Table 1: List of benzodiazepines under international control Name Major symptoms include perceptual disturbances, psychosis, hyperpyrexia and life-threatening convulsions. According to that classification, minor symptoms include anxiety, insomnia and nightmares. Withdrawal signs and symptoms can be classified as major or minor, like those of the alcohol syndrome. This is because tolerance and dependence can occur just weeks after use has commenced. Medically, benzodiazepines should only be used for the short-term relief of anxiety or insomnia which is severe and disabling. There is also the risk of cross-dependence developing to benzodiazepines. Apart from the increased risk of fatal overdoses, the usual injection-specific diseases such as tissue damage, gangrene and transmission of HIV and hepatitis C also occur if the drugs are injected. The EMCDDA’s Annual report on the state of the drugs problem in Europe highlights the fact that concomitant use of benzodiazepines and opiates is a major risk factor in drug-related deaths. A significant number of problem drug users swallow, ‘snort’ or inject high doses of benzodiazepines to enhance the euphoriant effects of opiates or to minimise unpleasant effects of psychostimulants. A similar fatal interaction can occur when opiates are taken with benzodiazepines as part of a pattern of polydrug use. The combined use of alcohol and benzodiazepines also increases the risk of a fatal overdose because both act as CNS depressants. The effect is perhaps most common when benzodiazepines are taken in combination with alcohol. Experimental studies show that these drugs impair driving ability and when alcohol is also used, the risk of being involved in or responsible for a road accident is significantly increased.īenzodiazepine intoxication can be associated with behavioural disinhibition, potentially resulting in hostile or aggressive behaviour. The European prevalence studies show that, excluding alcohol, benzodiazepines are along with cannabis the psychoactive substances most prevalent in the driving population. There is a significantly increased risk of adverse events in the elderly such as falls, diminished cognitive function and driving impairment, although the latter is not confined to the elderly. They are thus more at risk from the side-effects which include drowsiness, ataxia (staggering gait), mental confusion, impaired judgement and anterograde amnesia. Such half-lives vary between individuals, and the elderly tend to eliminate these drugs much more slowly. midazolam intermediate-acting compounds such as nitrazepam have half-lives greater than 24 hours, whereas long-acting compounds such as diazepam have half-lives greater than 48 hours. There is no clear division between anxiolytics and hypnotics, since most anxiolytics will induce sleep if taken at night and most hypnotics will sedate when taken during the day.ĭifferent benzodiazepines vary in the rate in which they are metabolised to pharmacologically active forms and particularly in their half-lives (see Table 1): short-acting drugs have a half-life of less than 24 hours e.g.
Because they have a lower tendency to cause a potentially fatal CNS depression compared to earlier drugs such as barbiturates, benzodiazepines are widely used in medicine for the treatment of anxiety (anxiolytics) and insomnia (sedative/hypnotics), as well as other psychological conditions such as panic attacks and panic disorders. They act by facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS. diazepam, lorazepam, midazolam), suppositories.īenzodiazepines are a group of CNS depressants which induce feelings of calm (anxiolysis), drowsiness and sleep.
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