Benzodiazepine Fact Sheet – p. 2
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:
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.
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