Benzodiazepines

What Are They, And How Do They Work?

Benzodiazepines are medications that are made by man and can result in mild to severe depression of the nerves in the central nervous system (or the brain) as well as drowsiness (aka sedation).

Anxiety, seizures, and other types of conditions and diseases that require treatment with benzodiazepines can be caused by over-activity of the brain’s nerves. These particular drugs can work by increasing the effects of GABA, which is the gamma-aminobutyric acid, in the brain. GABA is a neurotransmitter and a chemical that the brain’s nerves utilize to send messages among one another. GABA cuts down on the activity of the brain’s nerves, thereby boosting the effect of GABA with a benzodiazepine and reducing activity in the brain.

How Are Benzodiazepines Used?

Adults use benzodiazepines to treat a variety of conditions, including the following:

• Anxiety
• Panic disorders
• Nervousness
• Muscle spasms
• Sleeplessness
• Seizures
• Alcohol withdrawal
• Premenstrual syndrome
• Status epilepticus (which is a life-threatening condition of the brain)

Some additional uses of benzodiazepines include:

• Panic disorder
• Generalized anxiety disorder
• Social anxiety disorder

Benzodiazepine drugs, which are commonly referred to as benzos, are very habit forming and can result in addiction. Long-term use of these drugs can also lead to tolerance, meaning that lower doses of them can eventually become ineffective causing patients to take higher doses. Some individuals abuse these drugs in order to obtain a “high” because of the drug’s effects on the brain.

What Are the Know Side Effects of Benzos?

There are numerous side effects associated with the use of benzodiazepines, including the following:

• Constipation
• Nausea
• Vomiting
• Dry mouth
• Drowsiness
• Lightheadedness
• Confusion
• Memory impairment
• Fatigue
• Increase/decrease in appetite
• Weight gain
• Improper body balance
• Sedation
• Reduced libido

More serious side effects include the following:

• Fainting
• Increased heart rate
• Severe low blood pressure
• Slow heart rate
• Jaundice
• Respiratory depression
• Withdrawal symptoms
• Dependence and abuse
• Akathisia (which is a movement disorder)
• Seizures
• Suicide

Are You Able to Consume Alcohol with Benzodiazepines?

No, you should never consume alcohol when taking benzodiazepines as it is extremely dangerous. Individuals who do will feel the effects of the alcohol much faster. It isn’t safe to consume alcohol or take drugs with similar effects on the central nervous system simultaneously since these substances or drugs may interact with oral benzos by causing additional depression of the respiratory system and brain. Respiratory depression can result in breathing that is not adequate for supplying oxygen to the entire body, potentially resulting in death. Some examples of these products and drugs that can boost the sedative side effects or increase the risk of respiratory depression from benzos include:

Pain medications (opioids) that may result in respiratory depression:

• Acetaminophen/Hydrocodone
• Hydrocodone
• Oxycodone
• Fentanyl
• Morphine

Sedatives that may result in sedation:

• Eszopiclone
• Zolpidem
• Zaleplon
• Intermezzo
• Phenobarbital
• Several other drugs

Is It Possible To Become Addicted To Benzodiazepines?

Yes, these drugs are very habit forming, so it is possible to form an addiction to them. This is true even if you are taking them as prescribed by your health care professional. Individuals with a history of alcohol or drug abuse are more likely to develop an addiction to benzos. If these drugs are used over an extended period of time, it’s likely that you will develop a tolerance for them, meaning that you will need larger doses of the drug to treat your medical disease or condition due to the tolerance of the weaker formulation of the drug. Benzodiazepines can be effective for treating several conditions, such as insomnia and anxiety, but it is important that you are careful when taking these drugs due to the likelihood of addiction.

The street names for these drugs are Benzos and Downers. Addicts tend to abuse these drugs in order to obtain a “high”. They create a similar addition to opioids (narcotics like hydrocodone, oxycodone, morphine, and fentanyl) cannabinoids (marijuana), and GHB (gamma-hydroxybutyrate), which is a club drug.

These drugs are most frequently abused by adolescents and young adults who tend to crush the drugs up and snort them or just consume the tablet orally to get high. If this medication is abused, there are adverse effects with some of the following symptoms:

• Irritability
• Amnesia
• Hostility
• Disturbing and vivid dreams

Signs and symptoms that you may be addicted to benzos include the following:

• Nausea
• Diarrhea
• Vomiting
• Goosebumps
• Difficulty sleeping
• Bone and muscle cramps
• Uncontrollable leg movements

What Are the Symptoms and Signs of Withdrawal for Dependence of Benzodiazepine?

If you stop taking benzos suddenly, there is the chance that you will experience withdrawal symptoms that could include the following:

• Headaches
• Panic attacks
• Difficulty concentrating
• Irritability
• Sleep issues
• Dry heaving and vomiting
• Increased anxiety and tension
• Hand tremors
• Muscle pain and stiffness
• Palpitations
• A host of perceptual changes

The severity of the withdrawal symptoms will vary based on the duration and amount of the use of the benzodiazepines. In some cases, withdrawal symptoms can be deadly.

Benzodiazepines have been classified by the DEA, the Drug Enforcement Administration, as Schedule IV drugs, which means that they have a lower risk and potential of dependence than other more potent drugs like testosterone, codeine, Vicodin, anabolic steroids, Adderall, OxyContin, and Ritalin.

What Are the Different Kinds of Benzodiazepines?

Some examples of oral benzos include the following:

• Alprazolam (brand names: Xanax and Xanax XR)
• Clobazam (brand names: Onfi)
• Clonazepam (brand names: Klonopin)
• Clorazepate (brand names: Tranxene)
• Chlordiazepoxide (brand names: Librium)
• Diazepam (brand names: Diastat, Diastat Acudial, and Valium)
• Estazolam (brand names: Prosom, which is discontinued in the United States)
• Lorazepam (brand names: Ativan)
• Oxazepam (brand names: Serax, which is discontinued in the United States)
• Temazepam (brand names: Restorial)
• Triazolam (brand names: Halcion)

What Are the Formulations of Benzodiazepines?

All oral benzos are available in the form of a tablet.

• Alprazolam and clorazepate are available in extended-release tablets.
• Alprazolam, diazepam, clobazam, and lorazepam can be purchased in oral liquid form.
• Oxazepam, chloradiazepoxide, and temazepam are available in the form of capsules.
• Diazepam can be purchased as a rectal gel.
• Some benzos are available as injections.

Is It Safe to Take Benzos While Pregnant or Breastfeeding?

The Federal Drug Administration classifies benzos as pregnancy category D, meaning that the drugs can potentially result in harm to the fetus if administered to pregnant women. If benzodiazepines must be used in women who are pregnant or if the woman becomes pregnant while taking the drugs, it is imperative that the patient is informed of the potential risks to the fetus.

Benzodiazepines can enter the breast milk, and the drugs can result in lethargy as well as weight loss in the baby. As a result, these drugs should be used in mothers who are breastfeeding.

Common Benzodiazepines

Below is a list of examples of generic and brand names of benzodiazepines that are available within the United States.

• Alprazolam (brand name: Xanax)
• Clobazam (brand name: Onfi)
• Clonazepam (brand name: Klonopin)
• Clorazepate (brand name: Tranxene)
• Chlordiazepoxide (brand name: Librium)
• Diazepam (brand name: Valium)
• Estazolam (brand name: Prosom)
• Lorazepam (brand name: Ativan)
• Oxazepam (brand name: Serax)
• Temazepam (brand name: Restoril)
• Triazolam (brand name: Halcion)

Benzodiazepines are habit forming drugs, and it is possible for patients to become addicted to these drugs even if they are being taken as prescribed by their health care professional. Dosage, drug interactions, side effects, storage, as well as pregnancy and breastfeeding safety should be carefully reviewed before taking this medication.

Benzo Withdrawal Symptoms

The withdrawal symptoms for benzodiazepines are not something to be taken likely. Read on to learn more about the expectations when discontinuing use of these drugs.

Understanding the Withdrawal Time for Benzodiazepines

As a general rule, withdrawal symptoms for benzos will begin within 24 hours and can last for a few days and up to several months, depending on how long the abuse went out and the strength of the drug that was used. Extended withdrawal is not uncommon, though. Roughly 10 percent of individuals who abuse benzodiazepines will continue to feel withdrawal symptoms for years after stopping the drugs.

There isn’t a specific timeline that dictates the length of time a person will experience withdrawal from benzos. While each person will experience the withdrawal differently, it is possible to make certain estimations. Benzo withdrawal intensity and duration depends upon several different factors, including the following:

• Type of drug used
• Dosage amount
• Length of time taking the drug
• Method used to take the drug
• Abuse of other drugs/alcohol at the same time
• Underlying mental health or medical issues

According to the Drug Enforcement Administration (DEA), benzos are considered Schedule IV controlled substances. These drugs are tranquilizers and sedatives that are commonly prescribed to treat symptoms of anxiety, panic attacks, insomnia, muscle tensions/spasms, and seizure disorders. Common benzos include Xanax (generic name: alprazolam), Klonopin (generic name: clonazepam), Restoril (generic name: temazepam), Ativan (generic name: lorazepam), and Valium (generic name: diazepam). Alprazolam (Xanax) was the 13th most popular prescribed medication in the U.S. in 2012, according to one survey.

Benzos are taken regularly recreationally and they are abused for nonmedical purposes. In addition, they are being taken as prescribed medications.

Understanding the Onset of Withdrawal

Please note: It is not intended for benzodiazepines to be taken long-term due to the fact that extended use or abuse can result in the brain becoming both psychologically and physically dependent on the drugs.

Withdrawal symptoms, which can range from anything like physical manifestations like nausea and diarrhea to uncomfortable psychological symptoms, can occur once the drugs have been removed from the person’s bloodstream. A history of drug dependency in the family or any previous issues of substance abuse or dependency could increase the chances of a dependency developing in relation to a benzo and could also possibly add to the timeline duration for withdrawal.

Benzo drugs have a certain half-life that affects the duration it takes for the medication to leave a person’s bloodstream. If a person is dependent on the drug, as soon as it is purged from the body, it is possible for withdrawal to start. For short-acting benzodiazepines such as Xanax, withdrawal can start as soon as 10-12 hours after the last dose is taken. For longer-acting benzos like Valium, it can take symptoms a few days to appear. The withdrawal side effects aren’t usually lethal, but they are better managed under the medical attention and supervision of health care professionals.

Those taking benzodiazepines for numerous months or longer and in higher doses are more likely to experience longer-lasting symptoms than individuals that are taking the drugs for smaller doses for a shorter period of time. For instance, the FDA reports that individuals taking 4 mg per day or more of Xanax for more than three months were more at risk of dependency and more likely to experience more discomfort in terms of withdrawal symptoms than individuals who were taking smaller doses of Xanax for a shorter duration.

Some of the shorter-acting benzos such as Xanax are often considered more potent than some of the longer-acting like Valium. The withdrawal is comparable for both of them, but individuals who use the short-acting benzo medications may undergo more intense symptoms and much sooner since benzodiazepines with longer half-lives remain in the bloodstream longer, thereby slowing down the onset of the withdrawal symptoms.

Regardless of the type, benzos are designed to be depressants of the central nervous system, though each one works slightly differently and targets specific symptoms. For instance, Dalmane, Halcion, and Restoril are considered mainly hypnotic benzo medications that are prescribed for insomnia, whereas Ativan, Librium, Valium, and Xanax are considered anxiolytics and are prescribed primarily for anxiety-related symptoms. Then, Klonopin is considered mainly an anticonvulsant. There are various metabolites of these drugs that cause them to be somewhat different, which can also impact how quickly the drugs leave the body. Withdrawal from different benzos is often thought to cause the same overall symptoms; however, it’s possible that a person that is withdrawing from a hypnotic will experience sleep patterns that are more disruptive while an individual withdrawing from an anxiolytic will experience much higher anxiety levels.

The onset of withdrawal is also related to the way that the drug is ingested. For example, when the drug is injected or snorted, the drug is sent straight into the bloodstream, causing the drug to take a near instantaneous effect. If the drug is ingested orally like a pill, then it must be digested through the digestive tract, creating a less intense high and a slower start of the withdrawal symptoms.

Poly-Drug Abuse

Benzos are often abused regularly in conjunction with alcohol and/or other drugs. When this occurs, it is known as poly-drug abuse, and it can influence with severity and timeline of the withdrawal process. The Treatment Episode Data Set (TEDS) report from 2011 reported that 95 percent of individuals who were admitted into a drug treatment facility for dependency or abuse of benzodiazepines also abused alcohol or another drug at the same time. When other illicit substances are abused, it can increase the number and type of withdrawal symptoms that an individual experiences.

It is not recommended for an individual to stop taking benzodiazepines abruptly “cold turkey” without being under the supervision of a medical professional. Instead, it is recommended to undergo medical detox. Medical detox typically involves tapering off of the benzos with professional medical assistance and support. Apart from making certain that patients are safe throughout the entire process of detoxification, health care professionals can also assist in the alleviation of uncomfortable withdrawal symptoms. In many cases, medical detox can consist of substituting a long-acting benzo with a short-acting on during the weaning process to reduce the withdrawal symptoms and make the process a bit smoother for the patient. There are other medications that can also be prescribed during the detoxification process to treat certain symptoms, such as flumazenil. Research is ongoing and looking for new ways to ease the withdrawal process for benzodiazepines.

Phases of Withdrawal

There are three primary phases of benzodiazepine withdrawal: early, acute, and protracted withdrawal.

The phase of early withdrawal typically begins within just a few hours to a few days of halting the medications, and the phase can last several days. During this phase, a person may experience insomnia and anxiety symptoms since the brain will begin rebounding without the benzos in the system. Any symptoms that the drugs once suppressed will likely come back in a flooding fashion. The tapering process that is often used during the medical detox can help to diminish the rebound effect.

Several days after stopping a benzo medication, the acute withdrawal phase can start. This second phase makes up the majority of the withdrawal. The symptoms that may be experienced include panic, anxiety, muscle tension or spasms, diarrhea, nausea and/or vomiting, short-term memory impairment, clouded thinking, trouble concentrating, agitation, mood swings, twitching, hallucinations, blurred vision, seizures, and weight loss as a result of a decreased appetite. It’s during this second phase that certain medications can prove to be most beneficial at helping with withdrawal symptoms. During the acute withdrawal phase, suicidal thoughts and subsequent actions may occur, and therapy and support groups may assist in eliminating these emotions. This phase can last anywhere between two weeks to several months.

According to a study that ABC News published, around 10 percent of people can experience the third phase—which is known as protracted withdrawal—that can extend numerous months, possibly even years, after the use of a benzo medication has been stopped.

Individuals could experience prolonged insomnia and anxiety, tingling in their extremities, muscle twitches, and cognitive deficits as well as mood swings and depression that could be hard to manage. These symptoms can randomly appear without any warning at all. Mental health services/support outside of medical detoxification tend to include counseling and therapy to assist in the management of protracted withdrawal symptoms. If there is a mental health disorder present as well, which is known as co-occurring disorders, there is dedicated treatment that is tailored to these types of dual diagnoses that can effective during the recovery process.

Though there isn’t a specific timeline for the withdrawal period from benzos, mental health and medical professionals can assist in significantly reducing the duration and intensity of the symptoms that may be experienced during the benzodiazepine detox process. As previously mentioned, withdrawal from benzodiazepines should never be attempted on your own and should only be done under the supervision of medical personnel. Medical detox can assist in the safe removal of benzos from the brain and body, and a smooth recovery can be achieved by following up with family and therapy support services.

If you or someone you know has an addiction to benzodiazepines, reach out to us Shadow Mountain Recovery for help.