Benzodiazepine

"Benzo" redirects here. For other uses, see Benzo (disambiguation).

Benzodiazepines
Drug class
Structural formula of benzodiazepines.
Class identifiers
UseAnxiety disorders, seizures, muscle spasms, panic disorder
ATC codeN05BA
Mode of actionGABAA receptor
Clinical data
WebMDMedicineNet  RxList
External links
MeSHD001569
Legal status
In Wikidata

Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, insomnia, and seizures. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and was made available in 1960 by Hoffmann–La Roche, which followed with the development of diazepam (Valium) three years later, in 1963.[1] By 1977, benzodiazepines were the most prescribed medications globally; the introduction of selective serotonin reuptake inhibitors (SSRIs), among other factors, decreased rates of prescription, but they remain frequently used worldwide.[2][3]

Benzodiazepines are depressants that enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties. High doses of many shorter-acting benzodiazepines may also cause anterograde amnesia and dissociation.[4] These properties make benzodiazepines useful in treating anxiety, panic disorder, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal and as a premedication for medical or dental procedures.[5] Benzodiazepines are categorized as short, intermediate, or long-acting. Short- and intermediate-acting benzodiazepines are preferred for the treatment of insomnia; longer-acting benzodiazepines are recommended for the treatment of anxiety.[6]

Benzodiazepines are generally viewed as safe and effective for short-term use of two to four weeks,[7] although cognitive impairment and paradoxical effects such as aggression or behavioral disinhibition can occur.[8] According to the Government of Victoria's (Australia) Department of Health, long-term use can cause "impaired thinking or memory loss, anxiety and depression, irritability, paranoia, aggression, etc."[9] A minority of people have paradoxical reactions after taking benzodiazepines such as worsened agitation or panic.[8]

Benzodiazepines are associated with an increased risk of suicide due to aggression, impulsivity, and negative withdrawal effects.[10] Long-term use is controversial because of concerns about decreasing effectiveness, physical dependence, benzodiazepine withdrawal syndrome, and an increased risk of dementia and cancer.[11][12][13][14] The elderly are at an increased risk of both short- and long-term adverse effects,[15][16] and as a result, all benzodiazepines are listed in the Beers List of inappropriate medications for older adults.[17] There is controversy concerning the safety of benzodiazepines in pregnancy. While they are not major teratogens, uncertainty remains as to whether they cause cleft palate in a small number of babies and whether neurobehavioural effects occur as a result of prenatal exposure;[18] they are known to cause withdrawal symptoms in the newborn.

In an overdose, benzodiazepines can cause dangerous deep unconsciousness, but are less toxic than their predecessors, the barbiturates, and death rarely results when a benzodiazepine is the only drug taken. Combined with other central nervous system (CNS) depressants such as alcohol and opioids, the potential for toxicity and fatal overdose increases significantly.[19][20] Benzodiazepines are commonly used recreationally and also often taken in combination with other addictive substances, and are controlled in most countries.[21][22][23]

  1. ^ Cite error: The named reference isbn0-19-517668-5 was invoked but never defined (see the help page).
  2. ^ Balon R, Starcevic V, Silberman E, Cosci F, Dubovsky S, Fava GA, et al. (9 March 2020). "The rise and fall and rise of benzodiazepines: a return of the stigmatized and repressed". Revista Brasileira de Psiquiatria. 42 (3): 243–244. doi:10.1590/1516-4446-2019-0773. PMC 7236156. PMID 32159714.
  3. ^ Treating Alcohol and Drug Problems in Psychotherapy Practice Doing What Works. New York: Guilford Publications. 2011. p. 47. ISBN 978-1-4625-0438-1.
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  7. ^ Ashton H (May 2005). "The diagnosis and management of benzodiazepine dependence". Current Opinion in Psychiatry. 18 (3): 249–255. doi:10.1097/01.yco.0000165594.60434.84. PMID 16639148. S2CID 1709063.
  8. ^ a b Cite error: The named reference pmid18922233 was invoked but never defined (see the help page).
  9. ^ "Benzodiazepines". Better Health Channel. 19 May 2023.
  10. ^ Dodds TJ (March 2017). "Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature". The Primary Care Companion for CNS Disorders. 19 (2). doi:10.4088/PCC.16r02037. PMID 28257172.
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  14. ^ Kim HB, Myung SK, Park YC, Park B (February 2017). "Use of benzodiazepine and risk of cancer: A meta-analysis of observational studies". International Journal of Cancer. 140 (3): 513–525. doi:10.1002/ijc.30443. PMID 27667780. S2CID 25777653.
  15. ^ Cite error: The named reference tdamobd2004 was invoked but never defined (see the help page).
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  17. ^ By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel (November 2015). "American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults". Journal of the American Geriatrics Society. 63 (11). The American Geriatrics Society 2015 Beers Criteria Update Expert Panel: 2227–2246. doi:10.1111/jgs.13702. PMID 26446832. S2CID 38797655.{{cite journal}}: CS1 maint: numeric names: authors list (link)
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  19. ^ Cite error: The named reference pmid9780123 was invoked but never defined (see the help page).
  20. ^ "FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use". U.S. Food and Drug Administration (FDA) (Press release). 31 August 2016. Retrieved 1 September 2016.
  21. ^ Cite error: The named reference Charlson_2009 was invoked but never defined (see the help page).
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  23. ^ Cite error: The named reference pmid10622686 was invoked but never defined (see the help page).