Benzodiazepines (also called “benzos”) are a class of agents that work in the central nervous system and are used for a variety of medical conditions.
They act on specific receptors in the brain, called gamma-aminobutyric acid-A (GABA-A) receptors. Benzodiazepines attach to these receptors and make the nerves in the brain less sensitive to stimulation, which has a calming effect.
What are benzodiazepines used for?
Benzodiazepines may be used to treat:
- alcohol withdrawal
- anxiety
- as a muscle relaxant
- panic disorder
- seizures
- sleep disorders
- to induce relaxation and cause amnesia prior to surgical operations.
What are the differences between benzodiazepines?
All benzodiazepines work in a similar way but there are differences in the way individual benzodiazepines act on different GABA-A receptor sub-types. In addition, some benzodiazepines are more potent than others or work for a longer length of time. The table below summarizes the common benzodiazepines available in the U.S.
Common Benzodiazepines Available in the U.S.
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|
Generic Name |
Brand Name |
Common Uses |
Half-life* |
* The half-life is the amount of time it takes for half of the drug to be eliminated from the body. The shorter the half-life, the quicker the drug is eliminated.
All benzodiazepines are listed as DEA scheduled IV controlled substances. As controlled substances, all benzodiazepines have the potential for abuse, addiction and diversion. |
|
alprazolam |
Niravam, Xanax, Xanax XR |
anxiety, panic disorders |
6-26h (short-acting) |
|
chlordiazepoxide |
Librax |
anxiety, alcohol withdrawal |
30-100h (long-acting) |
|
clobazam |
Onfi |
Lennox-Gastaut syndrome, adjunct (seizures) |
71-82h (long-acting) |
|
clonazepam |
Klonopin |
seizure disorder, panic disorder, neuralgia (nerve pain) |
20-50h (long-acting) |
|
clorazepate |
Tranxene T-Tab |
anxiety, alcohol withdrawal, partial seizures |
20-100h (long-acting) |
|
diazepam |
Valium |
anxiety, sedation, alcohol withdrawal, muscle spasm, seizure disorders |
20-100h (long-acting) |
|
estazolam |
ProSom |
insomnia (short-term use) |
10-24h (medium-acting) |
|
flurazepam |
Dalmane |
insomnia (short-term use) |
40-100h (long-acting) |
|
lorazepam |
Ativan |
anxiety, insomnia (short-term use), seizures, sedation |
10-20h (medium-acting) |
|
midazolam |
Generic |
sedation, preoperative; general anesthesia induction; seizures |
2.5h (short-acting) |
|
oxazepam |
Generic |
anxiety, alcohol withdrawal |
5-15h (short-acting) |
|
quazepam |
Doral |
insomnia (short-term use) |
25h (medium-acting) |
|
remimazolam |
Byfavo |
sedation, preoperative, relaxant before minor procedures |
37 - 53 minutes (very short-acting) |
|
temazepam |
Restoril |
insomnia (short-term use) |
10-20h (medium-acting) |
|
triazolam |
Halcion |
insomnia (short-term use) |
2-5h (short-acting) |
Are benzodiazepines safe?
When prescribed by a doctor and used for short periods of time, such as the day of surgery or for less than two weeks (but not every night) to aid sleep, benzodiazepines are safe to take.
Problems start to arise when benzodiazepines are taken at higher dosages than recommended, or when they are taken for more than two to four weeks. Benzodiazepines are potentially addictive and the risk of becoming emotionally and physically dependent on them increases the more you take. In addition, tolerance can develop with their use. This is when the same dose no longer gives the same effect, and a dosage increase is needed to ease symptoms again.
Benzodiazepines should only be taken at the lowest dose for the shortest possible length of time.
What are the side effects of benzodiazepines?
Drowsiness, sleepiness, or dizziness are the most common side effects reported. This can make it dangerous for people taking benzodiazepines to drive or operate machinery or perform other hazardous tasks. Alcohol may potentiate these effects.
Other commonly reported side effects include:
- amnesia (forgetfulness)
- confusion
- constipation
- nausea
- sexual dysfunction
- unsteadiness when walking or standing
- unusually slow and shallow breathing
- vision problems (blurred or double vision).
Withdrawal symptoms may occur with abrupt discontinuation – symptoms may include convulsions, cramps, insomnia, sweating, tremors, and vomiting.
Some people develop a paradoxical reaction to benzodiazepines – this is the opposite reaction to what you would expect. They may become agitated or very anxious, develop hallucinations, have difficulty sleeping or exhibit bizarre behavior such as taking off their clothes in public or taking unnecessary risks.
For more about benzodiazepines see Benzodiazepines: Overview and Use.
