Download Benzodiazepine Fact Sheet

ALEXANDER LERMAN, M.D.
Adult, Child & Adolescent Psychiatry
250 North Bedford Road | Chappaqua Ny 10514
TEL. (914) 238-0566 | FAX (914) 914/238-0567 | E-MAIL: [email protected]
Benzodiazepine Fact Sheet
General
“Psychotropic drugs” are substances that as at least one of their effects influence the
functioning of brain cells. By selective use of psychotropic drugs a psychiatrist can — with greater
or lesser degrees of safety and effectiveness — disrupt or relieve symptoms of psychiatric illness.
At higher doses, most such substances are dangerous. In general, the more extreme the
symptom, the more likely a drug can help. Often, medication is only partially effective, and should
be used as one among several elements of a treatment plan.
Uses of Benzodiazepines
Benzodiazepine tranquilizers, include a family of drugs marketed under the names
Low dose
Mod. Dose
Approx Duration
Ativan (lorazepam)
0.5 mg
1 mg 2x/day
4 hours
Klonapin (clonazepam)
0.5 mg
1 mg 2x/day
6-8 hours
Valium (diazepam)
5 mg
5 mg 3x/d
4-6 hours
Xanax (alprazolam)
0.25 mg
0.25 mg 4x/d
3-4 hours
These drugs provide effective and generally highly safe treatment of anxiety and other
forms of acute emotional distress. Among the virtues of these drugs is their simplicity and
swiftness of action. The approximate effect of this drug is three to six hours in duration
Benzodiazepines can be used to treat anxiety in a number of different ways.

One strategy is to use the medication in small, relatively infrequent doses only when
needed.

A second strategy is to use the drug more intensively at the beginning of a
treatment, while at the same time initiating and antidepressant treatment to contain
anxiety, withdrawing the tranquilizers as the second drug becomes effective.

A third strategy involves chronic treatment with moderate to high doses of
benzodiazepine tranquilizers. While effective, and in some persons the treatment of
choice, is third strategy is accompanied by higher risks and is more controversial,
particularly when undertaken at high dosages, largely because of the risks of
habituation (see below).
Risks of Treatment
The principal risks of benzodiazepine treatment include
Sedation – these drugs can make you sleepy, particularly if mixed with alcohol or other CNS
depressants. Care should be taken driving late at night.
Rebound Anxiety — some people experience a “rebound” return of anxiety symptoms
when the medication wears off. This reaction is rare with low doses of medication, and more
likely to occur with Xanax (alprazolam) than other drugs.
Benzodiazepine Fact Sheet – p. 2
Cognitive dulling and memory problems — while rare at low doses, memory problems
and confusion can occur during the use of these drugs. Such problems are particularly common
in older people.
Impairment of coordination — Benzodiazepines can cause coordination problems
similar to those caused by alcohol. Great care should be taken driving and operating other
machinery while these drugs have been taken. Elderly people have increased risk of falling
Abuse and Addiction — Benzodiazepines are legally classified as controlled narcotics.
People who take large doses in search of a “high”, or seek relief of psychological distress by
using these drugs to become intoxicated risk becoming addicted to these medications, i.e.
physically and psychologically dependent on mind-dulling doses of medication. People who use
these medications responsibly, even at extremely high doses, virtually never become addicted —
although habituation (see below) can occur.
Habituation — A state of physical tolerance and dependency on medication can occur when
it is prescribed regularly at high doses. If the medication is stopped suddenly, withdrawal
reactions (see below) can occur. Habituation can always be reversed by tapering the dose of
medication over several weeks or months.
Withdrawal reactions — people who take high doses of medication can become
physiologically habituated to the drug, and prone to serious withdrawal reactions, including
potentially fatal epileptic seizures, if the drug is stopped suddenly. These reactions rarely if ever
occur in low-dose medication treatments.
Severe Intoxication — Extreme doses of medication — i.e. doses higher than those that
are ever medically prescribed on an out-patient basis — particularly if mixed with alcohol or other
narcotics, can lead to respiratory arrest and death.
Birth Defects — Benzodiazepines have been implicated in increased incidence of cleft
palate and other birth defects. These drugs should be avoided in all phases of pregnancy. If
you might be pregnant, or think you may have become pregnant while taking this medication,
consult a doctor immediately.
Safety Precautions

Do not mix these drugs with alcohol or illicit drugs.

Exercise caution driving or using heavy machinery when taking this medication,
especially when tired or late at night.

Use people you trust as outside observers — others may be the first to notice signs
of personality change or cognitive dulling.

Always report the amount of medication you are taking to your physician.

Regular follow-up visits, even if everything is going well, are essential to safely using
these medications.
Medication Interactions
Exercise caution about excessive drowsiness that can occur when these drugs are mixed
with other medications that can cause sedation, such as antihistamines and cough suppressants
in many cold medications. Tylenol, Advil, and decongestants are not a problem. Discuss the
medications your are taking with your physician and your pharmacist. Avoid “herbal” preparations
of unknown consistency and quality.
Pharmaceutical Promotions
Dr. Lerman does not accept gifts, free samples, investment schemes, or other forms of
payment from drug companies. He does participate in medical-education seminars and solicits
technical and other information from pharmaceutical companies.
Alexander Lerman MD