop taking them on your own.
Questions to Ask Your Health Team About Benzodiazepines
Before taking any medication, talk to your treatment team about the different treatment options and weigh the risks and benefits. It can help to write down your questions before meeting with your doctor, psychiatrist, or therapist. Do not hesitate to bring up any questions or concerns. Your treatment team is available to help you make a decision about whether or not to take medication.
Here are several questions to ask your care team before taking benzodiazepines:
- Would you recommend benzodiazepines for my condition?
- How much and how often should I take the medication?
- Is there a risk of tolerance, withdrawal, or addiction?
- What are common side effects of this medication?
- What should I do if I experience side effects?
- Are there any other medications or substances that I should avoid while taking this medication?
- What should I do if I want to stop the medication? Is it safe to stop cold turkey?
Final Thoughts
Benzodiazepines can be helpful for treating a variety of conditions, including anxiety, panic disorder, alcohol withdrawal, and epilepsy. They also carry risks that must be considered. It is important to talk through your decision to take benzodiazepines with your prescriber. They can help you weigh the pros and cons of the medication and determine whether it is right for you.
For Further Reading
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