Substance Abuse ServiceSt Vincent's Hospital, Fairview

Benzodiazepines

Benzodiazepines are a type of tranquillising medication, which can be prescribed for the short term treatment of severe anxiety, panic attacks, extreme distress, severe sleeping problems, muscle spasm and managing withdrawal from alcohol.

Benzodiazepines can be classed as long acting - in that they stay in your body for longer and their effects last longer than short acting benzodiazepines.

Newer benzodiazepine type medications are used specifically to only treat sleep disorders.

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Effects

You can get up to date information on medicines from your doctor, pharmacist or visit www.medicines.ie. Type in the name of your medicine in the ‘search for’ box at the top of the page. This will give you access to the Patient Information Leaflet (PIL) and the Summary of Product Characteristics (SPC) documents.

It is important that when prescribed this medication that a person does not drive or operate machinery. It can also be dangerous to drink alcohol whilst taking any form of benzodiazepines, due to the risk of overdosing.

 

Stopping Benzodiazepines

It is generally thought unwise to stop taking benzodiazepines suddenly as withdrawal symptoms can vary from mild to severe. As with any prescribed medicine, it is best to speak with your doctor about a need to reduce your prescription, and to do it gradually and in a planned way. If you have been getting benzodiazepines from a source other than a doctor, it is still wise to speak with your doctor about gradual reduction.

 

Worried About Your or Someone Else’s Use of Benzodiazepines?

You may be reading this information because you are concerned about how you or someone close to you is using their medication. The information below should give some indication of what to watch for, but does not take the place of talking to your doctor or other health professional.

1. Tolerance (that is, it takes more of the drug to have the same effect), to these drugs can occur quite quickly especially if they are used on a regular basis or if you take more than are prescribed. Since tolerance does occur, the drugs stop having useful effect after a fairly short period of time, and a person can end up wanting to take more of the drug to get the same effect.

2. Physical and Psychological Dependence can occur to these particular medications and may be identified by:

         a.  Increased usage of the drug & difficulties controlling use
         b.  Craving or desire to use the drug
         c.  Becoming preoccupied about obtaining a supply / taking it
         d.  Feeling the need to use it in more and more situations in order to cope.
         e.  Withdrawal symptoms when the drug is not taken
         f.   Continued use despite negative consequences

Sometimes people will get these medications from a variety of different places in addition to their own prescription. Common sources include family, friends and buying them ‘on the street’

 

What to Do?

If you would like to reduce and stop your usage, consider the following steps:

         1. Be accurate about how much / what type(s) / how often you use – writing down what dose
             you take, at what time every day for a week or two can help with this. A diary is provided on
             this site which you can print and used
         2. Look at what influences your usage – Stress? Money? Availability of medications? Fear of
             withdrawal? Using benzodiazepines to cope with the effects of alcohol or other drugs? etc.
         3. If you run short of medications, do you take something else instead?
         4. When you are clearer of your usual usage, speak with your doctor about a plan to, at first,
             cut down and discuss all the above with them.
         5. If family / friends supply you with extra tablets, let them know that you are cutting back /
             planning to stop.

 

Coping with Benzodiazepine Withdrawal

When you and your doctor have planned what the gradual reduction in medication will be, then it is unlikely you will experience any major symptoms at all. Sometimes people feel worried about changes in medication – and this worry can cause more symptoms than the dose reduction itself.

Advice contained in the patient workbook “Stopping Anxiety Medication” (1995, Oxford University Press, New York) is that if you do experience some symptoms, it can be helpful to gauge them against symptoms you have experienced and tolerated in the past. For example, have you ever had a bad case of the ‘flu? What sort of symptoms did you have? Did you have sweating, headaches, upset stomach? Tightness or soreness in the chest? Had you trouble sleeping? Did you experience any tremors or shaking and shivering?. Did you recover?

Were you excessively worried about your ‘flu symptoms? Probably not. You knew you had the ‘flu and it would pass. Although feeling pretty uncomfortable or miserable with the symptoms – most people wouldn’t worry too much or dwell on each sneeze or each and every ache and pain.

The workbook suggests considering the symptoms of any reduction as a type of “Benzo flu”. Reacting mentally in this way – having a willingness to tolerate the discomfort can be a helpful way for you to cope with withdrawal.

Sometimes  your  doctor  may suggest referral to specialist counselling service  that can help you
cope with / manage any symptoms or concerns you have about withdrawal and staying off benzodiazepines in the long term

For additional information on benzodiazepines follow the link to The Royal College of Psychiatrists website.

 

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Benzodiazepines Report                        Good Practice Guide