What are the types of Common Benzodiazepines (Benzos) ?
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Benzodiazepines are a class of drugs known as depressants that affect the central nervous system. They are categorized based on their duration of action into three types: long-acting, intermediate-acting, and short-acting benzodiazepines 1 3.
Long-acting type of benzodiazepines: #
- Diazepam (Brand names: Ducene®, Valium®) – It is used for anxiety disorders and has a long duration of action 1 4.
Intermediate-acting benzodiazepines: #
- Nitrazepam (Brand names: Alodorm®, Mogadon®) – This type has an intermediate duration of action 1.
Short-acting benzodiazepines: #
- Oxazepam (Brand names: Alepam®, Murelax®, Serepax®)
- Temazepam (Brand names: Euhypnos®, Normison®)
- Alprazolam (Brand names: Xanax®, Kalma®, Alprax®) – These are used for managing insomnia and anxiety and have a shorter duration of action. Short-acting benzodiazepines are known to have stronger withdrawal or ‘come down’ effects and can be more addictive than long-acting ones 1 2 3.
Other benzodiazepines mentioned across the sources include:
- Estazolam (Brand name: ProSom®)
- Flurazepam (Brand name: Dalmane®)
- Triazolam (Brand name: Halcion®)
- Midazolam (Brand name: Versed®) – This short-acting benzodiazepine is utilized for sedation, anxiety, and amnesia in critical care settings and before anesthesia 2.
Benzodiazepines are used for various medical purposes, including treating anxiety, insomnia, seizures, muscle relaxation, and as a sedative before specific medical procedures. However, they can be highly addictive and are generally recommended for short-term use only 3 4.
They are also associated with risks such as overdose, mainly when used with alcohol or other drugs.
What is the benzodiazepine use in medicine? #
Benzodiazepines are used in medical settings for a variety of therapeutic purposes. Here are some of the key uses and the conditions they treat:
- Anxiety Disorders: Benzodiazepines like diazepam, alprazolam, lorazepam, and clonazepam are commonly prescribed to relieve symptoms of anxiety. They are effective in reducing the physiological symptoms of anxiety, such as restlessness, tension, and nervousness.
- Seizure Disorders: Drugs like diazepam and clonazepam are used in the management of seizure disorders, including epilepsy. They can help control or stop seizures in certain types of epilepsy and are sometimes used in emergencies to stop a seizure that is already occurring.
- Muscle Relaxation: Diazepam has muscle relaxant properties and may be used to alleviate muscle spasms resulting from conditions such as cerebral palsy, paraplegia, or athetosis.
- Alcohol Withdrawal: Benzodiazepines, including diazepam and oxazepam, are used to manage the symptoms of alcohol withdrawal. They can help prevent seizures and alleviate the agitation and tremors associated with alcohol detoxification.
- Insomnia: Some benzodiazepines, particularly those with a shorter duration of action like temazepam, are prescribed for the short-term treatment of insomnia. They can help with sleep initiation and maintenance[Search results not provided].
- Panic Disorders: Alprazolam and clonazepam are also used to treat panic disorders, helping to reduce the frequency and severity of panic attacks.
- Sedation for Medical Procedures: Midazolam is a short-acting benzodiazepine that is often used to induce sedation before medical procedures or surgery[Search results not provided].
These medications are generally prescribed for short-term use due to the risk of dependence, tolerance, and withdrawal symptoms. Long-term use is usually avoided unless necessary and under strict medical supervision.
| Benzodiazepine | Medical Uses |
|---|---|
| Diazepam | – Anxiety disorders – Seizure disorders – Muscle relaxation – Alcohol withdrawal |
| Alprazolam | – Anxiety – Panic disorders |
| Lorazepam | – Anxiety |
| Clonazepam | – Seizure control – Panic attacks |
| Midazolam | – Sedation for medical procedures – Anesthesia adjunct |
| Nitrazepam | – Short-term relief of insomnia – Epilepsy (adjunct) |
| Oxazepam | – Anxiety – Alcohol withdrawal |
| Temazepam | – Insomnia |
| Estazolam | – Insomnia |
| Flurazepam | – Insomnia |
| Triazolam | – Insomnia |
What are the Sides Effects of Benzodiazepines? #
Below is a table that summarizes the common side effects for the mentioned benzodiazepines. The table categorizes them based on their duration of action: long-acting, intermediate-acting, and short-acting.
| Benzodiazepine (Brand name) | Common Side Effects |
|---|---|
| Long-acting | |
| Diazepam (Ducene®, Valium®) | Drowsiness, fatigue, muscle weakness, ataxia, dizziness, confusion, impaired coordination, memory impairment |
| Intermediate-acting | |
| Nitrazepam (Alodorm®, Mogadon®) | Daytime drowsiness, headache, muscle weakness, ataxia, confusion, impaired motor function, amnesia |
| Short-acting | |
| Oxazepam (Alepam®, Murelax®, Serepax®) | Anxiety, insomnia, agitation, irritability, memory impairment, confusion |
| Temazepam (Euhypnos®, Normison®) | Dizziness, nausea, headache, sleep disturbances, agitation, nervousness |
| Alprazolam (Xanax®, Kalma®, Alprax®) | Dependence, withdrawal symptoms, depression, headache, confusion, insomnia, nervousness |
| Other Benzodiazepines | |
| Estazolam (ProSom®) | Dizziness, drowsiness, fatigue, confusion, coordination problems, memory impairment |
| Flurazepam (Dalmane®) | Similar to other benzodiazepines, including drowsiness, confusion, and impaired coordination |
| Triazolam (Halcion®) | Short-term memory impairment, behavioral changes, sleep disturbances, confusion |
| Midazolam (Versed®) | Amnesia, euphoria, respiratory depression, hypotension, sedation, nausea |
This table provides an overview of the common side effects associated with each benzodiazepine. It’s important to note that the side effects can vary based on individual responses, dosage, and duration of use. Always consult healthcare professionals for medical advice and information on side effects.
How is the Use of Benzodiazepines Effective in Psychiatry? #
Use of Benzos in Psychiatry #
In psychiatric practice, benzodiazepines are commonly prescribed for:
- Anxiety Disorders: They are effective in reducing symptoms of anxiety and are often used for acute anxiety episodes or panic attacks 5.
- Insomnia: Short-acting benzodiazepines are frequently prescribed for short-term management of sleep disorders 5.
- Alcohol Withdrawal: Benzodiazepines can help manage withdrawal symptoms and prevent complications such as seizures 7.
- Mania and Agitation: They may be used to control acute restlessness and agitation in manic episodes of bipolar disorder 5.
- Adjunctive Therapy: Benzodiazepines can be used alongside antidepressants for anxious depression, or with antipsychotics in schizophrenia for additional symptom control 6 7.
Controversies and Risks #
Despite their therapeutic benefits, the use of benzodiazepines is not without controversy:
- Addiction and Dependence: There is a risk of developing tolerance and dependence, especially with long-term use. Withdrawal symptoms can be challenging and may include rebound anxiety and insomnia 5.
- Overdose Risk: When taken in overdose, especially with other substances like alcohol or opioids, benzodiazepines can be lethal 5 7.
- Cognitive and Psychomotor Impairment: Long-term use can lead to issues with memory, attention, and coordination, which may affect daily functioning 7.
- Misuse: There is a potential for misuse, particularly in individuals with a history of substance abuse. Misuse can lead to increased risk of harm and overdose.
Clinical Guidelines and Recommendations #
Due to these risks, clinical guidelines generally recommend that benzodiazepines be prescribed for the shortest duration necessary and at the lowest effective dose. They are often considered second-line treatments for chronic anxiety disorders, with preference given to antidepressants and psychotherapy 7.
For acute situations, such as severe anxiety or agitation, they may be used for their rapid onset of action but should be tapered off as soon as possible to avoid the development of dependence 5 7.
In summary, benzodiazepines play a significant role in the management of various psychiatric conditions, but their use must be carefully managed to balance their therapeutic effects against the risks of tolerance, dependence, and misuse. Clinicians must remain vigilant about prescribing practices and patient education to minimize the potential for harm 5 6 7.
References: #
- Alcohol and Drug Foundation. (2023, November 22). Benzodiazepines. https://adf.org.au/drug-facts/benzodiazepines/
- Drug Enforcement Administration. (n.d.). Drug Fact Sheet: Benzodiazepines. https://www.dea.gov/sites/default/files/2020-06/Benzodiazepenes-2020_1.pdf
- Better Health Channel. (n.d.). Drugs – Better Health Channel. https://www.betterhealth.vic.gov.au/healthyliving/drugsRxList. (n.d.).
- Benzodiazepines: Uses, Side Effects, Types, Interactions. https://www.rxlist.com/benzodiazepines/drug-class.htm
- Use of benzodiazepines in psychiatry. (1991). PubMed. https://pubmed.ncbi.nlm.nih.gov/1818422/
- Long-term benzodiazepine treatment in patients with psychotic disorders attending a mental health service in rural Greece. (2017). PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244055/
- Benzodiazepines remain important therapeutic options in psychiatric treatment. (2022). Karger Publishers. https://www.karger.com/Article/Abstract/826578
