What Are Benzodiazepines? 10 Things to Know About This Group Of Medications

Benzodiazepines, or "benzos" for short, are a group of medications that treat several health conditions. They're considered anxiolytics because they treat anxiety, and since they have sedative effects, they can be useful for sleep issues. They also treat panic disorder, seizures, and alcohol withdrawal.

Every year, tens of millions of people in the U.S. fill a benzodiazepine prescription. Though these medications can be effective, they come with several risks. Below, we'll answer 10 frequently asked questions about benzos. We'll explain what they are, what they're used for, and how to minimize the risks of these medications. Plus, we'll discuss whether some benzos are considered more effective or safer than others.

Note: While some benzodiazepines are approved for use in children, we'll focus on treatment for adults in this article.

1. What are benzodiazepines?

Benzodiazepines are a group of medications that affect the central nervous system (CNS), which includes the brain. While each benzo is unique, all of them have calming effects, relax the muscles, and cause sleepiness.

When benzodiazepines were discovered in the 1960s, they were a game changer for treating anxiety. Over the following decade, prescriptions for benzodiazepines skyrocketed. Given the prevalence of anxiety and insomnia (trouble sleeping) - two common reasons for prescribing these medications - it's not surprising they became so widely used. Thirty percent of adults in the U.S. experience anxiety at some point in their lives. And chronic insomnia affects up to 10% of adults, with occasional insomnia affecting up to 20% of adults.

Although millions of people are prescribed benzodiazepines each year, they have significant risks. This includes dependence and misuse, which is why they're classified as controlled substances and have limits on how they're prescribed and refilled.

2. What are benzodiazepines used for?

As mentioned, benzodiazepines are prescribed for several conditions. But they have varying FDA-approved uses, which may include:

• Panic disorder

• Anxiety disorders

• Seizures

• Muscle spasms

• Alcohol withdrawal

• Insomnia

3. What are some examples of benzodiazepines?

Most benzodiazepines have generic names ending in "-zolam" or "-pam." The table below contains a list of benzos, along with their FDA-approved uses and dosage forms. This isn't a complete list, but it covers the ones that are most often prescribed.

Keep in mind that your prescriber might recommend a benzo for a condition it's not specifically approved for, also known as an off-label use. For example, lorazepam (Ativan) may be used to treat alcohol withdrawal even though it's not specifically approved for that purpose. Your prescriber might also suggest a benzo to treat a condition not listed below.

4. What are benzodiazepines' mechanism of action?

Each benzodiazepine has a different chemical structure. But they're similar in that they all attach to specific receptors (proteins) in the body called gamma-aminobutyric acid (GABA) receptors. GABA receptors are found throughout the body, including in the brain and spinal cord.

GABA is a natural chemical in the body that has calming effects. When benzodiazepines bind to GABA receptors, they make it easier for GABA to attach to the receptors. This produces a calming effect on the muscles and brain, which helps to treat conditions like muscle spasms, anxiety, and seizures.

5. What are possible benzodiazepine side effects?

When used as prescribed for a short amount of time, benzodiazepines are typically safe. However, they can cause side effects, such as:

• Drowsiness

• Dizziness

• Weakness

• Coordination problems

In certain cases, like if you're prescribed temazepam for insomnia, drowsiness can be beneficial. But it can also be dangerous. Drowsiness, dizziness, and weakness can lead to falls, injuries, and accidents. And activities that require focus, like driving, might not be safe while taking benzos.

Taking benzodiazepines with certain substances that have similar effects increases these risks. Examples include:

• Opioids, such as oxycodone (Roxicodone, OxyContin) and hydrocodone / acetaminophen

• Sleep medications, such as zolpidem (Ambien) or eszopiclone (Lunesta)

• Antihistamines, such as diphenhydramine (Benadryl) and doxylamine (Unisom)

• Muscle relaxers, such as carisoprodol (Soma) and cyclobenzaprine (Amrix)

• Alcohol

Taking benzodiazepines with these substances also increases the risk of dependence, misuse, and overdose. The same is true for taking benzodiazepines differently than prescribed. This could be taking more than what's recommended or taking them for longer than recommended.

Benzodiazepines can also cause short-term memory problems, especially for older adults. But what about long-term effects? Some research has suggested long-term benzodiazepine use may raise the risk of developing dementia. But newer research, including a review of 30 studies and a long-term study comparing brain scans, doesn't support a link between benzodiazepines and dementia.

If you or someone you know struggles with substance use, help is available. Call SAMHSA's National Helpline at 1-800-662-4357 to learn about resources in your area.

6. Are some benzodiazepines safer than others?

Whether one benzodiazepine is safer for you than another depends on several factors, including the condition you're treating, what other medications you take, and if you have other health conditions. This is one reason it's important to share your medical history and up-to-date list of medications with your prescriber before taking a benzodiazepine.

Here are some instances in which one benzodiazepine may be safer than another:

• If you have trouble falling asleep, a short-acting benzodiazepine, such as temazepam, may be recommended over a long-acting benzodiazepine like diazepam. This is because short-acting benzodiazepines are less likely to cause drowsiness the morning after you take them.

• If you're treating anxiety, a long-acting benzodiazepine, such as clonazepam, may be a better option because it will stay in your system longer.

• For alcohol withdrawal, long-acting benzodiazepines like diazepam are typically preferred to lower the risk of withdrawal symptoms returning. But lorazepam may be a better option if you have certain health conditions, like liver disease.

• If you have liver problems, benzodiazepines that don't rely heavily on the liver to be broken down - such as lorazepam, oxazepam, and temazepam - may be the best options.

7. How long should you take benzodiazepines?

How long you should take a benzodiazepine depends on what condition you're treating. But in most cases, taking benzos for the shortest amount of time possible - and using the lowest dosage necessary - is best. Taking a benzo for a long time makes it more likely that you'll experience side effects.

There are situations in which long-term benzodiazepine use may be needed, like for treating seizures in some cases. For anxiety disorders, short-term use is usually best, but long-term use may be needed if other treatments don't work.

Is there a safest benzodiazepine for long-term use?

Some benzodiazepines - such as alprazolam, lorazepam, and diazepam - are more likely to cause misuse. These benzodiazepines are more likely to cause misuse because they enter the brain quickly. Benzodiazepines that don't stay in the system long, which also includes alprazolam, have an increased risk of misuse, as well.

If you need to take a benzodiazepine on a daily basis long term, your prescriber may opt for one that is slower-acting and lasts a longer amount of time in the body. This keeps blood levels of the medication steady throughout the day.

8. What is benzodiazepine withdrawal?

Benzodiazepine withdrawal can happen if you stop taking a benzodiazepine abruptly or reduce your dosage too quickly. That's why it's important to talk to your prescriber before you stop treatment. Based on the specific benzodiazepine you've been taking, your dosage, and the length of treatment, your prescriber can help you come up with a plan to gradually lower your dosage.

Benzodiazepine withdrawal symptoms include nausea, diarrhea, and headaches. You could also feel shaky, sweaty, or agitated. More serious symptoms, including seizures and hallucinations, are also possible.

Your prescriber can give you specific instructions for how to stop taking your benzodiazepine, but here are a few general points to keep in mind:

• If you're taking a high dosage, the process of stopping treatment will likely take longer.

• Short-acting benzodiazepines, like alprazolam, can cause more intense withdrawal symptoms.

• Your prescriber may want you to start taking another medication to manage your condition before you stop taking your benzodiazepine. They may have you take both medications until you start feeling the effects of the new one.

Benzodiazepine withdrawal symptoms usually aren't life-threatening, but they can be. Seek emergency care if you have symptoms that feel severe or if you experience a seizure.

9. When are benzodiazepines a good treatment option?

We've discussed the risks of benzodiazepines throughout this article. But it's important to also discuss the benefits. Benzodiazepines are effective medications for many people, and they can be useful for managing chronic conditions, especially when other medications have failed.

Additionally, there are situations in which benzodiazepines are considered first-choice medication options. For example, benzos like diazepam are some of the best medications for alcohol withdrawal symptoms. And for some cases of insomnia, benzos like temazepam are first-choice medications.

Benzodiazepines aren't usually first-choice medications for anxiety or panic disorder. But they may be prescribed for people with severe symptoms or when first-choice medications haven't worked well enough. First-choice medications typically include antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples of SSRIs include fluoxetine (Prozac) and sertraline (Zoloft). Examples of SNRIs include venlafaxine (Effexor XR) and duloxetine (Cymbalta)

Therapy is also an effective treatment option for several conditions benzodiazepines are prescribed for, including anxiety, panic disorder, and insomnia. Therapy may be used alone or alongside medication to treat these conditions. Specifically, cognitive behavioral therapy (CBT) has been shown to be effective for managing anxiety and insomnia. Lifestyle changes and natural remedies are also potential treatment options for anxiety and insomnia. You can talk to a healthcare professional about what treatment approach might be best for you.

10. Who shouldn't take benzodiazepines?

While benzodiazepines are effective for some people, they're not safe for everyone. A benzo may not be recommended if you:

• Are pregnantor breastfeeding

• Have a history of a substance use disorder

• Take opioids or drink alcohol

• Have liver or kidney disease

Additionally, benzodiazepine side effects pose a greater risk for you if you're an older adult. This is because benzos are more likely to stick around in your body longer. And you're more likely to experience falls while taking benzos - including falls that lead to injuries and broken bones. That's why experts recommend that adults 65 years and older avoid taking benzos unless absolutely necessary.

Additionally, you may need to avoid specific benzodiazepines if you take certain medications. For example, alprazolam can interact with some antibiotics and antifungals, including clarithromycin and oral ketoconazole. But lorazepam doesn't interact with these medications.

Lastly, as mentioned above, certain benzodiazepines may be preferred over others if you have liver problems. For example, lorazepam doesn't rely heavily on the liver to be broken down like clonazepam and alprazolam do. So it may be a safer option for people with existing liver disease.