Topics Index

TOPIC : Benzodiazepines
DISCUSSION :

"Benzodiazepines (BZDs) are classified as central nervous system depressants and have multiple uses in the treatment of anxiety and panic attacks, control of seizures, management of insomnia or used in critical care settings for sedation for procedures.
Antianxiety Agents: alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium),   lorazepam (Ativan), midazolam (Versed), oxazepam (Novaxapam, Serax)
Anticonvulsants: clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium)
Sedative/Hypnotics: chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam  (Valium), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed),  oxazepam (Novaxapam, Serax), temazepam (Restoril), triazolam (Halcion)
flunitrazepam (Rohypnol, Robutal) – banned in the US
BZDs produce antianxiety effects through potentiation of the inhibitor neurotransmitter, GABA. The effects can be expected within one hour of dosing. This rapid entry into the CNS produces a “rush” that may contribute to the likelihood of abuse. Other BZDs are converted to N-desmethyldiazapam and provide a long duration of antianxiety effects allowing once or twice daily dosing. Midazolam, a short-acting benzodiazepine, is utilized for sedation, anxiety, and amnesia in critical care settings and prior to anesthesia (Herfindal & Gourley, 1996).
BZDs are Schedule IV drugs with moderate abuse potential. Benzodiazepines are among the most widely prescribed medications. Fifteen members of this group are presently marketed in the United States, and about 20 additional benzodiazepines are marketed in other countries. Flunitrazepam (Rohypnol) is not manufactured or legally marketed in the United States, but is smuggled in by traffickers (http://www.streetdrugs.org/benzodiaz2.htm).
Although BZDs are widely prescribed, few individuals increase their dose on their own or engage in drug-seeking behavior. Those individuals who do abuse benzodiazepines maintain their supply by obtaining prescriptions from several doctors or buying products on the illicit market. Alprazolam and diazepam are the two most frequently encountered benzodiazepines on the illicit market. Street names associated with a few BZDs are chlordiazepoxide (Librium) - Lib, diazepam (Valium) – V, and flunitrazepam (Rohypnol) - forget me drug, Mexican valium, roofies, rope.
Side effects of BZDs include sedation, ataxia, and loss of coordination which are usually more common during the initial phase of treatment. Additional adverse effects include confusion/disorientation, impaired memory, paradoxical reactions such as excitement and aggressiveness, dizziness, and nausea. Repeated use of large doses or in some cases, daily use of therapeutic doses of benzodiazepines is associated with amnesia, hostility, irritability, and vivid or disturbing dreams.
Caution is recommended with the use of alcohol or other CNS depressants and benzodiazepines, which can be life threatening. Abuse of benzodiazepines is seen among heroin and cocaine abusers. Diazepam, then alprazolam and lorazepam have the greatest liability for abuse among the BZDs.
Dependence of BZDS is commonly seen and withdrawal symptoms occur in 44% of people who receive therapeutic doses for 4-6 weeks. Withdrawal may require hospitalization. Abrupt cessation of benzodiazepines is not recommended and tapering-down the dose eliminates many of the unpleasant symptoms. Discontinuation syndromes relate to the relapse of original symptoms of anxiety or a rebound of more intense symptoms. Withdrawal symptoms seen with long duration and high dosages include confusion, depersonalization, myoclonus, nausea, delirium, and psychosis. The onset of these symptoms can occur within 1-2 days (for short half-life BZDs) or 5-10 days (for long half-life BZDs) after discontinuation (Herfindal & Gourley, 1996).
Tolerance develops to the sedative, muscle relaxant, and anticonvulsant properties of the BZDs, but does not develop to the antianxiety effects in most patients.
Caution should be recommended against driving and taking BZDs until the effects are known. BZDs taken during pregnancy have been associated with birth defects if taken in the first trimester and withdrawal symptoms in the newborn infant.
"

Benzodiazepines (BZDs) are classified as central nervous system depressants and have multiple uses in the treatment of anxiety and panic attacks, control of seizures, management of insomnia or used in critical care settings for sedation for procedures.
Antianxiety Agents: alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium),   lorazepam (Ativan), midazolam (Versed), oxazepam (Novaxapam, Serax)

Anticonvulsants: clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium)

Sedative/Hypnotics: chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam  (Valium), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed),  oxazepam (Novaxapam, Serax), temazepam (Restoril), triazolam (Halcion) flunitrazepam (Rohypnol, Robutal) – banned in the US

BZDs produce antianxiety effects through potentiation of the inhibitor neurotransmitter, GABA. The effects can be expected within one hour of dosing. This rapid entry into the CNS produces a “rush” that may contribute to the likelihood of abuse. Other BZDs are converted to N-desmethyldiazapam and provide a long duration of antianxiety effects allowing once or twice daily dosing. Midazolam, a short-acting benzodiazepine, is utilized for sedation, anxiety, and amnesia in critical care settings and prior to anesthesia (Herfindal & Gourley, 1996).

BZDs are Schedule IV drugs with moderate abuse potential. Benzodiazepines are among the most widely prescribed medications. Fifteen members of this group are presently marketed in the United States, and about 20 additional benzodiazepines are marketed in other countries. Flunitrazepam (Rohypnol) is not manufactured or legally marketed in the United States, but is smuggled in by traffickers (http://www.streetdrugs.org/benzodiaz2.htm).

Although BZDs are widely prescribed, few individuals increase their dose on their own or engage in drug-seeking behavior. Those individuals who do abuse benzodiazepines maintain their supply by obtaining prescriptions from several doctors or buying products on the illicit market. Alprazolam and diazepam are the two most frequently encountered benzodiazepines on the illicit market. Street names associated with a few BZDs are chlordiazepoxide (Librium) - Lib, diazepam (Valium) – V, and flunitrazepam (Rohypnol) - forget me drug, Mexican valium, roofies, rope.

Side effects of BZDs include sedation, ataxia, and loss of coordination which are usually more common during the initial phase of treatment. Additional adverse effects include confusion/disorientation, impaired memory, paradoxical reactions such as excitement and aggressiveness, dizziness, and nausea. Repeated use of large doses or in some cases, daily use of therapeutic doses of benzodiazepines is associated with amnesia, hostility, irritability, and vivid or disturbing dreams.

Caution is recommended with the use of alcohol or other CNS depressants and benzodiazepines, which can be life threatening. Abuse of benzodiazepines is seen among heroin and cocaine abusers. Diazepam, then alprazolam and lorazepam have the greatest liability for abuse among the BZDs. 

Dependence of BZDS is commonly seen and withdrawal symptoms occur in 44% of people who receive therapeutic doses for 4-6 weeks. Withdrawal may require hospitalization. Abrupt cessation of benzodiazepines is not recommended and tapering-down the dose eliminates many of the unpleasant symptoms. Discontinuation syndromes relate to the relapse of original symptoms of anxiety or a rebound of more intense symptoms. Withdrawal symptoms seen with long duration and high dosages include confusion, depersonalization, myoclonus, nausea, delirium, and psychosis. The onset of these symptoms can occur within 1-2 days (for short half-life BZDs) or 5-10 days (for long half-life BZDs) after discontinuation (Herfindal & Gourley, 1996).

Tolerance develops to the sedative, muscle relaxant, and anticonvulsant properties of the BZDs, but does not develop to the antianxiety effects in most patients.

Caution should be recommended against driving and taking BZDs until the effects are known. BZDs taken during pregnancy have been associated with birth defects if taken in the first trimester and withdrawal symptoms in the newborn infant. 
RESOURCES :

Addiction Science Network (2009, March 25). Illicit drug index. Retrievved from: http://addictionscience.net/ASNdrugs.htm

Herfindal, E.T., & Gourley, D.R. (Ed.) (1996). Textbook of therapeutics: Drug and disease management. Baltimore, MD: Williams & Wilkerson.

http://www.streetdrugs.org/benzodiaz2.htm

http://www.streetdrugs.org/benzodiaz.htm

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