Table of ContentsView AllTable of ContentsUsesHow They WorkExamplesSide EffectsSafetyDrug InteractionsAdvantages vs. DisadvantagesAlternatives
Table of ContentsView All
View All
Table of Contents
Uses
How They Work
Examples
Side Effects
Safety
Drug Interactions
Advantages vs. Disadvantages
Alternatives
Benzodiazepines are a class of drugs (commonly referred to as “benzos”) prescribed to treat anxiety, panic disorder, seizures, insomnia, and alcohol withdrawal. They may also be used along with anesthesia during surgery.
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What Are Benzodiazepines Used For?
Approved indications for benzodiazepine use in adults include:
Providers are generally able to use their medical expertise to prescribe FDA-approved drugs for unapproved uses as long as they judge that the drug is medically appropriate for you.
Examples of these uses with benzodiazepines include:
How Do They Work?
Benzodiazepines, as a class, work on a certain type of receptor found throughout your brain and spinal cord, which make up thecentral nervous system.
This receptor is a protein called gamma-aminobutyric acid type A (GABA-A) receptor. Benzodiazepine drug molecules mimic the naturally occurringneurotransmitterGABAand bind to this receptor. This allows chloride ions to enter the neuron cells, which results in CNS depression. Outward signs of this include calmness, sleepiness, or drowsiness.
How quickly benzodiazepines begin to work depends on which specific drug you’re taking and how you’re taking it. Taken orally, most benzodiazepines are well absorbed. Some of the fastest-acting drugs in this class are:
Intravenous (IV) injection results in rapid onset of effects. Midazolam, in particular, is one of the mostlipophilicbenzodiazepines, meaning it rapidly crosses the blood-brain barrier (to enter your CNS).
Why Benzodiazepines Work
These effects help relieve the symptoms of certain conditions it’s used for, such as anxiety and panic disorder, and are why it is sometimes used for sedation.
Most Commonly Prescribed BenzodiazepinesThe most commonly prescribed benzodiazepines are:AtivanKlonopinValiumXanax
Most Commonly Prescribed Benzodiazepines
The most commonly prescribed benzodiazepines are:AtivanKlonopinValiumXanax
The most commonly prescribed benzodiazepines are:
What Are the Side Effects?
Side effects of benzodiazepines are somewhat common. For example, the following side effects have occurred in greater than or equal to 1% of people taking Xanax during clinical trials:
Another commonly used benzodiazepine, Valium, has been associated with the following side effects:
Some more serious warnings exist for the benzodiazepine drug class as a whole. These include:
How to Take Benzodiazepines Safely
However, here are a few general tips for taking benzodiazepines safely:
Use in Older Adults
The American Geriatrics Society (AGS) lists benzodiazepines as a class of medications that should be avoided in people 65 and older. Nevertheless, they’re still occasionally prescribed to this population.
Use of these drugs in older adults comes with risks of dependence, cognitive deficits (or impaired thinking), falls, and car accidents.
These risks are even greater if benzodiazepines are used in older people who have a history of falls or who are already receivingtwo or moreother CNS drugs (such as opioids, muscle relaxants, sleeping pills, orbarbiturates, among others).
In cases in which benzodiazepines are necessary in an older individual, the most favored options are known as the “LOT drugs” (lorazepam, oxazepam, and temazepam). This is because they are shorter-acting and do not have active metabolites, making them less likely to cause residual or longer-term side effects.
Even in this case, the lowest effective dose for the shortest possible period will prove to be the safest in older adults.
Drug Interactions to Watch Out For
If you take benzodiazepines, be aware of potential drug or substance interactions. This includes:
Benzodiazepines have both advantages and disadvantages to their use. While effective, they can come with potentially serious side effects and require some precautions when taking them.
ProsEffective at reducing anxietyHelpful for sleep problemsWork well as muscle relaxantsCan treat and prevent epileptic seizuresVariety of options within the drug class with different onsets and durations of actionsConsPotential for misuse, abuse, and addictionHas cognitive side effects, such as mental slowing andanterograde amnesia(difficulty forming new memories)Can be habit-forming and difficult to taper down the dose in people who have taken them regularly for more than a few weeksNot recommended for use in older people (65 and above) due to the increased risk of respiratory depression, excessive sedation, and cognitive effects
ProsEffective at reducing anxietyHelpful for sleep problemsWork well as muscle relaxantsCan treat and prevent epileptic seizuresVariety of options within the drug class with different onsets and durations of actions
Effective at reducing anxiety
Helpful for sleep problems
Work well as muscle relaxants
Can treat and prevent epileptic seizures
Variety of options within the drug class with different onsets and durations of actions
ConsPotential for misuse, abuse, and addictionHas cognitive side effects, such as mental slowing andanterograde amnesia(difficulty forming new memories)Can be habit-forming and difficult to taper down the dose in people who have taken them regularly for more than a few weeksNot recommended for use in older people (65 and above) due to the increased risk of respiratory depression, excessive sedation, and cognitive effects
Potential for misuse, abuse, and addiction
Has cognitive side effects, such as mental slowing andanterograde amnesia(difficulty forming new memories)
Can be habit-forming and difficult to taper down the dose in people who have taken them regularly for more than a few weeks
Not recommended for use in older people (65 and above) due to the increased risk of respiratory depression, excessive sedation, and cognitive effects
Benzodiazepines are often prescribed for conditions like anxiety and insomnia, even though other treatments exist that show equal or better results with fewer risks and side effects.
A few alternatives to benzodiazepine therapy are:
Older adults are somewhat limited in options for safe medications due to the likelihood of side effects of many drugs worsening with age.
However, the AGS considers antidepressants Silenor (doxepin) and Remeron (mirtazapine) as good and safe options for treating insomnia in older people.
Summary
Benzodiazepines are a powerful medication class with a wide variety of indications and off-label uses, such as anxiety disorders, epileptic seizures, and insomnia, and for initiating anesthesia.
While effective for these purposes, benzodiazepines come with several important risks to consider. They are associated with dependence, misuse and abuse, cognitive impairments, and increased likelihood of severe side effects, particularly when combined with other depressant substances like opioids or alcohol.
The safest way to take benzodiazepines is on an as-needed basis rather than scheduled, at the lowest effective dose possible, and ideally for only a short period.
Speak with your healthcare provider about first trying safer, evidence-based alternatives such as cognitive behavioral therapy and other medications like antidepressants.
25 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Dubovsky SL, Marshall D.Benzodiazepines remain important therapeutic options in psychiatric practice.Psychother Psychosom. 2022;91(5):307-334. doi:10.1159/000524400
Edinoff AN, Nix CA, Hollier J, et al.Benzodiazepines: uses, dangers, and clinical considerations.Neurol Int. 2021;13(4):594-607. doi:10.3390/neurolint13040059
Jacobi J, Fraser GL, Coursin DB, et al.Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.Crit Care Med. 2002;30(1):119-41. doi:10.1097/00003246-200201000-00020
Chung CY, Chen CL, Wong AM.Pharmacotherapy of spasticity in children with cerebral palsy.J Formos Med Assoc. 2011;110(4):215-222. doi:10.1016/S0929-6646(11)60033-8
Carlos K, Prado GF, Teixeira CD, et al.Benzodiazepines for restless legs syndrome.Cochrane Database Syst Rev. 2017;3(3):CD006939. doi:10.1002/14651858.CD006939.pub2
Bergman H, Bhoopathi PS, Soares-Weiser K.Benzodiazepines for antipsychotic-induced tardive dyskinesia.Cochrane Database Syst Rev. 2018;1(1):CD000205. doi:10.1002/14651858.CD000205.pub3
Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG.Current treatment options for REM sleep behaviour disorder.J Pers Med. 2021;11(11):1204. doi:10.3390/jpm11111204
Prommer E.Midazolam: an essential palliative care drug.Palliat Care Soc Pract. 2020;14:2632352419895527. doi: 10.1177/2632352419895527
National Institutes of Health. DailyMed.Label: midazolam hydrochloride injection, solution.
National Institutes of Health. DailyMed.Label: Nayzilam midazolam spray.
National Institutes of Health. DailyMed.Label: Klonopin clonazepam tablet.
National Institutes of Health. DailyMed.Label: Halcion triazolam tablet.
National Institutes of Health. DailyMed.Label: Restoril temazepam capsule.
National Institutes of Health. DailyMed.Label: Xanax alprazolam tablet.
National Institutes of Health. DailyMed.Label: Ativan lorazepam tablet.
National Institutes of Health. DailyMed.Label Chlordiazepoxide hydrochloride capsule.
National Institutes of Health. DailyMed.Label: Valium diazepam tablet.
National Institutes of Health. DailyMed.Label: Valtoco diazepam spray.
National Institutes of Health. DailyMed.Label: diazepam injection, solution.
Kroll DS, Nieva HR, Barsky AJ, Linder JA.Benzodiazepines are prescribed more frequently to patients already at risk for benzodiazepine-related adverse events in primary care.J Gen Intern Med. 2016;31(9):1027-1034. doi:10.1007/s11606-016-3740-0
Markota M, Rummans TA, Bostwick JM, Lapid MI.Benzodiazepine use in older adults: dangers, management, and alternative therapies.Mayo Clin Proc. 2016;91(11):1632-1639. doi:10.1016/j.mayocp.2016.07.024
National Institutes of Health.Benzodiazepines and opioids.
Baldwin DS, Aitchison K, Bateson A, et al.Benzodiazepines: risks and benefits. a reconsideration.J Psychopharmacol. 2013;27(11):967-971.
Guina J, Merrill B.Benzodiazepines I: upping the care on downers: the evidence of risks, benefits and alternatives.J Clin Med. 2018;7(2):17. doi:10.3390/jcm7020017
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