Benzodiazepines

Question 1

What are Benzodiazepine anxiolytics effective for?

Answer 1

• Alleviating anxiety levels
• Muscle spasm
• Epilepsy
• Insomnia
• Alcohol withdrawal

Question 2

When can Benzodiazepine anxiolytics not be used?

Answer 2

Cannot be used for stress, unhappiness or minor physical disease.

Question 3

What can Benzodiazepines inhibit?

Answer 3

It can inhibit psychological adjustments in bereavement

Question 4

Which patients are more likely to be dependent on Benzodiazepines?

Answer 4

Patients with history of alcohol or drug abuse and with marked personality disorders

Question 5

What is the normal dose and duration for Benzodiazepines?

Answer 5

Limit to lowest possible dose for the shortest period of time

Question 6

Why are beta blockers not used as anxiolytics?
And what are some benefits of using them for anxiety?

Answer 6

Beta blockers do not affect psychological symptoms of anxiety, like worry, fear, tension.
They reduce autonomic symptoms like palpitations, tremor.

Question 7

What are some examples of Benzodiazepines?

Answer 7

Chlordiazepoxide
Alprazolam
Diazepam
Lorazepam
Nitrazepam
Clobazam
Midazolam

Question 8

What can abrupt withdrawal of Benzodiazepines cause?

Answer 8

Confusion
Toxic psychosis
Convulsions
A condition resembling delirium tremens

Question 9

What are the symptoms of Benzodiazepine withdrawal syndrome?

Answer 9

• Insomnia
• Anxiety
• Loss of appetite
• Loss of body weight
• Tremor
• Perspiration
• Tinnitus
• Perceptual disturbances

Some continue for weeks and months after stopping the medication

Question 10

When can Benzodiazepine withdrawal syndrome develop? And how long do they last?

Answer 10

Anytime up to 3 weeks after stopping Long Acting benzodiazepine, but may occur within a day with short acting ones.

They can last for weeks or months after stopping them.

Question 11

How does Benzodiazepine withdrawal work?

Answer 11

It is carried over a reduction rate that is tolerable to the patient.
The rate depends on initial dose, duration of use and the patients clinical response.

Question 12

How long does it take short term users and long term users to withdraw?

Answer 12

Short terms users are people who have been using it for 2-4 weeks and it can take 2-4 weeks to withdraw.

Long term users can take several months or more to withdraw. Usually resolve within 6-18 months.

Question 13

What is the protocol for withdrawing long term Benzodiazpines?

Answer 13

Transfer patient to equivalent dose of diazepam (preferably at night).

Reduce diazepam dose by 1-2mg every 2-4 weeks. If withdrawal symptoms occur maintain dose until symptoms lessen.

Reduce diazepam dose further if necessary in similar steps for 500mcg towards the end of the withdrawal. Then stop completely.

Question 14

Can benzodiazepines be used for insomnia?

Answer 14

Yes, associated with anxiety.
And when it is severe, disabling or causing extreme distress.

Question 15

Which patients are short acting benzodiazepines normally given to?

Answer 15

Patients with hepatic impairment and elderly patients

Question 16

Which type of benzodiazepines carry a greater risk of withdrawal symptoms?

Answer 16

Short acting benzodiazepines

Question 17

What are I.V Diazepams and lorazepams normally used for?

Answer 17

Panic attacks

Question 18

What are the cautions with Benzodiazepines?

Answer 18

• Avoid prolonged use
• Avoid abrupt withdrawal
• Avoid use in drug/alcohol dependent/abuse patients
• Has paradoxical effects (a paradoxical increase in hostility and aggression)

Question 19

What are the paradoxical effects of Benzodiazepines?

Answer 19

• Increase in hostility and aggression
• Effects range from talkativeness & excitement to aggression and antisocial acts
• Increased anxiety & perceptual disorders

Question 20

What are the side effects of Benzodiazepines?

Answer 20

• Decreased alertness
• Anxiety
• Ataxia & confusion (more in elderly)
• Dizziness & drowsiness
• Fatigue
• G.I disorders
• Sleep disorders
• Muscle weakness
• Hypotension
• Altered mood
• Tremor
• Suicidal thoughts

Question 21

What are the contraindications for Benzodiazepines?

Answer 21

• Acute pulmonary insufficiency
• Unstable myasthenia gravis
• Sleep apnoea syndrome
• Hepatic impairment; esp severe impairment

Question 22

Can Benzodiazepines be used in pregnancy?

Answer 22

Yes, but avoid regular use. Only use if there is a CLEAR indication like seizure control.
This is because there is a risk of neonatal withdrawal symptoms when used in pregnancy

Question 23

Can high doses of Benzodiazepines in late pregnancy and labour be used?

Answer 23

No!
Because it may cause neonatal hypothermia and hypotonia (decreased muscle tone) & respiratory depression.

Question 24

Can Benzodiazepines be used when breastfeeding?

Answer 24

It should be avoided, as it is present in breastmilk.

Question 25

What patient and carer advice should be given with Benzodiazepines?

Answer 25

• Drowsiness may persist the next day and affect performance of skilled task like driving
• The effects of the drug are enhanced by alcohol
• It can cause a coma with people with hepatic impairment.

Question 26

Can Benzodiazepines be given to people with hepatic impairment?

Answer 26

Yes but should be avoided.
If necessary, use ones with shorter half lives.

Question 27

Which Benzodiazepines have shorter half lives?

Answer 27

LLATOM

• Lormetazepam
• Loprazolam
• Temazepam
• Oxazepam
• Midazolam
• Alprazolam

These are the ones that are safer to use