Benzodiazepines are a class of drugs that are primarily used for treating anxiety in children and adults. They can also benefit people with conditions such as insomnia and panic attack disorder.
They help treat symptoms such as:
- decreased need for sleep
- racing thoughts
- unusual talkativeness
- increased activity
Taking benzodiazepines increases a person’s risk for addiction, so these medications are usually limited to short-term use for the temporary relief of symptoms.
According to certain 2019 recommendations, people with severe anxiety or panic attack disorder should be prescribed the lowest effective dose of benzodiazepines for no more than 2 to 4 weeks. People with insomnia should be prescribed low doses of benzodiazepines for up to 1 week.
Slang terms for benzodiazepines include benzos, downers, and Xannies.
Benzodiazepines by the numbers
Benzodiazepines have become more popular over time.
According to the Food and Drug Administration (FDA), U.S. outpatient pharmacies dispensed
According to a 2016 study in the American Journal of Public Health, the number of U.S. adults filling prescriptions for benzodiazepines increased by 67 percent from 1996 to 2013.
A 2018 study in Psychiatric Services, a journal by the American Psychiatric Association, found evidence of increasing use — and misuse — of benzodiazepines in the United States.
During the previous year, 12.6 percent of people ages 18 and older, or more than 1 in 8, used benzodiazepines. Over 17 percent of them misused the drugs, meaning they took the drugs without a prescription, for longer than prescribed, with opioids, or in other ways that weren’t approved by a doctor.
Benzodiazepines are usually administered orally or intravenously. Some are also available as a topical gel or nasal spray.
The following are some common benzodiazepines and the conditions the Food and Drug Administration (FDA) has approved them to treat:
|Name of benzodiazepine||Why it’s prescribed|
|alprazolam (Xanax, Xanax XR)||anxiety or panic attack disorder|
|chlordiazepoxide (Librium)||anxiety or symptoms of alcohol withdrawal|
|clonazepam (Klonopin)||seizures or panic attack disorder|
|diazepam (Diastat, Valium, Valtoco)||anxiety, symptoms of alcohol withdrawal, muscle spasms, or certain epileptic seizures|
|lorazepam (Ativan, Loreev XR)||anxiety|
|temazepam (Restoril)||short-term treatment of insomnia (7 to 10 days)|
|triazolam (Halcion)||short-term treatment of insomnia (7 to 10 days)|
A doctor may also prescribe benzodiazepines for treatment of chronic insomnia or for conditions such as post-traumatic stress disorder (PTSD) or mania associated with bipolar disorder, although the FDA has not approved them for these purposes. This is known as off-label drug use.
Off-label drug use
Off-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.
Benzodiazepines increase gamma-aminobutyric acid (GABA), which is a neurotransmitter (or chemical messenger) in the brain. This slows down the nervous system and has a relaxing, sedative effect that works to relieve anxiety.
Benzodiazepines have the advantage of taking effect quickly but are not recommended for long-term or routine use.
There are three kinds of benzodiazepines, each of which has a different half-life. The half-life is the amount of time that elapses before only half of the drug’s dosage remains active in your body.
According to a
- 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.
Older adults are at a higher risk of benzodiazepine side effects such as memory problems and falls. People ages 65 years and older should avoid these medications, according to criteria developed by the American Geriatric Society. The College of Psychiatric and Neurologic Pharmacists recommends that people ages 55 years and older avoid benzodiazepines.
Benzodiazepines can also worsen some conditions, such as:
The side effects of benzodiazepines may vary slightly between the different types of these drugs. All benzodiazepines have the following common side effects:
In addition, common side effects of some frequently prescribed benzodiazepines may include:
- slowed and ineffective breathing, also known as respiratory depression (for alprazolam, chlordiazepoxide, diazepam, lorazepam, and triazolam)
- nausea or nervousness (for temazepam)
Rare side effects of benzodiazepines may include:
- irregular heart rate
- hostile and aggressive behavior
- double vision
- changes in your sex drive
- difficulties urinating
If you’re taking a benzodiazepine, check with your doctor to see if it’s safe to drive a vehicle, operate machinery, or perform activities that require a focus on details.
Because of the increased risk of respiratory depression, benzodiazepines should not be taken with the following medications:
- Opioids. Combining benzodiazepines with oxycodone (OxyContin, Roxicodone), hydrocodone (Hysingla ER), or other opioids can be lethal. Around 75 percent of overdose deaths involving benzodiazepines also involve opioids.
- First-generation antihistamines. First-generation antihistamines include over-the-counter medications such as:
- dimenhydrinate (Dramamine)
- diphenhydramine (Benadryl, Sominex)
- doxylamine (Unisom)
- Insomnia medications. These include zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata).
The following medications can affect how benzodiazepines are absorbed by your body:
- Antacids. Antacids can decrease the absorption of benzodiazepines and reduce their concentration in your blood.
- Proton pump inhibitors (PPIs). These medications, such as omeprazole (Prilosec) and esomeprazole (Nexium), are used to treat acid reflux. They can interact with the liver enzymes that remove benzodiazepines from your body, increasing the amount that remains in your blood.
Benzodiazepines should not be combined with alcohol or other substances that inhibit the central nervous system either. Alcohol can increase side effects such as drowsiness, and it also increases the risk of an accidental overdose.
Get immediate medical help if you’re taking benzodiazepines with opioids, alcohol, or other sedating medications and are experiencing symptoms such as:
- dizziness or lightheadedness
- extreme sleepiness
- difficulty breathing
If you’ve taken a benzodiazepine for a long time, you may become physically and psychologically dependent on the drug.
If you suddenly stop taking the medication, you may experience withdrawal symptoms such as:
The symptoms may be life threatening.
To avoid withdrawal symptoms, your doctor will slowly lower the dosage of the benzodiazepine.
Withdrawal symptoms may be worse for short-acting benzodiazepines because your body has less time to adjust to being without them. Your doctor may change your prescription to a long-acting benzodiazepine such as clonazepam and slowly lower the dosage.
Although benzodiazepines can effectively treat anxiety and insomnia, they’re addictive and can cause lethal interactions with other drugs such as opioids.
Only take these medications as your doctor prescribes. Talk with a healthcare professional if you have any concerns about safely taking benzodiazepines.
Benzodiazepines should be taken on a short-term basis under a doctor’s supervision. Be sure to tell your doctor about any other medications you are taking.
To prevent potentially fatal withdrawal symptoms, it’s important that you do not suddenly stop taking benzodiazepines. Instead, your dosage should be slowly lowered.