Benzodiazepines

Benzodiazepines are a group of medications most often prescribed to manage anxiety in both children and adults. They may also provide relief for individuals experiencing conditions such as insomnia and panic attack disorder.

These drugs are designed to reduce symptoms that can include:

• reduced need for sleep
• racing thoughts
• excessive talkativeness
• heightened activity levels
• agitation
• distractibility

Because benzodiazepines carry a significant risk of dependence and addiction, healthcare providers typically recommend them for short-term use to ease acute or temporary symptoms.

According to certain 2019 recommendations, individuals with severe anxiety or panic attack disorder should receive the lowest effective dose of benzodiazepines for no longer than 2 to 4 weeks. For insomnia, low doses are generally advised for up to 1 week.

Common slang terms for benzodiazepines include benzos, downers, and Xannies.

Benzodiazepines by the numbers

The use of benzodiazepines has increased over the years.

Data from the Food and Drug Administration (FDA) show that U.S. outpatient pharmacies dispensed around 92 million benzodiazepine prescriptions in 2019.

A 2016 study published in the American Journal of Public Health reported that the number of U.S. adults filling benzodiazepine prescriptions rose by 67 percent between 1996 and 2013.

Additionally, a 2018 study in Psychiatric Services identified evidence of both increased use and misuse of benzodiazepines across the United States.

Within the previous year, 12.6 percent of adults ages 18 and older — more than 1 in 8 people — reported using benzodiazepines. Of these individuals, over 17 percent misused the medications, meaning they used them without a prescription, for longer than directed, together with opioids, or in ways not approved by a healthcare professional.

Types of benzodiazepines

Benzodiazepines are most commonly taken orally or administered intravenously. Some formulations are also available as a topical gel or nasal spray.

Below are several widely used benzodiazepines and the conditions the Food and Drug Administration (FDA) has approved them to treat:

Physicians may sometimes prescribe benzodiazepines for chronic insomnia or for conditions such as post-traumatic stress disorder (PTSD) or mania associated with bipolar disorder, even though the FDA has not specifically approved them for these uses. This practice is referred to as off-label drug use.

Off-label drug useOff-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that has not yet been approved.However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use drugs to treat their patients. So your doctor can prescribe a drug however they think is best for your care.

How benzodiazepines work

Benzodiazepines enhance the activity of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain. By boosting GABA, these medications slow central nervous system activity, producing a calming and sedative effect that helps relieve anxiety and promote sleep.

One advantage of benzodiazepines is their rapid onset of action. However, due to the risk of tolerance and dependence, they are not recommended for extended or routine use.

There are three main categories of benzodiazepines, classified by their half-life. A half-life refers to the time required for half of the drug’s active dose to remain in the body.

According to a 2013 study:

• Short-acting drugs have a median half-life of 1 to 12 hours. Triazolam is an example of a short-acting drug.
• Intermediate-acting drugs have an average half-life of 12 to 40 hours. Examples include alprazolam, clonazepam, and lorazepam.
• Long-acting drugs have an average half-life of 40 to 250 hours. Examples include chlordiazepoxide and diazepam.

Who should avoid them

Older adults face a higher likelihood of side effects from benzodiazepines, including memory impairment and an increased risk of falls. Based on criteria developed by the American Geriatric Society, people ages 65 years and older should generally avoid these medications. The College of Psychiatric and Neurologic Pharmacists advises avoidance beginning at age 55.

A 2019 literature review found that benzodiazepine use during pregnancy is associated with premature delivery and low birth weight.

Furthermore, a 2022 South Korean study reported that high-dose use during the first trimester slightly increased the risk of developmental problems and heart defects in children.

Benzodiazepines may also aggravate certain medical conditions, including:

• depression
• fibromyalgia
• hypoxia, or low oxygen in your tissues, due to disorders such as: asthma chronic obstructive pulmonary disease (COPD) sleep apnea

Benzodiazepines side effects

Although specific reactions can vary by medication, all benzodiazepines share several common side effects:

• drowsiness
• dizziness
• lightheadedness

Additional side effects associated with some frequently prescribed benzodiazepines include:

• slowed and ineffective breathing, also known asrespiratory depression(for alprazolam, chlordiazepoxide, diazepam, lorazepam, and triazolam)
• nausea or nervousness (for temazepam)

Benzodiazepines and headache

Headache is considered a common side effect of temazepam (Restoril) and an uncommon side effect of certain other benzodiazepines.

Less common but potentially serious side effects may include:

• confusion
• irregular heart rate
• amnesia
• hostile or aggressive behavior
• hallucinations
• double vision
• rashes
• changes in sex drive
• difficulties urinating

If you are taking a benzodiazepine, consult your doctor to determine whether it is safe to drive, operate heavy machinery, or perform tasks that demand close attention.

Possible drug interactions

Due to the elevated risk of respiratory depression, benzodiazepines should not be used with the following medications:

• Opioids. Combining benzodiazepines with oxycodone (OxyContin, Roxicodone), hydrocodone (Hysingla ER), or other opioids can be fatal. Around 75 percent of overdose deaths involving benzodiazepines also involve opioids.
• First-generation antihistamines. These over-the-counter medications include: dimenhydrinate (Dramamine) diphenhydramine (Benadryl, Sominex) doxylamine (Unisom)
• Insomnia medications. These include zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata). For individuals comparing sleep aid options, understanding factors such as Zolpidem 10 mg price CVS and overall Zolpidem cost without insurance may be relevant when discussing treatment affordability with a healthcare provider.

The following drugs may influence how benzodiazepines are processed in the body:

• Antacids. These can reduce the absorption of benzodiazepines and lower their levels in the bloodstream.
• Proton pump inhibitors (PPIs). Medications such as omeprazole (Prilosec) and esomeprazole (Nexium), commonly used for acid reflux, may interfere with liver enzymes responsible for breaking down benzodiazepines, potentially increasing blood concentrations.

Benzodiazepines should also be avoided in combination with alcohol or other central nervous system depressants. Alcohol can intensify drowsiness and significantly raise the risk of accidental overdose.

Seek immediate medical attention if you are using benzodiazepines along with opioids, alcohol, or other sedating agents and experience:

• dizziness or lightheadedness
• extreme sleepiness
• difficulty breathing

Benzodiazepine withdrawal

Long-term use of a benzodiazepine can lead to both physical and psychological dependence.

If the medication is stopped abruptly, withdrawal symptoms may occur, including:

• nightmares
• hallucinations
• sweating
• headache
• upset stomach
• seizures

In some cases, withdrawal symptoms can be life threatening.

To reduce the risk of withdrawal, doctors typically taper the dosage gradually rather than stopping the medication suddenly.

Withdrawal may be more intense with short-acting benzodiazepines because the body has less time to adjust. In some cases, a physician may transition a patient to a long-acting benzodiazepine such as clonazepam and then slowly decrease the dose.

Takeaway

Benzodiazepines can be effective for short-term management of anxiety and insomnia, but they carry risks of addiction and potentially fatal drug interactions, particularly with opioids.

Always use these medications exactly as prescribed by your doctor. If you have concerns about safety, side effects, or cost — including questions about Zolpidem cost without insurance when comparing sleep medications — speak with a qualified healthcare professional to review your options.

Benzodiazepines should be taken for limited periods under close medical supervision. Inform your doctor about all other medications and supplements you are using.

To avoid serious and potentially life threatening withdrawal symptoms, never stop taking benzodiazepines abruptly. Your dosage should be reduced gradually under medical guidance.