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“You need to take a chill pill!” You’ve probably heard this expression, usually meant to encourage someone to relax. The phrase “chill pill” most likely originated from the calming effects that drugs like benzodiazepines cause. However, these “chill pills” aren’t safe for everyone.
Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan), are controlled substances and require a prescription from a healthcare provider.
Read on to learn more about the benefits, side effects, and risks of benzodiazepines.
What are benzodiazepines?
Benzodiazepines, sometimes called “benzos,” are a class of anxiolytic (anti-anxiety) prescription medications. This class of drugs includes alprazolam (Xanax), lorazepam (Ativan), and several others—all known for their calming and sedating effects. A healthcare provider typically prescribes these drugs as short-term or “as needed” treatments instead of long-term treatments.
Besides easing anxiety symptoms, benzodiazepines can stop seizures. Seizures are caused by uncontrolled electrical activity between brain cells. Benzodiazepines work by increasing the effects of a naturally occurring brain chemical called GABA (gamma-aminobutyric acid) which blocks brain signals, slowing down brain stimulation and producing a calming, anticonvulsive (anti-seizure) effect (Bounds, 2020).
What are benzodiazepines used to treat?
A few decades ago, drugs like Xanax (alprazolam), Valium (diazepam) were very popular prescription drugs to treat anxiety disorders. But since the 1990s, they’re no longer first-choice treatments. One reason is that they carry several risks, including addiction. They may cause dangerous interactions if combined with other “downers”— drugs or substances that slow down the central nervous system (CNS). A few examples of downers include alcohol, opioids (such as hydrocodone, oxycodone, or tramadol), or sleep aids (such as Ambien) (Salzman, 2001).
Benzodiazepines are controlled substances, and healthcare professionals must follow special rules to prescribe and dispense them (DEA, n.d.).
Another reason for declining benzodiazepine popularity is the emergence of newer medications that are effective for treating anxiety disorders but come with fewer risks. Antidepressants are now considered first-choice options for treating most anxiety disorders, such as generalized anxiety disorder (GAD), along with cognitive-behavioral therapy. Specifically, antidepressants such as SSRIs and SNRIs have been used long-term to treat anxiety disorders since the FDA first approved them in the 1990s (Munir, 2021; Salzman, 2001; Strawn, 2018).
SSRIs and SNRIs are not addicting, and they’re effective as long-term treatments for anxiety disorders. One caveat to taking SSRIs or SNRIs is that they take weeks to start working. So, your healthcare provider may suggest a benzodiazepine as a short-term or as-needed treatment for anxiety symptoms until your antidepressant “kicks in” (Munir, 2021; Bystritsky, 2020).
SSRIs: everything you need to know
Despite their risks and the availability of other treatment options, benzodiazepines are approved by the FDA for several medical purposes. They’re not usually prescribed for long-term daily use but are typically recommended for short-term or as-needed use in certain situations. Your healthcare professional can tell you more about whether a specific benzodiazepine is appropriate for you. Each benzodiazepine (listed in the next section) has different approved uses. Some examples of these FDA-approved uses include (Bounds, 2020):
- Panic attacks and panic disorder
- Relief of anxiety symptoms
- Muscle spasms
- Alcohol withdrawal (“detox”) symptoms
- Short-term treatment of insomnia (trouble sleeping)
- Sedation before surgery or medical procedures
There are many types of benzodiazepines. Many of the brand-name versions of these drugs are no longer available. Benzodiazepines are generic prescription drugs and are usually inexpensive.
The top four most commonly prescribed benzodiazepines are (Griffin, 2013):
- alprazolam (Xanax)
- lorazepam (Ativan)
- clonazepam (Klonopin)
- diazepam (Valium)
Other benzodiazepines include (Griffin, 2013):
- chlordiazepoxide (Librium)
- clorazepate (Tranxene)
- estazolam (Prosom)
- flurazepam (Dalmane)
- midazolam (Nayzilam, Versed)
- oxazepam (Serax)
- temazepam (Restoril)
- triazolam (Halcion)
Side effects of benzodiazepines
Common side effects of all benzodiazepines include (Bounds, 2020):
- Dizziness, unsteadiness, or fainting
- Nausea or vomiting
Risks: what to know before taking benzodiazepines
Before taking a benzodiazepine, you should know that the FDA has issued boxed warnings for this drug class. Boxed warnings are the strongest type of warning from the FDA and include (FDA, 2020):
Risk of dangerous effects with opioids
Taking benzodiazepines with opioids can cause harmful side effects, such as severe drowsiness, respiratory depression (slowed breathing), coma, and, in rare cases, death. Examples of opioids include painkillers such as fentanyl, codeine, hydrocodone, oxycodone, and tramadol, and street drugs such as heroin.
It’s vital to avoid combining benzodiazepines with an opioid unless you and your healthcare provider have discussed the risks and there are no other alternative treatments left for you to try. And, your healthcare provider will have a plan for you to monitor and manage these risks, such as being prepared with Narcan (naloxone), a nasal spray that can reverse opioid effects in the event of an overdose. For more information, talk to your pharmacist, who can dispense Narcan to you without a prescription in the United States (Emergent, 2021).
Risk of abuse and addiction
Even if you take a benzodiazepine as prescribed, it’s possible to become addicted to it. You may start to feel that you need it, physically and mentally. This can lead to taking the drug more often than prescribed, raising your risk of side effects or overdose. You may have an increased risk if you’ve had substance abuse problems in the past, so be sure to discuss this with your healthcare provider.
What is addiction? Are there treatments?
Risk of dependence and withdrawal
The use of benzodiazepines can lead to physical dependence, and withdrawal effects can occur if you suddenly stop taking them. Withdrawal symptoms can cause harmful effects, including seizures, especially if you took the drug long-term or in high doses. Before you stop a benzodiazepine medication, your healthcare provider will guide you on gradually decreasing your dose before stopping it completely.
This is not an all-inclusive list of the risks and side effects of benzodiazepines. It’s best to talk with your healthcare provider if you have questions about taking a benzodiazepine.
Taking benzodiazepines safely
You shouldn’t take a benzodiazepine (or any prescription drug) if it’s offered to you by a friend or family member. Not only is this against the law, but it’s safest to only take medications prescribed by your healthcare provider after a discussion of the pros and cons.
There’s no doubt: benzodiazepines are effective medications. They’re helpful for several legitimate medical purposes. Benzodiazepines provide quick relief of anxiety or seizure symptoms and are especially useful in short-term or as-needed situations. The bottom line is to be mindful of their risks. Avoid combining benzodiazepines with alcohol, opioids (including prescription painkillers), or sleep aids, and be careful not to take a higher dose than prescribed.
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- Bystritsky, A. (2020). Pharmacotherapy for generalized anxiety disorder in adults. In UpToDate. M.B. Stein & M. Friedman (Eds.). Retrieved July 26, 2021 from https://www.uptodate.com/contents/pharmacotherapy-for-generalized-anxiety-disorder-in-adults
- Drug Enforcement Agency (DEA). (n.d.). Drug scheduling. Retrieved from https://www.dea.gov/drug-information/drug-scheduling
- Emergent Devices Inc. (2021). Getting Narcan is simple. Retrieved July 30, 2021 from https://www.narcan.com/
- Food and Drug Administration (FDA). (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
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Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.