Benzodiazepines Overview
Benzodiazepines (“benzos”) are a class of drugs used to treat anxiety and other mental health conditions. They’re used as short-acting medications for anxiety disorders like panic disorder, insomnia, and conditions like restless leg syndrome. The list of benzos includes Valium, Ativan, Klonopin, and Xanax.
What Are Benzodiazepines?
Benzodiazepines are a class of drugs that work on the central nervous system. They act on specific receptors in the brain – gamma-aminobutyric acid-A (GABA-A) receptors, attaching to them and making the nerves in the brain less sensitive to stimulation. This produces a calming effect.
Though Benzodiazepines are typically used to treat anxiety disorders like panic disorder and generalized anxiety disorder, the calming effect they produce makes them effective for insomnia. They may also be prescribed as a muscle relaxant to treat restless leg syndrome and certain seizure disorders.
List of Benzodiazepines
There are a wide variety of benzodiazepines on the market:
- Adinazolam (Deracyn®)
- Alprazolam (Xanax®, Alprox®)
- Bentazepam (Thiadipona®)
- Bretazenil
- Bromazepam (Lexotan®, Lexotanil®)
- Bromazolam
- Brotizolam (Noctilan®)
- Camazepam (Albego®, Paxor®)
- Chlordiazepoxide (Librium®)
- Cinazepam (Levana®)
- Cinolazepam (Gerodorm®)
- Clobazam (Frisium®)
- Clonazepam (Rivatril®, Klonopin®)
- Clonazolam
- Clorazepate (Tranxene®)
- Clotiazepam (Clozan®)
- Cloxazolam (Sepazon®)
- Delorazepam (Dadumir®)
- Deschloroetizolam
- Diazepam (Valium®)
- Diclazepam
- Estazolam (ProSom®)
- Ethyl carfluzepate
- Etizolam (Etilaam®)
- Ethyl loflazepate (Victan®)
- Flualprazolam
- Flubromazepam
- Flubromazolam
- Fluclotizolam
- Flunitrazepam (Rohypnol®)
- Flunitrazolam
- Flurazepam (Dalmane®)
- Flutazolam (Coreminal®)
- Flutemazepam
- Flutoprazepam (Restas®)
- Halazepam (Paxipam®)
- Ketazolam (Anxon®)
- Loprazolam (Dormonoct®)
- Lorazepam (Ativan®)
- Lormetazepam (Loramet®)
- Meclonazepam
- Medazepam (Ansilan®)
- Metizolam
- Mexazolam (Melex®)
- Midazolam (Hypnovel®)
- Nifoxipam
- Nimetazepam (Erimin®)
- Nitemazepam
- Nitrazepam (Pacisyn®)
- Nitrazolam
- Nordiazepam (Madar®)
- Norflurazepam
- Oxazepam (Seresta®)
- Phenazepam (Phenazepam®)
- Pinazepam (Domar®)
- Prazepam (Lysanxia®)
- Premazepam
- Pyrazolam
- Quazepam (Doral®)
- Rilmazafone (Rhythmy®)
- Temazepam (Restoril®)
- Tetrazepam (Myolastan®)
- Triazolam (Halcion®)
Are Benzos Safe to Take?
Benzodiazepines are frequently prescribed for anxiety because they are effective in managing and reducing the symptoms. They are generally safe when taken as prescribed and under the guidance of a physician but can be harmful when used chronically or combined with other drugs. They’re highly addictive and extremely dangerous to mix with alcohol, prescription painkillers, or sedatives like sleeping pills.
Benzodiazepine Uses
Benzos are commonly prescribed for anxiety disorders, though they may be used to treat a variety of other conditions. Used properly, benzos induce a calming effect that can help patients with anxiety or insomnia relax.
All benzos work in the same way, but the intensity and duration of their effects vary.
Anxiety
Benzodiazepines are effective in treating a variety of anxiety disorders like panic disorder and generalized anxiety disorder. These medications enhance the activity of the neurotransmitter GABA, which induces a feeling of calm and drowsiness. The benzos most commonly used to treat anxiety disorders are alprazolam, lorazepam, and clonazepam.
Sleep Disorders
The field of sleep disorders is complex and includes a variety of conditions that can impact proper rest, including:
Insomnia: Difficulty falling asleep or staying asleep
Daytime drowsiness: Nonrestorative sleep
Disorders of arousal: Disruptive behaviors that affect sleep
In the 1970s, benzos became available for the treatment of insomnia.{1] They are rapid eye movement (REM) sleep-suppressant medications. Due to the potential for addiction and withdrawal symptoms, benzos aren’t commonly used for sleep disorders. Instead, newer hypnotics and benzodiazepine-like agents are used.
As a Muscle Relaxant
Benzodiazepines can be used to treat muscle spasms and skeletal pain in the short term.[2] They can be used to relieve skeletal muscle spasticity and its accompanying pain as a result of neurologic disorders like stroke or spinal cord injury.
Diazepam and lorazepam are the types of benzos often used, but only for short periods. Otherwise, their habit-forming potential can alter the sleep cycle and create a sleep disorder once the drug is stopped.
Panic Disorder
Panic disorders are an anxiety disorder that includes sudden attacks of panic or fear. People with panic disorder often experience increased anxiety over having another panic attack, leading them to avoid situations that may trigger their anxiety.
Benzodiazepines like alprazolam and clonazepam are approved by the FDA for the treatment of panic disorder[3], but only on a short-term basis. These medications aren’t often used in patients who have panic disorder and a history of substance abuse.
Seizures
Seizure disorders are disorders in which nerve cell activity in the brain is disturbed, causing seizures. Seizures may cause the patient to experience abnormal behavior, symptoms, and sensations, including a loss of consciousness.
Benzos may be prescribed as anxiolytics, sedatives, and anticonvulsants to promote central nervous system depression. For certain types of seizures, benzos like clobazam and clonazepam are the first-line treatment.[4]
Alcohol Withdrawal
Alcohol withdrawal occurs when heavy alcohol users suddenly decrease their alcohol consumption – or cease completely. The symptoms can include mild to moderate tremors, agitation, and anxiety, as well as severe symptoms like delirium tremens, hallucinations, and seizures.
Benzos are a safe and effective treatment for alcohol withdrawal.[5] They can minimize the anxiety that occurs with alcohol withdrawal, prevent agitation and seizures, and prevent delirium tremens as a short-term treatment.
Benzodiazepine Dosage
| Drug | Dosage |
| Alprazolam (Xanax) | 0.25 mg to 1 mg 3x/day |
| Chlordiazepoxide (Librium) | 5 mg to 25 mg 3x/day |
| Clonazepam (Klonopin) | 0.5 mg to 1 mg 3x/day |
| Diazepam (Valium) | 5 mg to 25 mg 3x/day |
| Lorazepam (Ativan) | 0.5 mg to 1 mg 3x/day |
Benzodiazepine Withdrawal Symptoms
The most common side effects associated with benzodiazepines are:
- Sedation
- Dizziness
- Weakness
- Unsteadiness
- Other side effects may include:
- Transient drowsiness
- Depression
- Loss of orientation
- Sleep disturbances
- Confusion
- Irritability
- Headache
- Aggression
- Excitement
- Memory impairment
All types of benzodiazepines can lead to physical dependence. Stopping after short-term use can lead to withdrawal syndrome. Stopping suddenly after chronic use or misuse may lead to tremors, seizures, vomiting, sweating, and muscle cramping.
How to Detox from Benzodiazepines
Benzodiazepines have the potential for emotional and physical dependence. They should only be taken at the lowest dose for the shortest possible length of time. Dependence can occur when benzos are taken at higher doses than recommended or for longer periods. Tolerance may develop as well.
People with a physical or emotional dependence on benzos can wean off of them with a tapered dose to minimize withdrawal symptoms, typically with medically assisted detox. If you or someone you know is experiencing withdrawal from benzos, you must seek medical help to prevent potentially life-threatening consequences.
Benzodiazepine Detox Timeline
Ceasing the use of benzodiazepines can have serious withdrawal symptoms, including severe symptoms like seizures.
Stopping the use of benzos isn’t a matter of willpower. Consult a medical professional to detox from benzos safely and slowly to minimize the symptoms of withdrawal.
Each benzodiazepine medication has a specific half-life that influences the length of time it takes for the drug to leave the bloodstream. Withdrawal begins once the drug leaves the body.
For shorter-acting benzos, withdrawal can begin about 10 or 12 hours after stopping the drug. Longer-acting benzos may take a few days before withdrawal symptoms appear. Withdrawal symptoms will be similar, but some of the shorter-acting benzos may be more intense.
Each individual may experience withdrawal differently, which depends on factors like:
- The length of time taking benzos
- Dosage
- Type of benzo
- Method used to take benzos
- Underlying medical or mental health issues
- Abuse of other substances
These symptoms may include:
- Anxiety
- Panic
- Insomnia
- Muscle spasms
- Nausea and vomiting
- Diarrhea
- Seizures
- Hallucinations
- Mood swings
The general timeline is:
- First symptoms appear in 6-12 hours
- Symptoms last 1-4 days
- Symptoms peak around week 2 and begin to subside
If not addressed properly, symptoms can last several months or even years.
Benzodiazepine Overdose Symptoms & OD Treatment
The symptoms of overdose with benzodiazepines may be hard to identify since they mimic the symptoms of misuse. These symptoms may include:
- Drowsiness or fatigue
- Confusion, agitation, anxiety
- Dizziness
- Slurred speech or acting drunk
- Amnesia
- Blurred vision
- Difficulty breathing
- Stupor or unresponsiveness
- Hallucinations
- Low blood pressure
- Physical weakness
- Poor coordination
- Loss of muscle tone
- Coma
- Death
Overdose or toxicity are more likely if benzos are combined with alcohol or an opioid drug.
If adverse effects are seen or there are several adverse effects at once, seek medical attention immediately.
Benzos and Alcohol
Because benzos are prescribed and safe when used as directed, people often mistakenly assume they can combine the use of benzos with alcohol. These two substances have a depressive effect, however, which can exponentially increase the risk of overdose, coma, or death.
In addition, some people choose to mix benzos with alcohol, since the two have the same mechanism of action. This amplifies the effects of both drugs compared to the use of either substance alone.
Side Effects: Benzos vs. Barbiturates
Benzos and barbiturates are often compared and confused. These drugs have the same drug classification and sedative effects on the body that result in a feeling of calm and relaxation. The primary difference between them is their mechanism of action, which influences how potent they are, how long their effects last, and how dangerous they can be.
| Side Effects | Benzos | Barbiturates |
| Lightheadedness | X | |
| Drowsiness | X | |
| Confusion | X | |
| Sedation | X | |
| Memory impairment | X | |
| Poor balance | X | X |
| Nausea | X | |
| Vomiting | X | X |
| Constipation | X | X |
| Abdominal pain | X | |
| Dizziness | X |
Are Benzos Addictive?
Because benzos are prescribed and produce a calming effect, rather than euphoria, people may think they’re not addictive. These drugs are highly addictive, however, and may lead to emotional and physical dependence.
Long-term use increases the risk of addiction. Due to the natural process of tolerance, a person will need higher dosages to produce the same effects. When the abuse stops or the dose is cut back, withdrawal symptoms may emerge that can be potentially life-threatening.
Benzodiazepine Addiction Treatment & Rehab Options
Addiction can be a challenge to break free from. It’s not a matter of willpower and abstaining from drugs – stopping cold turkey can be painful and potentially life-threatening. Fortunately, there are inpatient and outpatient treatment options for benzodiazepine treatments.
If you or someone you know is addicted to benzos, it’s important to seek professional help to avoid potentially dangerous complications from sudden withdrawal or overdose.
There are facilities designed for medically assisted benzodiazepine detox. Using proprietary IV and oral medication protocols, medical professionals can keep patients comfortable and safe during detox to manage the withdrawal symptoms safely and effectively.
Once detox is complete, continuing treatment focuses on addressing the underlying causes of addiction to benzos and the behaviors that contribute to substance abuse. Using innovative treatments like cognitive behavioral therapy, mental health professionals can guide patients in recognizing the habits that support substance use and develop better coping and stress management techniques.
Benzodiazepines Frequently Asked Questions
If you have questions about benzodiazepines, you should always seek the guidance of a physician. But here are some common questions people have about different types of benzos, their effects, and how they work in the body.
Due to its high potency and long-lasting effects, the strongest benzodiazepine is clonazepam, also known as Klonopin®. Other high-potency benzos include alprazolam (Xanax®), lorazepam (Ativan®), and triazolam (Halcion®), though they’re short-acting.
Benzos are divided into long, intermediate, and short-acting types. Short-acting benzos typically have a stronger withdrawal and may be more addictive than long-acting types, though all benzos have the potential to be habit-forming.
Benzodiazepines are a type of sedative medication that slows the body and brain functions. This makes them effective with anxiety and insomnia, though it also creates potential for adverse effects when combined with other sedatives like alcohol.
Benzos are depressants that produce sedation and hypnosis, relieve anxiety, and reduce seizures. This is because they slow the messages traveling between the brain and the body.
No, benzodiazepines are depressant drugs that have a sedative effect. If benzos are prescribed to a person with depressive disorders, it could make the symptoms worse. Benzos may be combined with standard antidepressants, however.
Benzodiazepines are controlled in Schedule IV of the Controlled Substances Act.[6]
Benzos and barbiturates are often confused as they are in the same drug classification and produce similar effects. Benzos are now prescribed for situations in which barbiturates used to be, but some benzos are used only for specific purposes. This is because they have a wider variety of therapeutic uses and reduced risk of abuse or tolerance – though they are still highly addictive.
Benzodiazepines are gamma-amino butyric acid (GABA) receptor agonists. This is an inhibitory neurotransmitter that lessens a nerve cell’s ability to receive, create, or send chemical messages to other nerve cells.
Yes, benzos are anxiolytics, or anti-anxiety agents, that can treat anxiety disorders and produce a calming effect.
Prolonged use or misuse of benzodiazepines creates a higher risk of experiencing psychotic symptoms like delusions and hallucinations.
The body has a natural chemical called gamma aminobutyric acid (GABA) that reduces the activity in the areas of the brain responsible for emotions, memory, reasoning, and essential functions like breathing. Benzos increase the effects of GABA on the brain and body to create feelings of calm, relaxation, and sedation.
Tolerance to a drug occurs when the body builds up resistance to it, causing the drug to no longer work effectively. This leads people to increase the dosage or frequency to get the same effects. Tolerance to benzos develops at different rates and to different degrees, depending on the type of benzo, the dosage, and the length of use.
Benzos are only legally available through prescriptions. They must be prescribed by a licensed physician, though people may get benzos illegally on the illicit market. Because of the abuse potential of benzos, it’s important to be monitored by a physician while taking benzos.
Benzos are effective at treating anxiety, though they may be used for sleep disorders, seizure disorders, and conditions like restless leg syndrome. Though less common now, benzos were once used for pre-surgical sedation and general anesthesia.
Because benzos slow down essential functions in the brain like heart rate and breathing, it can temporarily lower blood pressure. Long-term benzo abuse or an overdose can have low blood pressure as a symptom, which is dangerous.
All benzos have side effects that can range from mild to severe.
Benzodiazepines should only be prescribed for the shortest amount of time possible. Taking benzos regularly, even for just a few weeks, can lead to addiction and withdrawal. Physicians recommend taking benzos for only two to four weeks.
Benzos increase the risk of addiction, withdrawal, and overdose, especially when combined with other drugs or alcohol. Long-term use of benzos can lead to cognitive decline and memory problems as well.
Benzos should be avoided in any patient with a history of drug use or patients with certain chronic health conditions. It’s important to speak to your doctor about whether benzos are appropriate for you.
Some benzos are considered safe during pregnancy, such as diazepam, but there is a small risk of birth defects. Benzos should not be used during lactation, however, as they can cause lethargy, sedation, and weight loss in infants.
Some physicians prescribe benzos to children as a short-term treatment for severe anxiety. This is not only to prevent adverse effects, but because benzos have been shown to stop working after a month or two in children.
Recover From Benzodiazepine Addiction
Benzodiazepines come in many forms and provide an effective treatment for anxiety and sleep disorders, but they have a high potential for abuse and addiction. If you or a loved one is affected by benzodiazepine addiction, you don’t have to do it alone.
At Gallus, we believe in dignity in healing. Contact us today to take the first step in your recovery.