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Benzodiazepines Drugs are a class of medications that work in the central nervous system and are used for a variety of medical conditions, such as anxiety, seizures, and for alcohol withdrawal. Benzodiazepines work by blocking excessive activity of nerves in the brain and other areas in the central nervous system.ORDER NOW

Benzodiazepines

As a class, benzodiazepines are similar in how they work in the brain but have different potencies and durations of actions. Because of this, some benzodiazepines work better than others in the treatment of particular conditions. Common examples of benzodiazepines include alprazolam (brand: Xanax), diazepam (brand: Valium) and lorazepam (brand: Ativan).

Common benzodiazepine uses:

• for sleep
• to induce relaxation and loss of memory of medical procedures or surgery
• to reduce anxiety (anxiolytic)
• panic disorders
• to treat or prevent seizures
• alcohol withdrawal treatment
• muscle relaxant

Benzodiazepines are a large drug class 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 affordable for most people.

All benzodiazepines are listed as DEA schedule IV controlled substances. As controlled substances, all benzodiazepines have the potential for abuse, addiction and diversion.

Benzodiazepines List

A Boxed Warning, the FDA’s most stringent safety warning, exists on all benzodiazepine product information. When benzodiazepines are combined with other sedatives, opiates or alcohol, the risk of serious side effects such as profound sedation, respiratory depression, coma, and death may occur. Abuse, misuse, addiction, physical dependence, and withdrawal reactions greatly increases with use of this drug class. he Centers for Disease Control and Prevention recommends that doctors avoid prescribing Xanax and other benzodiazepines with opioid pain medication whenever possible.

Flumazenil is a benzodiazepine antagonist antidote that can be given intravenously in the emergency setting to reverse the effects of a benzodiazepine overdose.

Table 1 lists U.S. 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.

Related: Generic Drugs – Availability and Patent Status

How do benzodiazepines work?|Benzodiazepines side effects

Benzodiazepines work in the central nervous system, selectively occupying certain protein areas in the brain called GABA-A receptors. There are three types of GABA (gamma-aminobutyric) receptors in the brain: GABA-A, GABA-B, and GABA-C. GABA is the main inhibitory neurotransmitter in the brain (a chemical that helps to block a nerve action). GABA helps to regulate movement, sight, anxiety, and many other brain functions.

Benzodiazepines open GABA-activated chloride channels and allow 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.

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 or tremors
• sleeping difficulties
• confusion
• anxiety
• hallucination
• seizures
• delirium tremens

Medications such as benzodiazepines are a first-line treatment for acute alcohol withdrawal. Benzodiazepines reduce withdrawal symptoms and may be life-saving for the patient. Commonly used medicines in this group include: chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan). Lorazepam (Ativan) or oxazepam (Serax) may be preferred in patients with liver impairment such as cirrhosis. Chlordiazepoxide, diazepam, and lorazepam can be given orally, intravenously, or intramuscularly. Oxazepam may be useful but is only available orally.

Anxiety|Types of Benzodiazepines

Anxiety and worry is a common problem in adults; however, when chronic, unwarranted worry lasts for a period of six 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 6.8 million adults or about 3% of the U.S. population, but more than half remain untreated. It can be very common in older patients.

Common symptoms of GAD include:

• 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 patient preference. For patients who do not want to use medications, cognitive behavioral therapy and relaxation therapy have been shown to be effective; however the combination may work best. Daily exercise has been shown to helpful for many patients with anxiety.

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. Only short-term use of low-dose benzodiazepines (2 to 6 weeks) is recommended, with a slow, gradual tapering once the antidepressant effect takes hold. Concerns about risks of tolerance, dependence, and diversion with benzodiazepines limit their usefulness in GAD. Benzodiazepines should be avoided in patients with a history of drug abuse.

Common benzodiazepines used for GAD include alprazolam, clonazepam, diazepam, and lorazepam. Mirtazapine (Remeron) 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, due to addictive risk.

Benzodiazepines should be used with extreme caution in the elderly due to the risk for excessive sedation, confusion, falls and fractures