Benzo Overdose: Learn the Signs and What to Do Next

Benzodiazepines (also known as benzos) can be helpful medications for people with conditions like anxiety and panic disorder. But like other sedative medications, benzos have risks of dependence, misuse, and overdose.

If you are prescribed a benzo, you may have questions about their safety. The number of benzo overdoses have increased significantly in the past 2 decades. The most recent data is from 2022, when almost 11,000 people died of an overdose involving benzos.

Dependence, misuse, and overdose can happen to anyone taking benzos. But taking your benzo exactly as prescribed significantly decreases your risk. Here's what you need to know about staying safe and recognizing benzo overdose symptoms.

What is a benzo?

Benzos are sedative medications. They work by binding to gamma-aminobutyric acid (GABA) receptors in the brain. GABA is a chemical with a calming effect. When benzos bind to GABA receptors, GABA becomes more active. This results in mental and physical relaxation. But it can also lead to side effects like drowsiness, dizziness, and poor coordination that causes falls. More seriously, slowed breathing and overdose may occur.

Benzos are prescribed for many reasons, including insomnia (trouble sleeping), seizures, and mental health conditions. Depending on which benzo is prescribed, these are often considered off-label uses. Examples of some common benzos include:

• Alprazolam (Xanax)

• Clonazepam (Klonopin)

• Diazepam (Valium)

• Lorazepam (Ativan)

• Temazepam (Restoril)

Can you overdose on benzos?

Yes, it's possible to overdose on benzos. But it's unlikely if you take benzos as prescribed and avoid other medications and substances that make benzo side effects more intense.

Taking more benzos than what's prescribed to you increases your risk of overdose. Your risk is also increased if you combine benzos with certain other medications and substances that have similar side effects as benzos, such as alcohol, opioids, and muscle relaxers.

Most benzo overdose deaths involve more than just benzos. Over 80% of overdose deaths involving benzos also involved opioids. And less than 5% of benzo overdose deaths involved a benzo only. That's why it's recommended to avoid taking opioids and benzos together.

Any type of benzo can cause an overdose. But not all benzos are the same. They differ in how you take them, how quickly they work, and how long their effects last. Some, like alprazolam, have quick, intense effects but don't last as long as long-acting benzos, such as diazepam.

Although all benzos can cause an overdose, we'll focus on two commonly used benzos and their overdose risk below.

Can you overdose on Valium?

Yes, you can overdose on Valium. Valium is a long-acting benzo, so it stays in your system longer than most other benzos. This means that it can still interact with other medications and substances long after you've taken it.

Can you overdose on Xanax?

Yes. In fact, Xananx is the most commonly involved benzo in benzo-related overdoses. And some research shows that Xanax overdoses often lead to serious outcomes, such as needing special care in the hospital intensive care unit and being on a ventilator.

What are benzo overdose symptoms?

The signs and symptoms of benzo intoxication and overdose can vary from person to person. This may include mental status changes, such as:

• Drowsiness

• Extreme lethargy

• Unconsciousness, or being difficult to arouse

• Confusion

A benzo overdose can also affect other parts of the body. Beyond someone's mental state, other signs of a benzo overdose include:

• Quick side-to-side eye movements (nystagmus)

• Blurry vision

• Slurred speech

• Poor muscle control and coordination

• Weak pulse or low blood pressure

• Irregular, shallow, or slowed breathing

A benzo overdose is life-threatening. Besides death, a benzo overdose can also lead to aspiration pneumonia (from choking on vomit), rhabdomyolysis (serious muscle breakdown), and coma.

Benzodiazepine overdose treatment

Responding to a benzo overdose quickly is important. We'll cover information below for how to respond in the moment, and the medical care that's needed after emergency personnel arrive.

Immediate response

If you think someone is experiencing a benzo overdose, seek emergency help immediately by calling 911. If you think opioids are involved in the overdose, administer naloxone (Narcan, Zimhi) or nalmefene (Opvee, Zurnai). These are injectable or nasal medications that rapidly reverse the effects of an opioid overdose.

Even if you're not sure whether opioids are in a person's system, administering naloxone or nalmefene is a good idea. They're not harmful, even if opioids aren't involved. Nalmefene is a prescription-only product, but naloxone can be found over the counter.

While you wait for emergency care, try to keep the person overdosing awake. If you can't, turn the person to their side so they're not lying on their back (which puts them at risk for choking on vomit).

Hospital care

A benzo overdose requires medical care in a hospital or similar setting. But exact treatment depends on the severity of the overdose and whether other substances are involved.

At the hospital, your medical team will monitor your breathing, heart rate, and blood pressure. The following treatments may be used:

• Breathing support, with oxygen or intubation

• Medications and IV fluids to keep your heart rate and blood pressure in normal range

• Additional doses of naloxone or nalmefene if opioids are involved

• Gastric lavage (stomach pumping)

• Flumazenil in specific circumstances

Flumazenil, the benzo overdose antidote

Flumazenil is a medication that can reverse the effects of a benzo overdose. But unlike naloxone or nalmefene for opioid-involved overdoses, flumazenil isn't recommended for every benzo overdose. This is because unlike naloxone or nalmefene, it can be harmful.

The main risk of flumazenil is possible seizures. When someone takes benzos regularly - or has become dependent on them - their brain adapts to always having benzos in their system. When benzo effects are suddenly reversed, a sudden increase in brain activation and signaling can occur. And this can lead to a seizure.

Flumazenil may be helpful for some benzo overdoses, but experts say the risks often outweigh the benefits. So it's used only in certain situations. For example, flumazenil may be helpful for children who accidentally ingest benzodiazepines.

What are the signs of benzo misuse?

It's important to remember that benzos help a lot of people. They can help decrease unwanted symptoms of anxiety and improve quality of life.

Taking your benzo medication exactly as prescribed significantly reduces the risk of harm. But any benzo has the potential to cause dependence and misuse and can lead to sedative use disorder. This increases your risk of harm, including overdose.

That's why it's a good idea to know the signs of benzo misuse. Seek help if you notice any of these symptoms in yourself or a loved one:

• Taking a benzo more often, or in higher doses, than what's prescribed

• Seeking benzo prescriptions from multiple prescribers

• Using illicit benzos or other drugs

• Using someone else's prescription

• Being unable to cut back on benzo use despite wanting to

• Cravings, or strong urges for benzos

• Continuing to take benzos despite negative impacts at home, work, or school

It can be difficult to talk to a loved one about benzo misuse. But help is always available. If you or someone you know struggles with substance use, help is available. Call the Substance Abuse and Mental Health Services Administration's National Helpline at 1-800-662-4357 to learn about resources in your area.

Frequently asked questions