Benzodiazepine
Benzodiazepines are used in short term relief of severe, disabling anxiety but their prolonged use is discouraged because of tolerance and dependency.
Benzodiazepine withdrawal syndrome may be delayed (but less so with short-acting agents) in its onset and longer than barbiturate withdrawal syndrome. The benzodiazepine syndrome is characterized by:
- insomnia
- anxiety
- tremor
- perspiration
- loss of appetite
- delusions
Every person on long-term or high dosage of any benzodiazepine should be weaned off the drug. Any abrupt discontinuation may result in confusion, psychosis, convulsions similar to delirium tremens.
Benzodiazepines may impair ability to drive vehicles and operate machinery. The impairment is increased by consumption of alcohol. Long-acting benzodiazepine "hang-over" can cause the same problems the following day.
These drugs are preferred to the use of barbiturates because they have a lower abuse potential and relatively lower adverse reactions or interactions. However, drowsiness, ataxia, confusion, vertigo, impaired judgement and a number of other effects are common.
Benzodiazepines are divided into three groups for treatment of insomnia. Short-acting compounds act for less than six hours and have few residual effects, but rebound insomnia is common and anxiety levels may increase. Intermediate-acting compunds have an effect for 6-10 hours, may have mild residual effects but rebound insomnia is not common. Long-acting compunds have strong sedative effects that persist and accumulation may occur.
Some examples of benzodiazepines:
- diazepam ("Valium")
- oxazepam (a metabolite of diazepam)
- alprazolam
- prazepam
- bromazepam
- clorazepate dipotassium
- lorazepam
- temazepam
- medazepam
- flunitrazepam
- clonazepam
Diazepam under the proprietary name - Valium, was one of the best selling medicinal products.
