Benzodiazepines
Benzodiazepines are drugs that slow certain types of nerve signals throughout the central nervous system and can provide relief in a wide variety of conditions. Some benzodiazepines are actually found naturally, albeit in very tiny concentrations, in both the brain and the cerebrospinal fluid. Acting on the brain's cortex region, benzodiazpines affect emotions; in the brain stem, they reduce convulsions; and in the spinal cord, they reduce muscle spasms. When effects on the brain stem become important, the drugs can cause problems with walking and balance, rather than curing a problem.
The group of drugs known as benzodiazepines includes alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan). These medicines take effect fairly quickly, usually within one hour after they are taken. They are available only with a physician's prescription, and should not be used to relieve the nervousness and tension of normal everyday life. The recommended dosage depends on the type of benzodiazepine, its strength, and the condition for which it is being taken.
Benzodiazepines are most often used antianxiety drugs, helping to relieve nervousness, tension, and other symptoms.
While anxiety is a normal response to stress, some people have unusually high levels of anxiety that can interfere with everyday life. For these people, benzodiazepines can help bring their feelings under control. The medicine can also relieve troubling symptoms of anxiety, such as pounding heartbeat, breathing problems, irritability, nausea, and faintness.
In addition to the calming effect, benzodiazepenes bring on a feeling of drowsiness; sleep comes more quickly, and the sleep is deeper than normal.
Side effects of benzodiazepines can include confusion, slurred speech, lack of coordination, dizziness, headache, and nausea. The exact profile of side effects varies from drug to drug, and sometimes doctors and patients must experiment to obtain a good level of relief with manageable side effects. Also, side effects usually go away as the body adjusts to the drug. They not require medical treatment unless they persist or they interfere with normal activities. More serious side effects are not common, but may occur. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they have found out how the drugs affect them.
Overall, benzodiazepines are extremely safe drugs, with a wide margin between an effective therapeutic dose and a toxic overdose. However, severe overdoses can be fatal, especially if taken by a person who is drinking alcohol at the same time.
From time to time, social critics have charged that use of these drugs merely masks significant emotional problems by reducing the sensation of anxiety. In some cases, they charge, patients may take antianxiety drugs for years rather than facing critical problems in their emotional lives. For this reason, people who take benzodiazepines to relieve nervousness, tension, or symptoms of panic disorder should check with their physicians every two to three months to make sure they need to continue taking the medicine. If the need for these medicines persists for many months, patients might consider some form of psychotherapy or counseling to address the underlying causes of the anxiety.
Patients who are taking benzodiazepines for sleep problems should check with their physicians if they are not sleeping better within 7-10 days. In some cases, switching to different drug in this category will improve the situation. In other cases, sleep problems that last longer than this may be a sign of another medical problem.
As implied by the wide range of effects, benzodiazepines are sometimes prescribed for other conditions, such as muscle spasms, epilepsy and other seizure disorders, phobias, panic disorder, withdrawal from alcohol, and short-term sleep problems.
Some doctors have prescribed benzodiazepines even more widely, for conditions such as irritable bowel syndrome, premenstrual syndrome, nausea and vomiting caused by cancer chemotherapy, and to reduce the distress of alcohol withdrawal. Even though formal research on these uses is lacking, they appear to be logical applications, and some doctors find that their patients get relief.
Patients who take a benzodiazepine for more than a few weeks may become dependent on the drug. Doctors try not to prescribe benzodiazepines to people who have a tendency toward drug dependence, as might be indicated by heavy use of alcohol. Overall, about 20% of the general population seems at risk for such problems. Withdrawal symptoms can include anxiety, tingling, headache, nervousness, irritability, sleep problems, digestive problems, tremors, and even seizures. Because benzodiazepines tend to accumulate in the body, withdrawal symptoms may not appear immediately. Physicians are warned that these symptoms can appear as much as a week after the patient takes a final dose of one of these drugs. It is often difficult for either the patient or the doctor to know whether symptoms are caused by withdrawal or by a return of the patient's original symptoms. Although the severity of the withdrawal problem varies from drug to drug in this class, a patient should get medical advice before discontinuing a particular benzodiazepine. In some cases, a physician may choose to decrease dosages gradually over several weeks or months rather than advising the patient to stop the medication abruptly.
Benzodiazepines may cause behavior changes in some people, similar to those seen in people who act differently when they drink alcohol. More extreme changes, such as confusion, agitation, and hallucinations, also are possible. Anyone who starts having strange or unusual thoughts or behavior while taking this medicine should get in touch with his or her physician.
Because benzodiazepines work on the central nervous system, they may add to the effects of alcohol and other drugs that slow down the central nervous system, such as antihistamines, cold medicine, allergy medicine, sleep aids, medicine for seizures, tranquilizers, some pain relievers, and muscle relaxants. They may also add to the effects of anesthetics, including those used for dental procedures. These effects may last several days after treatment with benzodiazepines ends.
The combined effects of benzodiazepines and alcohol or other CNS depressants (drugs that slow the central nervous system) can be very dangerous, leading to unconsciousness or, rarely, even death. Anyone taking benzodiazepines should not drink alcohol and should check with his or her physician before using any CNS depressants. Taking an overdose of benzodiazepines can also cause unconsciousness and possibly death. Anyone who shows signs of an overdose or of the effects of combining benzodiazepines with alcohol or other drugs should get immediate emergency help. Warning signs include slurred speech or confusion, severe drowsiness, staggering, and profound weakness.
Some benzodiazepines may change the results of certain medical tests. Before having medical tests, anyone taking this medicine should alert the health care professional in charge.
People with certain medical conditions or who are taking other medicines can have problems if they take benzodiazepines. Benzodiazepines may interact with other medicines. When this happens, the effects of one or both of the drugs may change, or the risk of side effects may become greater. Before taking benzodiazepines, tell the physician if you are taking any other medications, or if you have allergies, are pregnant, breastfeeding, a current or former drug or alcohol abuser, suffering from mental illness, seizures, epilepsy, swallowing problems, chronic lung disease such as emphysema, asthma, or chronic bronchitis, kidney or liver disease, glaucoma, hyperactivity, myasthenia gravis, porphyria, or sleep apnea.
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