Benzodiazepines are mainly associated with anxiolytics, anticonvulsants and sedatives. Benzodiazepines are also widely used in medicine - they are used both for premedication of patients before surgery and for managing sudden agitation in patients and for treating anxiety disorders. Benzodiazepine therapy is implemented by doctors with extreme caution, because these drugs have one of the greatest addictive potential among therapeutic agents.

Contents:

  1. Benzodiazepines: indications for use
  2. Benzodiazepines: breakdown
  3. Benzodiazepines: action
  4. Benzodiazepines: contraindications
  5. Benzodiazepines: side effects
  6. Benzodiazepines: overdose
  7. Benzodiazepines: who can prescribe a prescription?

Benzodiazepineshave been used in medicine since the 1950s, when the first of them was discovered - chlordiazepoxide. The mentioned drug is practically no longer used, however, another benzodiazepine - diazepam - produced a few years after chlordiazepoxide, is still used today. In the more than half a century that has passed since the appearance of benzodiazepines on the market, many different preparations of this group have been produced that function essentially the same, but differ in strength and duration of action.

Benzodiazepines: indications for use

Benzodiazepines are most often associated with anxiety-relieving drugs, however, preparations from this group are used not only in the treatment of psychiatric diseases. The indications for benzodiazepines include:

  • anxiety disorders (e.g. generalized anxiety disorder, panic attacks - these drugs are used especially for temporary anxiety relief);
  • short-term treatment of insomnia;
  • treatment of epileptic seizures;
  • premedication before surgery;
  • alleviating alcohol withdrawal symptoms;
  • treatment of painful muscle contractures;
  • delirium treatment.

Benzodiazepines are also used in emergencies. They are sometimes administered to aggressive patients and patients characterized by significant psychomotor agitation.

Benzodiazepines are drugs intended rather for adults. ATchildren, they are rarely used - alternative anti-anxiety agents are preferred in this age group.

Benzodiazepines: breakdown

The basic classification of benzodiazepines is based on the duration of action of each agent.

For this reason, there are benzodiazepines:

  • short-acting (e.g. triazolam or loprazolam);
  • with a medium duration of action (e.g. alprazolam, estazolam);
  • long-acting (like diazepam or clonazepam).

When dividing benzodiazepines, one can take into account not only their duration of action, but also the speed with which the effects of these drugs appear. Fast-acting benzodiazepines are, for example, diazepam and triazolam. Medicines, the effects of which become apparent after a long time after taking them, are, for example, lorazepam or oxazepam.

This division is important, for example, when choosing a drug appropriate to the needs of a given patient: for example, when it is necessary to control significant psychomotor agitation, benzodiazepines that act quickly are used.

Benzodiazepines: action

Benzodiazepines work by attaching to benzodiazepine receptors, which are components of GABAergic receptors. These structures belong to the so-called inhibitory receptors. In the nervous system, they exist in conjunction with chloride receptors. Stimulation of GABAergic receptors results in an increased influx of chloride ions into the cell, which in turn leads to the occurrence of neuron hyperpolarization.

The attachment of benzodiazepines to these receptors makes them more susceptible to the attachment of the stimulating neurotransmitter (GABA). The effect of stimulating GABAergic receptors is to "sleep" nerve cells, thanks to which benzodiazepines exert a sedative and hypnotic effect. In addition to such effects, these drugs also have an anticonvulsant effect, reduce muscle tension and reduce psychomotor excitability.

Benzodiazepines: contraindications

Due to the fact that benzodiazepines can impair the respiratory process, these drugs should not be used by people withrespiratory problems . Examples of diseases in which benzodiazepines are contraindicated include chronic obstructive pulmonary disease (COPD), myasthenia gravis and obstructive sleep apnea.

Due to the highaddictive potential , benzodiazepines should not be used by patients who have ever had an addiction (whether from alcohol, drugs or other drugs) .

A contraindication tobenzodiazepine therapy is alsopregnancy .

The use of benzodiazepinesin the elderly is controversial . This situation results from the fact that in this group of patients there is the highest risk of benzodiazepine addiction. Another aspect that forces the careful implementation of benzodiazepine therapy in the elderly is that this age group is at the highest risk of developing side effects from these anti-anxiety drugs.

Caution is advised when prescribing benzodiazepines in patients suffering from depression. This is because such patients could use anti-anxiety drugs to commit suicide.

Benzodiazepines: side effects

Side effects appearing during the use of benzodiazepines are mainly due to the mechanism of action of these drugs.

Patients treated with agents from this group may experience:

  • sleepiness,
  • motor coordination disorders,
  • muscle weakness,
  • memory disorders,
  • lowering libido,
  • headaches,
  • feeling of general weakness,
  • lower blood pressure,
  • nausea.

It should be borne in mind that taking benzodiazepines may impair psychomotor performance. For this reason, people using anti-anxiety medications should make sure that they are actually able to safely travel on the road before driving a car.

The side effect of benzodiazepines that arouses interest among patients may be the so-calledparadoxical reaction . It occurs rarely, as it affects less than 1 in 100 people who take benzodiazepines. Its risk is greatest in patients from extreme age groups (young and elderly) and in patients with organic brain damage. The paradoxical reaction to benzodiazepines consists in the fact that taking the drug - instead of bringing the patient to silence and calming down - results in aggression and significant psychomotor agitation.

Risk of addiction to benzodiazepines

Benzodiazepines have a relatively high addictive potential. The risk of developing dependence appears even after two to four weeks of therapy, therefore the chronic use of these drugs is recommended to patients only when there is a definite necessity.

Dependence on benzodiazepines may be manifested by increasing tolerance to the drug - patients may need higher and higher doses of anxiolytics for the effects of therapy to appear. Another sign that there has been dependence may be symptoms that appear after withdrawalbenzodiazepines. They can be:

  • loss of appetite,
  • weakness,
  • seizures,
  • increased sweating,
  • depressed mood,
  • increased irritability,
  • anxiety,
  • insomnia,
  • muscle tremors,
  • memory, attention and concentration disorders.

The primary way to avoid addiction is to use benzodiazepines in the lowest doses possible and for as short a time as possible. There may be times, however, that the patient becomes addicted. In such a situation, the management is based on a gradual reduction in the dose of the drug used, while discontinuing the patient, long-acting benzodiazepines may also be prescribed instead of short-acting ones (in the case of the latter, withdrawal symptoms appear much more often).

Benzodiazepine dependence should definitely be avoided because, if it occurs, the time needed to stop taking the drug completely may be many months.

Taking benzodiazepines together with alcohol is especially dangerous, as it significantly increases the patient's risk of death.

Benzodiazepines: overdose

Overdosing on these drugs results in various ailments. These can be speech and gait disturbances, but also life-threatening problems such as coma and respiratory depression.

In the event of an overdose of benzodiazepines, treatment is performed in a hospital setting, where patients are administered a substance antagonist to anxiolytics - flumazenil.

Benzodiazepines: who can prescribe a prescription?

Because benzodiazepines are anti-anxiety drugs, some patients may think that they are only prescribed by psychiatrists. But you can get a prescription for benzodiazepines, for example, from your GP. When choosing the doctor to whom we go for an anxiolytic drug, we should consider what exactly our problem is.

For people suffering from anxiety disorders, it will be best to visit a psychiatrist, but in the case of short-term sleep problems, a visit to the GP should be sufficient.

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About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea(most willingly strolling along its shore with headphones in their ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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