Reference Guide to Benzodiazepines

Highlights 

• Benzodiazepines are common prescription medications used to treat anxiety, insomnia, seizures, alcohol withdrawal, and muscle spasms.

• These medications come in three sub-types: short-acting, intermediate-acting, and long-acting.

• Benzodiazepines carry a risk of dependency and abuse, so it’s essential to use these medications as directed and under a doctor’s supervision.

Anxiety is a normal part of life. Most people worry, but when anxiety becomes a daily part of life — even if there’s no obvious reason for it — it might be time to speak to your doctor. 

It’s estimated that more than 300 million people worldwide experience anxiety disorders. They’re the most common type of mental disorder and can be highly treatable.

Benzodiazepines are one option to treat anxiety and other conditions. Let’s explore in more detail what benzodiazepines are, how they work, the different types, side effects, and other helpful information so you can work with your doctor to make an informed decision.

What Are Benzodiazepines?

Benzodiazepines (also known as “benzos”) are a type of medication that promotes relaxation. Some conditions they’re used to treat include:

• Anxiety disorders
• Muscle spasms
• Seizures
• Insomnia
• Alcohol withdrawal

These medications slow down the central nervous system. With less stimulation, the brain can relax and make a person feel less anxious. 

How Do Benzodiazepines Work?

Benzodiazepines enhance the activity of the neurotransmitter gamma-aminobutyric acid, or GABA. GABA is a natural chemical in the brain that slows down nerve activity.

Benzodiazepines bind to specific receptors in the brain that are sensitive to GABA. This helps to make it easier for GABA to bind to these receptors. As a result, benzodiazepines boost the calming effect of GABA on nerve cells. These cells become less excited, creating a sedative effect.

Individuals taking benzodiazepines may find it easier to sleep and feel less anxious. 

Benzodiazepine Differences and Similarities

Benzodiazepines are classified by their duration of action — short-acting, intermediate-acting, and long-acting. 

While side effects, drug interactions, and warnings and indications are similar among the three subtypes, key differences include:

• Duration of effects: Short-acting benzodiazepines wear off more quickly, making them suitable for short-term or as-needed use, while intermediate- and long-acting forms have more prolonged effects, making them suitable for longer-term management of conditions.
• Risk of dependence and withdrawal: Generally, the shorter the action, the quicker the body adjusts to and depends on the effects, leading to potential withdrawal symptoms when the medication is stopped. Intermediate- and long-acting forms may be associated with more gradual withdrawal.
• Usage patterns: Short-acting types are often used for acute management of anxiety or sleep issues, while longer-acting types may be preferred for chronic management due to their sustained effects.

There are also similarities among the three subtypes, including: 

• Common side effects: Side effects across all types include sedation, motor impairment, cognitive impairment, dependence, and withdrawal symptoms.
• Adjusting for individual needs: The choice among the subtypes often depends on the patient’s individual health status, the specific condition being treated, and personal history, including the risk of abuse or dependency.
• Monitoring: Regardless of the subtype, it’s crucial to monitor for side effects, effectiveness, and any signs of dependency or withdrawal, adjusting the treatment plan as necessary.

Short-Acting Benzodiazepines

Short-acting benzodiazepines have a brief duration of action, providing a rapid onset after ingestion and quicker relief of symptoms.

They also have a shorter half-life, which means they are metabolized and eliminated from the body more quickly. This also means they are effective for a shorter period of time before their effects wear off. 

Because they wear off more quickly, you may need to take short-acting benzodiazepines more often to maintain their effects.

Common examples of short-acting benzodiazepines include:

• triazolam (Halcion): Often used for short-term treatment of severe insomnia.
• midazolam (Versed): Commonly used in anesthesia for its sedative and anxiolytic properties.

Warnings and Contraindications — Short-Acting Benzodiazepines

While helpful in managing certain conditions, all benzodiazepines come with warnings and considerations. Warnings and contraindications may vary by medication, so it’s essential to explore these with your healthcare provider before taking any new medications.

Short-term benzodiazepines may be more contraindicated in situations requiring sustained alertness and coordination due to the rapid onset of sedation.

The following warnings and contraindications also apply to short-acting benzodiazepines:

• Respiratory depression. These medications can depress respiratory function, especially when combined with other CNS depressants, and are risky for individuals with respiratory disorders.
• Dependence and withdrawal. There is a significant risk of physical dependence and withdrawal symptoms, which can be severe, including anxiety, agitation, and, in extreme cases, seizures.
• Abuse potential. Due to their quick and potent effects, there’s a high risk for abuse and misuse, especially in individuals with a history of substance abuse.
• Pregnancy and breastfeeding. Generally contraindicated or used with extreme caution during pregnancy and breastfeeding due to potential adverse effects on the fetus or infant.
• Elderly or debilitated patients. Increased sensitivity to the sedative and motor impairing effects, leading to a higher risk of falls and cognitive impairment.
• Psychiatric conditions. Use with caution in individuals with a history of depression or other psychiatric conditions as they can exacerbate symptoms.
• Acute narrow-angle glaucoma. Typically contraindicated in patients with acute narrow-angle glaucoma due to the risk of increasing intraocular pressure.
• Severe hepatic impairment. Use with caution or avoid in patients with significant liver disease as it can affect the metabolism and clearance of the medication, leading to increased effects.
• Operating machinery. Impaired motor coordination and drowsiness may affect the ability to drive or operate machinery safely.
• Alcohol and drug interactions. Enhanced effects and potentially dangerous interactions when combined with alcohol, opioids, or other drugs that depress the central nervous system.

Side Effects —Short-Acting Benzodiazepines

In general, compared to intermediate- and long-acting benzodiazepines, short-acting medications have: 

• More pronounced sedation and drowsiness due to rapid onset.
• A higher risk of rebound anxiety and insomnia when they’re discontinued.
• Increased potential for memory impairment and psychomotor impairment, affecting activities like driving.

Side effects of short-acting benzodiazepines may vary by medication and by dosage, but be on the lookout for these potential adverse reactions: 

• Drowsiness and sedation. One of the most common side effects, leading to impaired alertness and coordination. This can affect activities such as driving and operating machinery.
• Cognitive impairment. Short-term use can impair memory and learning, a condition often referred to as “benzo fog,” affecting concentration and mental clarity.
• Motor coordination impairment. Users may experience a decrease in motor coordination, resulting in clumsiness or unsteady gait, increasing the risk of falls, especially in the elderly.
• Dependence and withdrawal. Even short-term use can lead to physical dependence. Abrupt cessation or reduction in dosage can lead to withdrawal symptoms, which can be severe, including anxiety, agitation, and in rare cases, seizures.
• Increased risk of accidents. Due to the sedative effects, there’s an increased risk of accidents and injuries, particularly falls in the elderly.
• Respiratory depression. Especially in higher doses or when combined with other central nervous system depressants, it can lead to slowed breathing.
• Paradoxical reactions. Some individuals may experience increased anxiety, agitation, aggression, or hallucinations, opposite to the calming effect typically sought.
• Tolerance. Over time, users may require larger doses to achieve the same therapeutic effect, leading to higher risk of side effects.
• Gastrointestinal issues. Some may experience nausea, constipation, or other digestive discomfort.
• Mood changes. Depression or mood swings may occur, especially in individuals with a history of these conditions.
• Allergic reactions. Severe allergic reactions can also occur and require immediate medical attention. These include symptoms such as:
  • Tongue or throat swelling
  • Trouble breathing
  • Nausea
  • Vomiting

For information about the specific drug you’re taking, visit Drugs.com and search for your medication, or refer to the medication labeling included with your prescription. 

Drug Interactions —Short-Acting Benzodiazepines

Short-acting benzodiazepines can interact with various drugs, potentially altering their effects or increasing side effects. 

Compared to the other benzodiazepines, rapid onset increases the risks of severe interactions with alcohol, opioids, or other sedatives, leading to acute respiratory depression or profound sedation.

Following is a list of potential interactions for short-acting benzodiazepines, but again, be aware that potential interactions will vary by medication and dosage. 

• Central nervous system (CNS) depressants: Concurrent use with other CNS depressants such as alcohol, opioids, other benzodiazepines, or sleep medications can lead to enhanced sedation, respiratory depression, and increased risk of overdose.
• Anticonvulsants: Some anticonvulsants can affect the metabolism of benzodiazepines, either increasing toxicity or decreasing efficacy.
• Antidepressants: Certain antidepressants may increase sedative effects or impact the metabolism of benzodiazepines.
• Antifungal agents: Some antifungal medications, especially azole antifungals, can inhibit the metabolism of benzodiazepines, leading to increased blood levels and prolonged effects.
• Cimetidine: This heartburn medication can decrease the metabolism of benzodiazepines, increasing their duration and intensity.
• Oral contraceptives: Can slow down the elimination of benzodiazepines, leading to increased effects.
• Protease inhibitors: Used in HIV treatment, these can increase benzodiazepine levels by inhibiting their metabolism.
• Smoking: Cigarette smoking can decrease the effectiveness of benzodiazepines due to the induction of certain liver enzymes that metabolize the drugs.
• Grapefruit juice: Can increase the blood levels of certain benzodiazepines, intensifying their effects and side effects.
• Herbal products: Some herbs, like St. John’s Wort, can affect the metabolism of benzodiazepines, while others like kava and valerian may increase sedative effects.

Refer to the Drugs.com Drug Interaction Checker for the complete list of known interactions for the medication you’re taking or considering.

Intermediate-Acting Benzodiazepines

Intermediate-acting benzodiazepines last longer than short-acting benzodiazepines and have a longer half-life. They stay in the body longer, and their effects take longer to wear off.

Medications in this subtype are often prescribed for patients who need a balance between onset and duration of action.

They’re typically prescribed for conditions that require longer-lasting relief, such as generalized anxiety disorder, muscle spasms, or certain types of seizures. They can also be used for short-term relief of insomnia or sleep disturbances.

Commonly prescribed intermediate-acting benzodiazepines include:

• alprazolam (Xanax): Used for anxiety and panic disorders.
• lorazepam (Ativan): Prescribed for anxiety disorders and as a pre-anesthetic.
• temazepam (Restoril): Used for the short-term treatment of insomnia.
• oxazepam (Serax): Often prescribed for anxiety and alcohol withdrawal.

Warnings and Contraindications — Intermediate-Acting Benzodiazepines

Similar to short-acting medications, the warnings and contraindications of intermediate-acting benzodiazepines can vary by medication and dosage. Interactions may be more prolonged or moderate in intensity compared to short-acting varieties, requiring careful monitoring.

Here’s a general list of warnings to discuss with your provider:

• Respiratory depression. Patients with respiratory conditions like COPD or sleep apnea should use caution, as benzodiazepines may worsen respiratory function.
• Substance abuse history. These medications are not recommended for individuals with a history of substance abuse due to the high potential for dependence and addiction.
• Pregnancy and nursing. Generally contraindicated during pregnancy and nursing because of the risk of harm to the fetus or nursing infant.
• Elderly patients. Older adults are at increased risk of cognitive impairment, falls, and other accidents, necessitating careful use and often dose adjustments.
• Psychiatric conditions. Those with a history of depression or other psychiatric conditions should use benzodiazepines cautiously, as they can exacerbate certain symptoms.
• Acute narrow-angle glaucoma. These drugs are contraindicated in individuals with this condition but may be used with caution in those with open-angle glaucoma.
• Severe liver impairment. Those with significant liver disease should avoid or use benzodiazepines cautiously due to the risk of increased toxicity and impaired metabolism.
• Operating machinery. Due to the impairment of cognitive and motor functions, users should be cautious when driving or operating heavy machinery.
• Alcohol and other CNS depressants. Using benzodiazepines with other central nervous system depressants can lead to severe sedation or more serious complications.
• Withdrawal and tolerance. There’s a risk of developing tolerance and dependence, particularly with prolonged use, and withdrawal should be managed carefully.
• Allergic reactions. Individuals known to be hypersensitive to benzodiazepines should not use them.

Consult with your doctor for a complete overview of warnings and contraindications before starting any new medication.

Side Effects — Intermediate-Acting Benzodiazepines

Compared to short-acting benzodiazepines, intermediate-acting types:

• Tend to cause a moderate level of sedation, usually with a smoother onset and offset.
• Have a lower risk of rebound effects compared to short-acting types, though they’re still present.
• Have a potentially less-abrupt risk of cognitive and motor impairment.

Intermediate-acting types can have mild to serious side effects, including:

• Drowsiness and sedation. These medications often lead to feelings of tiredness and can significantly impair alertness and coordination.
• Cognitive impairment. Users might experience difficulties with memory, attention, and problem-solving, affecting daily activities and responsibilities.
• Motor coordination issues. There might be an increased risk of falls and other accidents due to impaired balance and coordination, especially in older adults.
• Dependence and withdrawal. Regular use can lead to physical dependence, and sudden discontinuation can result in withdrawal symptoms, which can be severe.
• Respiratory depression. In some cases, especially when taken with other depressants, these drugs can slow down breathing, which can be dangerous.
• Tolerance. Over time, users may need higher doses to achieve the same effect, leading to more pronounced side effects.
• Mood changes. Some individuals might experience alterations in mood, including increased anxiety or depression.
• Gastrointestinal disturbances. Nausea, vomiting, or constipation may occur, affecting one’s comfort and appetite.
• Paradoxical reactions. A small percentage of users might experience the opposite of the intended calming effects, such as increased anxiety or aggression.
• Amnesic effects. Particularly at higher doses, these drugs can cause difficulties in forming new memories, known as anterograde amnesia.

Let your doctor know of any new or unusual symptoms you notice after beginning any benzodiazepine. 

Drug Interactions — Intermediate-Acting Benzodiazepines

Drug interactions with intermediate-acting benzodiazepines are similar to those for short-acting benzodiazepines. However, they may be more prolonged or moderate in intensity compared to short-acting varieties, requiring more careful monitoring.

Here’s the list of known interactions for the intermediate-acting types:

• Central nervous system depressants. Using benzodiazepines with other CNS depressants like alcohol, opioids, or sedatives can significantly increase sedation, respiratory depression, and the risk of overdose.
• Anticonvulsants. Some anticonvulsants affect how benzodiazepines are metabolized, potentially changing their effectiveness or side effect profile.
• Antidepressants. Certain antidepressants might interact with benzodiazepines, increasing sedation or affecting how the body processes the benzodiazepines.
• Antifungal agents. Azole antifungals, in particular, can inhibit the metabolism of benzodiazepines, leading to higher blood levels and prolonged effects.
• Cimetidine. Commonly used for acid reflux, cimetidine can decrease the metabolism of benzodiazepines, increasing their duration and intensity.
• Oral contraceptives. These may slow the elimination of benzodiazepines from the body, potentially leading to prolonged effects.
• Protease inhibitors. Often used in HIV therapy, these can increase the levels of benzodiazepines by inhibiting their metabolism.
• Smoking. Cigarette smoking may decrease the effectiveness of benzodiazepines due to increased metabolism by certain liver enzymes.

Get a complete list of known potential interactions for your specific medication with the Drugs.com Drug Interaction Checker.

Long-Acting Benzodiazepines

Long-acting benzodiazepines have an extended duration of action compared to short-acting and intermediate-acting benzodiazepines. They’re typically prescribed to treat conditions that require continuous and prolonged management.

Due to their prolonged effect, there’s an extended risk of interaction with CNS depressants over a longer period. There may also be increased interaction with medications that affect liver enzymes due to the extended metabolism.

Doctors typically prescribe long-acting benzodiazepines with caution. Because these medications stay in the body for longer, they may carry a higher risk of dependence and withdrawal symptoms.

Doctors will monitor you closely while on these medications to minimize potential risks and side effects. Long-term use is usually discouraged.

Examples of long-acting benzodiazepines include:

• Diazepam (Valium): Used for a range of conditions including anxiety, muscle spasms, and seizures.
• Clonazepam (Klonopin): Primarily for seizure disorders and panic disorders.
• Chlordiazepoxide (Librium): Often used in alcohol withdrawal and anxiety disorders.

Warnings and Contraindications — [Long-Acting Benzodiazepines]

Warnings and contraindications for long-acting benzodiazepines will vary by medication. Generally speaking, long-acting benzodiazepines carry a greater risk of dependency and should be used with caution.

Other warnings may be medication-specific. For example, diazepam is contraindicated in the following individuals:

• Known hypersensitivity to diazepam or its ingredients
• Patients under 6 months of age
• Myasthenia gravis
• Severe respiratory insufficiency
• Severe hepatic insufficiency
• Sleep apnea
• Acute narrow-angle glaucoma

Taking diazepam with other sedatives can cause dangerous side effects or death. Consult with your doctor prior to taking any muscle relaxers, over-the-counter sleep aids, or other medications for anxiety or seizures.

Concomitant use of diazepam with opioids is discouraged and should be used only for patients who do not respond to alternative treatments.

 It is not recommended to drink alcohol while taking diazepam since this medication depresses the central nervous system.

Abrupt withdrawal from diazepam could create a temporary increase in the risk of seizures, both in frequency and severity.

Women who are pregnant or plan to become pregnant should know that taking diazepam could have negative effects on the developing fetus. Diazepam may also pass into the breastmilk, so it’s not recommended if breastfeeding.

Side Effects — [Long-Acting Benzodiazepines]

Side effects with long-acting benzodiazepines are common and may vary between medications and dosages. The most commonly reported side effects of diazepam are:

• Drowsiness
• Fatigue
• Muscle weakness
• Ataxia

Individuals have also reported the following adverse effects:

• Confusion
• Depression
• Headache
• Slurred speech
• Vertigo
• Constipation
• Nausea
• Dizziness
• Blurred vision
• Hypotension
• Tremors
• Dysarthria
• Stimulation
• Restlessness
• Hallucinations
• Sleep disturbances
• Muscle spasms
• Dry mouth
• Changes in libido

There have also been reports of falls and fractures in individuals taking benzodiazepines, with the risk increasing in those who take other sedatives and the elderly.

This is not a complete list of side effects, and these side effects may vary from person to person.

Drug Interactions — [Long-Acting Benzodiazepines]

Long-acting benzodiazepines may interact with other drugs, such as the drug types listed for short-acting benzodiazepines. For example, there are 515 known drug interactions with diazepam. Use the Drug Interaction Checker for a complete list.

Exploring Benzodiazepines as a Treatment Option

Benzodiazepines have been shown to provide relief from anxiety and insomnia in many patients, allowing them to live a higher quality of life. They’re often used for short periods of time, and results can vary by individual, medication, and dosage.

However, some medications in this drug class may increase insomnia, worsen anxiety, or create unwanted side effects. The benefits might not always outweigh the risks, so it’s essential to talk openly with your doctor and use benzodiazepines under close supervision.

Get the Lowest Price for Your Benzodiazepines

If you’re taking a benzodiazepine, BidRX can help you save money on your prescription. Create a free account, list your medication, and let pharmacies bid for your business. You can accept the offer that fits your budget and have your medications shipped to your door. 

Find your anxiety medications on our medication page and place your bid today.

This information is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication.