Benzodiazepines
(such as Diazepam - Valium -  Nitrazepam - Mogadon - Xanax -  and others)

This group of drugs are also known as tranquillisers and sedatives. The best known are probably diazepam (brand name Valium) and nitrazepam (Mogadon). Benzodiazepines basically fall into two groups - the anxiolytics (for treating anxiety) and the hypnotics (for treating insomnia). Benzodiazepines are useful drugs for treating a number of conditions but, because of their Side effects and the risk of dependency (see below), they are not suitable as routine 'sleeping tablets', nor are they an effective treatment for depression.

    * How do benzodiazepines work?
    * What are they for?
    * Side effects
    * Withdrawing from a benzodiazepine (read these paragraphs carefullly.)
      {Your doctor must not prescribe benzodiazepines for longer than three
      weeks.  Otherwise severe withdrawal problems usually result.  These can
      be serious enough to cause death!}

    * Before taking a benzodiazepine
    * Interactions with other medicines
    * How to use a benzodiazepine
    * Types of benzodiazepines
    * Self-help for insomnia and anxiety

How do benzodiazepines work?

Benzodiazepines work by depressing the part of the brain, called the reticular activating system, that regulates how active the brain is. They do this by increasing the action of a substance called gamma-aminobutyric acid (GABA), a chemical involved in slowing down the transmission of nerve signals in the brain.

What are they for?
While all benzodiazepines essentially have the same action in the brain, some calm its activity to a greater extent, making certain drugs more suitable for treating anxiety and others for treating insomnia. Benzodiazepines are also used in anaesthesia, and for treating epilepsy and muscle spasms. They may also be prescribed for people who are experiencing an episode of mania - a mental disorder that involves excessive activity and long periods without sleep.

Side effects
The main problem with benzodiazepines is that a course taken for more than a few weeks can cause physical and psychological dependence. This means that you may need to take more of the drug for it to have the same effect (known as tolerance) and also that you may find it difficult to stop taking the drug (become addicted). This is known as the 'benzodiazepine withdrawal syndrome'. Symptoms of this syndrome, can occur in people who stop taking the drug after a period of as little as 2-4 weeks. They include confusion, insomnia, anxiety, loss of appetite and so weight, shaking, sweating, and ringing in the ears. Because of this, the Government's advisory group (the Committee on Safety of Medicines) advises doctors that benzodiazepines should not be routinely taken for more than 2-4 weeks for anxiety, and even then should only be used to treat severe, distressing and disabling anxiety or insomnia.

In the past, before the disadvantages were known, doctors prescribed benzodiazepines more widely - to treat, for example, relatively mild forms of anxiety or to help people after bereavement.

Benzodiazepines can also cause a range of side effects, the most common being confusion, stumbling, memory loss, drowsiness, light-headedness, a hangover effect (feeling the effects of the drug the next day), and an increase in aggression. Because of the side effects benzodiazepines can cause, they can impair your ability to drive or operate machinery, even the day after the last dose taken. They can also enhance the effects of alcohol.

Some benzodiazepines used to help with sleep are 'short acting' (e.g. temazepam) and when used to treat insomnia are less likely to cause a hangover effect the next day than the long-acting ones (e.g. nitrazepam). However, the short-acting benzodiazepines are more likely to lead to dependence and withdrawal syndrome. The long-acting anxiolytics, such as diazepam, can be given at night to treat insomnia and anxiety in someone with both, because their effects last into the next day.

Withdrawing from a benzodiazepine
If you have been taking a benzodiazepine for some time (e.g. more than 3  weeks) you might be dependent on it, and you shouldn't stop taking it suddenly. This can cause unpleasant, and possibly dangerous, physical symptoms (such as convulsions). With your doctor's help and advice, you will need to stop taking the drug gradually, reducing the dose over a period of weeks. Certain nutritients are somethimes found helpful in such cases.

Before taking a benzodiazepine
A doctor will review your medical history and will take into account issues such as the following before prescribing a benzodiazepine

    * a lung or breathing disorder
    * muscle weakness
    * a history of drug or alcohol abuse
    * pregnancy or breastfeeding

Your doctor will generally not prescribe benzodiazepines if you have:

    * severe breathing problems or acute lung disease
    * sleep apnoea (that involves long intervals between breaths when sleeping)
    * severe liver disease
    * severe mental health problems

. 
Interactions with other medicines

Do not take any other medicines or herbal remedies with a benzodiazepine, including those you have bought without a prescription, before talking to your doctor or pharmacist.

    * All drugs that have a tranquillising or sedative effect on the brain such as alcohol, will increase the effects of benzodiazepines
    * Some antimicrobial drugs (antibiotics and antivirals) inhibit the breakdown of certain benzodiazepines, making them work for longer periods.

How to use a benzodiazepine

Your doctor must not prescribe benzodiazepines for longer than three weeks.  Otherwise severe withdrawal problems will result.  These can be serious enough to cause death!

Benzodiazepines are only available on a doctor's prescription. Many brands of these drugs are not available on the NHS, however, and can only be prescribed in their generic form (ie chlordiazepoxide but not Librium; diazepam but not Valium). For more information about generic and proprietary versions of medicines with identical active ingredients look at our article on explaining medicines. Benzodiazepines come as tablets or capsules and some also come as solutions, rectal preparations and injections. It is important to take a benzodiazepine only in the doses your doctor has prescribed for you and to stop taking it as instructed.

Types of benzodiazepines
Anxiolytic benzodiazepines
 * 

Diazepam (Valium)
 * 

Alprazolam (Xanax)
 * 

Bromazepam (Lexotan)
 * 

Chlordiazepoxide (Librium)
 * 

Chlorazepate (Tranxene)
 * 

Lorazepam (Ativan)
 * 

Oxazepam

Other (non-benzodiazepine) anxiolytics
 * 

Buspirone (Buspar)
 * 

Beta-blockers - medicine article click here
 * 

Meprobamate (Equagesic) - this is a Controlled Drug and rarely used

Hypnotic benzodiazepines
 * 

Nitrazepam (Mogadon)
 * 

Flunitrazepam (Rohypnol)
 * 

Flurazepam (Dalmane)
 * 

Loprazolam
 * 

Lormetazepam
 * 

Temazepam

Other (non-benzodiazepine) hypnotics
 * 

Zalepon (Sonata)
 * 

Zolpidem (Stillnoct)
 * 

Zopiclone (Zimovane
 * 

Chloral hydrate
 * 

Triclofos
 * 

Clomethizole
 * Antihistamines 

Self-help for insomnia and anxiety

There is much you can do to help yourself if you suffer from anxiety and/or insomnia. Relaxation techniques, meditation and yoga can all help you learn to relax and sleep better. These can be self-taught, but it is probably better to start off in a class, which are now widely available in health clubs and sports facilities etc. Certain complementary therapies, such as acupuncture, aromatherapy, massage and reflexology have been shown to help people relax and to relieve anxiety. Other things you can do for yourself include avoiding drinks with caffeine in, such as tea, coffee and cola, particularly in the evening, if you suffer from insomnia.

Other tips for a good night's sleep include:

    * Making sure your bedroom is quiet (or wear ear plugs), well ventilated and not too hot or cold; having a regular bedtime.
    * Try not to sleep in the daytime.
    * Avoid drinking too much alcohol, which can cause you to wake very early.
    * Avoid large meals late in the evening.
    * Avoid working, watching television, using the computer or having difficult conversations late into the evening.
    * Take regular exercise.
    * Have a warm bath just before you go to bed.

November 2001