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What are Benzos?

Medically Reviewed by
Nzinga Harrison, MD
May 12, 2021

Benzos are one of the most globally recognized and widely prescribed medications since the 1970s. According to the National Center for Health Statistics (NCHS), Benzodiazepine is prescribed at about 66 million doctors’ appointments a year in the U.S.

Benzos, also known as minor tranquilizers, are pharmaceutical medications that help slow down brain activity in the central nervous system and the messages traveling between the brain and the body. This is achieved by altering the activity of the neurotransmitter gamma-aminobutyric acid (GABA) that can trigger reactions such as stress and anxiety.

Benzodiazepines are considered safe and effective when used as prescribed. However, it’s only effective as a short-term solution, as long-term use can lead to adverse effects such as tolerance and addiction. The majority of benzodiazepines are sold as pills or tablets for oral use, while some benzos are sold as a clear, odorless injectable liquid. 

What Are Benzos Used For?

Benzodiazepines are prescribed as a treatment for a variety of mental disorders and ailments. The U.S. Food and Drug Administration (FDA) has approved the use of benzodiazepines for the treatment of various medical conditions such as:

  • Insomnia
  • Generalized anxiety disorder
  • Social anxiety disorders
  • Seizures and epilepsy
  • Panic disorder

Benzodiazepines are also prescribed off label to treat health conditions such as:

  • Certain sleep disorders
  • Tic disorders
  • Bipolar disorder
  • Alcohol withdrawal management

Types of Benzos

Although over 2,000 different types of benzodiazepines are produced, only around 15 are currently approved for use by the FDA. 

FDA approved benzodiazepines in the United States include:

  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Clorazepate (Tranxene)
  • Diazepam (Valium)
  • Estazolam (Prosom)
  • Flurazepam (Dalmane)
  • Lorazepam (Ativan)
  • Midazolam (Versed)
  • Oxazepam (Serax)
  • Temazepam (Restoril)
  • Triazolam (Halcion)
  • Quazepam (Doral)

Each benzo differs in terms of potency, absorbability, and purpose. Benzos can be categorized into two main groups such as hypnotics and anxiolytics. Hypnotic benzos are short-acting medications generally used for the treatment of sleep disorders such as insomnia. Anxiolytics are long-acting benzos generally used for the treatment of anxiety.

Hypnotic benzodiazepines include:

  • Flurazepam
  • Loprazolam
  • Lormetazepam
  • Nitrazepam
  • Temazepam

Anxiolytic benzodiazepines include:

  • Alprazolam
  • Chlordiazepoxide Hydrochloride
  • Diazepam
  • Lorazepam
  • Oxazepam
  • Clobazam

Some of the most commonly prescribed benzodiazepines in the U.S. are Valium, Ativan, Klonopin, Librium, and Halcion.

Valium

Valium, also known by its generic name diazepam, is an oral medication that functions by increasing the activity of certain neurotransmitters in the brain. Valium is a long-acting benzodiazepine used for the treatment of:

  • Anxiety disorders
  • Alcohol withdrawal symptoms 
  • Muscle spasms and stiffness
  • Valium is also used in conjunction with other medications to treat seizures

Valium can cause mild to severe side effects in certain people. The most common side effects of Valium include:

  • Drowsiness
  • Tiredness
  • Muscle weakness
  • Loss of coordination

Inform your doctor of any persisting side effects or adverse reactions.

Ativan

Ativan, also known by its generic name lorazepam, is an intermediate-acting prescription tranquilizer. Ativan functions in a similar manner to Valium by decreasing brain activity to produce relaxation. This medication is manufactured and sold in the form of tablets and as liquid solutions for intravenous (IV) injection. Ativan is utilized in the treatment of:

  • Anxiety disorder
  • Insomnia 
  • Panic attacks 
  • Alcohol withdrawal
  • Status epilepticus (continuous seizures)
  • Irritable bowel syndrome

Ativan can cause mild or severe side effects. The more common side effects of Ativan include:

  • Drowsiness
  • Dizziness
  • Weakness or Tiredness
  • Changes in appetite
  • Dry mouth

Serious side effects include:

  • Difficulty breathing or swallowing
  • Severe skin rash
  • Persistent, fine tremor or inability to sit still
  • Irregular heartbeat
  • Suicidal thoughts

Some of these side effects may dissipate within a few days or a couple of weeks. But if the side effects are persistent or more severe, contact your doctor immediately. If you know someone at immediate risk of self-harm, suicide, or pose a danger to those around them, seek assistance immediately.

Klonopin

Klonopin, also known by its generic name clonazepam, is available as a tablet or as an orally disintegrating tablet (wafer). Klonopin is an intermediate-acting benzodiazepine that functions by decreasing abnormal electrical activity in the brain. Klonopin is used to treat conditions such as:

  • Panic Disorders
  • Social anxiety disorder (SAD)
  • Certain types of seizures

As with any medications, Klonopin comes with the risk of possible side effects. Some of the most common side effects include:

  • Feeling tired or depressed
  • Drowsiness
  • Dizziness
  • Memory problems
  • Problems with balance and coordination

Klonopin may cause serious side effects, including:

  • Worsening episodes of seizures
  • Severe drowsiness
  • Unusual mood and behavior changes
  • Aggression
  • Hallucinations

Inform your healthcare provider if these conditions persist and hinder your safety or quality of life.

What are Benzos?

Librium

Librium, also known by its generic name chlordiazepoxide, is a sedative and hypnotic medication with a medium to long half-life. Librium acts upon the brain and nerves (central nervous system) to produce calming effects. It functions by enhancing the effects of a certain natural chemical in the body known as GABA. Librium is used to treat conditions such as:

  • Anxiety disorders
  • Acute alcohol withdrawal 
  • To relieve fear and anxiety before surgery

Librium is usually prescribed for no longer than four months due to its addictive nature. And similar to many benzodiazepines, Librium comes with its own set of side effects.

Common side effects of Librium include:

  • Drowsiness
  • Tiredness
  • Dizziness
  • Nausea
  • Vomiting
  • Constipation

Librium may cause severe side effects, including:

  • Severe drowsiness
  • Unusual mood or behavior changes
  • Aggression
  • Worsened sleep problems
  • Jaundice
  • Thoughts of suicide

Inform your doctor if the condition persists or worsens so your dosage can be altered or an alternative medication can be prescribed.

Halcion

Triazolam, sold under the brand name Halcion is a central nervous system depressant tranquilizer of the triazolo-benzodiazepine class of drugs, which are derivatives of benzodiazepines. Halcion acts on the brain to produce a calming effect and is used as a short-term treatment for certain sleep problems such as insomnia. Halcion is generally prescribed for a period of one to two weeks or less. 

Halcion helps you fall asleep faster, stay asleep longer, and lessen how often you wake up during the night to improve the quality of your sleep. The most common side effects of Halcion include:

  • Dizziness
  • Daytime drowsiness 
  • Loss of coordination
  • Headache
  • Tingly or prickly feeling on your skin

While these symptoms generally dissipate within a few days, some may experience more severe side effects such as:

  • Unusual mood and behavior changes
  • Confusion
  • Memory loss (amnesia)
  • Hallucinations
  • Depression
  • Suicidal thoughts

If you experience any of these severe symptoms, contact your doctor immediately and address these issues.

Do Benzos Pills Affect Other Medications?

Benzodiazepines can interact with certain medications negatively, so doctors must be kept informed of all the medications you consume. This also includes supplements and herbal medications. Medication that can react with benzodiazepines includes:

The FDA has reported that benzodiazepines, when used in combination with opioid medications or other sedating medications, can result in serious adverse reactions, including slowed or difficult breathing and death. Seek immediate medical attention if you experience unusual dizziness or lightheadedness, extreme sleepiness, slow or difficult breathing, or unresponsiveness.

Who Should Not Take Benzos?

Just as it’s important to notify your doctor of other medications you may be taking, it’s also important to discuss your medical history and current conditions before being prescribed benzos. Benzodiazepines must be avoided by individuals who are diagnosed with:

  • Severe lung disease or breathing problems
  • Sleep apnea 
  • Severe liver or kidney disease
  • Chest and lung complications
  • Myasthenia gravis
  • A history of alcohol or drug abuse
  • Personality disorder

Benzos aren’t suitable for children, except in rare cases of acute anxiety or insomnia caused by fear or sleepwalking.

Benzodiazepines should also be avoided if possible during pregnancy. As it increases the risk of physical complications in the developing baby, such as:

  • Cleft palate
  • Urinary tract abnormalities
  • Heart abnormalities
  • Stomach abnormalities
  • Dyslexia 
  • Dyspraxia 
  • Autism
  • Attention deficit hyperactivity disorder (ADHD)

If benzos are consumed during the last term of pregnancy, it can cause complications in newborn babies, including:

  • Drowsiness
  • Floppy muscles
  • Breathing problems
  • Low body temperature
  • Withdrawal symptoms such as abnormal sleeping patterns, high-pitched crying, tremor, vomiting, and diarrhea

Breastfeeding should also be avoided while taking benzodiazepines as traces of the medication are present in breast milk and may gradually build up in the baby’s body and cause side effects.

Most benzodiazepines are often used for short periods of time due to their ability to cause tolerance, dependence, and addiction over long-term use.

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Nzinga Harrison, MD

Dr. Harrison serves as the Chief Medical Officer for Eleanor Health with more than 15 years experience practicing medicine. She is a double-board certified physician with specialties in general adult psychiatry and addiction medicine. Dr. Harrison has spent her career as a physician treating individuals from marginalized communities with substance use and other psychiatric disorders. As a physician executive, she has served as Senior Vice President and Chief Medical Officer roles committed to creating and improving systems-based delivery of psychiatric and substance abuse care. She is a vocal advocate for stigma reduction, and is passionate about the necessity for whole-person care as individuals and communities seek to recover from and prevent substance use disorders.

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