Benzodiazepines are also referred to as tranquillisers and are drugs mainly prescribed for anxiety and insomnia. They are occasionally prescribed for epilepsy, as muscle relaxants, and as a detox from alcohol. They should only be prescribed short term as they can have serious side effects, withdrawal symptoms and addiction problems if overused. They should only be used short-term for the likes of anxiety until the effects of longer term treatment options (eg. counselling, antidepressants, mood stabiliser medication) start working. Benzodiazepines have been prescribed in Ireland for over 50 years and there has been a long history of overprescribing. When they first came out, the likes of “valium” were seen as wonder drugs, their potential problems and side effects were not realised initially and “mother’s little helpers” were overprescribed by family doctors. Only in the last few years have efforts been made to reduce over and inappropriate prescribing.
How they work?Benzodiazepines work by slowing the communication between neurons giving a calming effect to many functions of the brain. Benzodiazepines main effect is to reduce anxiety and agitation, while it does this quickly (within half an hour); this effect is short lived (a few hours only). Side effects can include drowsiness and slowing of mental and bodily movements.
Benzodiazepines may cause confusion, slurred speech, coordination problems, impairment of judgement and memory loss in some people, especially at higher doses. Paradoxically they can cause mood swings in some people (perhaps this is more when the dose wears off). With long term use, tolerance can occur; this involves needing higher doses to produce the same effects. Dependence can also occur with longer term use (more than a week); symptoms can include feeling a constant need for the drug with the feeling of not being able to function right without it and developing withdrawal symptoms if the drug is stopped. Withdrawal symptoms can be debilitating and can include nausea, vomiting, sweats, low mood, and paranoia and panic attacks.
Benzodiazepines combined with alcohol or other medication (even some common over the counter medicines such as pain-killers and anti-histamines) can cause loss of consciousness and respiratory failure. Side effects are rare if doses are kept low and courses are short (ideally 4 weeks maximum).
Types of benzodiazepineExamples of benzodiazepine include include alprazolam (Xanax®), clonazepam (Rivotril®), lorazepam (Ativan®), diazepam (Valium®, Anxicalm®), and chlordiazepoxide (Librium®). Some benzodiazepines have a very sedative effect so are only used as sleeping tablets; these include triazolam (Halcion®), nitrazepam (Mogadon®), temazepam (Nortem) and flurazepam (Dalmane). They should only be used short term as sedatives due to the reasons like tolerance, dependence and withdrawal symptoms described earlier.
Use in the elderlyIn older people, benzodiazepines are associated with more severe side effects including marked sedation and psychomotor impairment (slowdown of mental and physical activity), higher risk of fractures (especially hip fractures) and driving accidents, and a quicker development of tolerance, dependence and withdrawal symptoms (when compared to younger patients). Their use in the elderly should be avoided but if they are used they should be used with caution.
This article is shortened for this Health Blog.. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie