Benzodiazepines

Alprazolam (Xanax®) Clonazepam (Rivotril®) Diazepam (Valium®) Lorazepam (Ativan®) Oxazepam (Serax®) Temazepam (Restoril®) Triazolam (Halcion®)

What is this medication used for?

Benzodiazepines are medications used in the management of seizure disorders (epilepsy), sleeping difficulties (insomnia), anxiety and panic disorders, post-traumatic stress disorders (PTSD), agitation, acute alcohol withdrawal, and the treatment of periods of extreme slowing or excessive purposeless movement (catatonia).

Benzodiazepines have also been used alone and in combination with antipsychotic medication in the management of schizophrenia.

When potential benefits outweigh risks, benzodiazepines may be prescribed “off-label.” Learn more about off-label medication use: http://bit.ly/KMH-off-label-use

When will the medication start to work?

Benzodiazepines are usually prescribed to be taken regularly, but may also be taken on an ‘as needed’ basis. You should start to feel an improvement of anxiety, insomnia, alcohol withdrawal or catatonia symptoms within 30-60 minutes of taking benzodiazepines.

Talk with your doctor if you feel that benzodiazepine therapy has not been helpful or if side effects are too bothersome. Your doctor may recommend switching you to a different medication.

Is this medication addictive?

The use of benzodiazepines may lead to physical and psychological dependence (such as unable to sleep without medication) or abuse (taking more than prescribed). Using benzodiazepines for a short period of time minimizes this risk. As the dosage and duration of treatment increases, the risk of dependence or abuse becomes higher.

If you have been taking it for a long period of time and suddenly stop, you may experience worsened sleep problems (rebound insomnia) or feelings of anxiety. Your doctor will explain how to safely lower the dose gradually to prevent uncomfortable withdrawal effects as your body adjusts to being without it.

How do I take this medication?

This depends on the medication that is prescribed to you. The dose that gives the most benefit with the least side effects is different for each person. Benzodiazepine use varies from occasional use ‘as needed’ to regular use up to four or more times daily. Usually, you will start with a low dose and may slowly increase this dose over several days or weeks, based on how you tolerate it. Your doctor will determine the dose that works best for you based on your symptoms and response to this medication. Do not take more than the recommended dosage before talking to your doctor.

Benzodiazepines may come in a variety of forms depending on the medication: tablets, capsules, sublingual tablets, and injections. If you take sublingual tablets, place the tablet(s) under your tongue and do not swallow for two minutes. This allows enough time for the medication to be absorbed.

Tell your doctor or pharmacist if you:

Have allergies or bad reactions to a medication
Take (or plan to take) other prescription or non-prescription medications, including natural medicines. Some medications interact with benzodiazepines. Your doctor may adjust medication doses or monitor for side effects
Have a history of lung disease or breathing problems, liver or kidney problems, narrow-angle glaucoma, sleep apnea, seizure disorder, myasthenia gravis
Have a history of depression, any other psychiatric condition or thoughts of self-harm
Miss a menstrual period, are pregnant, breast-feeding or planning a pregnancy
Use alcohol or drugs. Taking benzodiazepines together with certain substances may cause a bad reaction. Learn more at www.DrugCocktails.ca

Possible common or serious side effects:

Side effects may be more common when starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

Dizziness, poor coordination, confusion or headache
Vivid dreams or nightmares
Memory problems (amnesia) or morning drowsiness
Blurred vision, dry mouth or unpleasant taste
Nausea, vomiting, stomach ache or constipation
Increased sleep difficulties or anxiety after you stop taking benzodiazepines (“rebound effect”)

Contact your doctor immediately if you experience:

Mood or behavioral changes, excitement, talkativeness, irritability, anger or aggression, or trouble sleeping
Hallucinations (hearing, seeing or feeling things that are not there)
Imbalance leading to falls
Thoughts of hurting yourself, suicide, increased hostility or worsening symptoms
Getting out of bed without being fully awake and taking part in activities you are not aware of and do not remember (complex sleep-related behaviors)

What precautions should my doctor and I be aware of when taking this medication?

Before starting benzodiazepines, try making small changes to sleep habits to see if you have a need for medication. For example, good sleep habits include:
- avoiding caffeine and other substances that can disrupt sleep (alcohol, nicotine, cannabis)
- sticking to a regular sleep/wake schedule (avoid sleeping in or taking naps)
- powering down devices early in the evening and avoiding stimulating activities, large meals or exposure to bright lights before bedtime
- keeping the bedroom only for sleep, free of distractions
Many medications may interact with benzodiazepines, including other sleep-aides, antidepressants, mood stabilizers, scopolamine and several others. If you are (or begin) taking any other prescription, over-the-counter medication, natural health product or supplement, check with your doctor or pharmacist to see if they are safe to use.
While taking this medication, if you feel dizzy, drowsy or slowed down in the morning, do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking benzodiazepines.
When taking benzodiazepines avoid large amounts of caffeinated products (tea, coffee, cola). This may decrease the effect of the medication and may lead to increased anxiety or difficulty sleeping.
Avoid eating grapefruit or drinking grapefruit juice while taking clonazepam or alprazolam as this may lead to increased side effects.

What special instructions should I follow while using this medication?

Keep all appointments with your doctor.
Tell your doctor about your sleep pattern or anxiety symptoms. Your doctor will monitor your sleep disorder and response to this medication.
Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you take benzodiazepines regularly and forget to take it, skip the missed dose and take your next dose at its regularly scheduled time the next day. DO NOT double your next dose to try to ‘catch up’.

How does this medication work?

Benzodiazepines affect actions of the brain chemical GABA. By enhancing the action of GABA, benzodiazepines have a calming effect on parts of the brain that may be overactive. This helps to manage anxiety, insomnia, and seizure disorders.

How do I store this medication?

Keep this medication in the original container, stored at room temperature away from moisture and heat and protected from light. Keep this medication out of reach and sight of children.

How well does the medication work in children and adolescents?

When used to treat anxiety disorders, benzodiazepines decrease symptoms such as nervousness, fear and excessive worrying. Benzodiazepines may also help with the physical symptoms of anxiety, including fast and strong heartbeat, trouble breathing, dizziness, shakiness, sweating and restlessness. Typically, benzodiazepines are prescribed to manage anxiety symptoms that are uncomfortable, frightening or interfere with daily activities for a short period of time before other anti-anxiety treatments like cognitive-behavioural therapy (CBT) or anti-anxiety medications take effect. Benzodiazepines do not cure anxiety disorders, but may help to improve overall functioning. Whenever possible, the addition of CBT to this medication may help to increase the potential benefits.

Benzodiazepines may also be used to reduce agitation in episodes of elevated mood (mania) or psychosis. When used to improve sleep, benzodiazepines may shorten the time it takes you to fall asleep, decrease the number of times you wake up during the night, and increase your total sleep duration.

How long should I take the medication for?

Benzodiazepine treatment should usually be kept as short as possible (less than 2 weeks). However, some people may need to take it for a longer period of time. For anxiety disorders, patients may only take benzodiazepines on an ‘as-needed’ basis for immediate symptoms. For insomnia, benzodiazepines may be taken occasionally on an ‘as needed’ basis when you have sleep difficulties. Your doctor will discuss the benefits and risks of taking benzodiazepines with you. At this time, you can also discuss how long you might need to take this medication.

If you take benzodiazepines regularly, do not increase, decrease, or stop taking this medication without discussing with your doctor. If you stop taking benzodiazepines suddenly, it is possible you may experienced worsened symptoms or “rebound effects.”