How long should I take benzodiazepines?
For most people, benzodiazepines are helpful only as a temporary measure, to be used only in the following ways:
• on occasion, to help you sleep or when anxiety can’t be managed with non-drug approaches
• daily, for up to a few weeks, to help re-establish sleep patterns or to reduce anxiety while waiting for an antidepressant or other treatment to take effect.
Some people may continue to use benzodiazepines for longer, even months or years. Some do so because they continue to find these drugs helpful and have agreed with their prescribing physician that the benefits of continuing to use them outweigh the risks. There are also those who continue to use benzodiazepines over a longer term because the prescribing doctor has not re-examined their continued use. In this instance, ask another doctor to review your prescription.
Are benzodiazepines addictive?
When used on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction. This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher than normal doses. People with a history of substance abuse should avoid or minimize use of benzodiazepines as they are at higher risk of becoming addicted.
Signs of addiction include strong cravings for the effects of the drug, taking more of the drug than intended and continuing to use the drug despite the problems it may cause. Addiction may develop with or without physical dependence.
When benzodiazepines are taken regularly over a long period of time, the body adapts to the presence of the drug. This is known as physical dependence. Physical dependence, on its own, is not the same as addiction. Signs of physical dependence include tolerance and withdrawal.
People are said to have developed tolerance to a drug when the same dose, taken over time, no longer has the desired effect. With benzodiazepines, it is known that:
• Tolerance to the sleep-inducing effects may develop within a few weeks of regular use; however, tolerance does not usually develop with occasional use.
• Tolerance to the anxiety-relieving effects is less likely to develop.
• Tolerance to the effects of one type of benzodiazepine leads to tolerance to other benzodiazepines, and to other drugs with similar effects, including alcohol.
Some people who develop tolerance may take higher and higher doses to feel the same intensity of effect as when they started taking the drug. These people may find it difficult to stop using benzodiazepines.
Withdrawal symptoms of benzodiazepines may be similar to the reasons why the drugs were prescribed in the first place. The severity of withdrawal symptoms depends on the type of benzodiazepine used, the amount used and length of time it is used, and on whether the drug is stopped abruptly. Symptoms can include headache, insomnia, anxiety, tension, sweating, difficulty concentrating, tremor, sensory disturbances, fatigue, stomach upset and loss of appetite. Severe withdrawal symptoms from regular use of benzodiazepines in high doses may include agitation, paranoia, delirium and seizures. Withdrawal symptoms generally begin within a few days after treatment is stopped, and may continue for two to four weeks or longer.
The safe use of benzodiazepines
Take only as directed by your doctor; do not increase your dose.
Once you have slept well for two or three nights in a row, try to get to sleep without taking the medication.
If you have been taking benzodiazepines regularly for a few weeks or more, check with your doctor before reducing or stopping your medication.
How do I cut down or stop taking benzodiazepines?
Most often, benzodiazepines are prescribed to help people get through stressful situations or to provide relief while waiting for other treatment to take effect. When used in this way, on occasion or daily for a few weeks, most people can stop taking them without difficulty or withdrawal effects.
Stopping use can, however, be hard for some people, even when the use is short term. Problems are most likely to occur when:
• the issues that caused you to take these drugs in the first place have not yet been dealt with
• no other medication or talk therapy has been started.
People who wish to stop using benzodiazepines after using them regularly over a longer term will need to cut back their use gradually over an extended period of time. This approach reduces withdrawal effects and helps ensure success in stopping. Because the ideal process for cutting down varies depending on the benzodiazepine you are taking, the dose and the length of time you have been taking it, ask your doctor to help you set up a schedule. If the long-term use has been at high doses, stopping use requires medical supervision.
Will benzodiazepines interact with other medications?
These drugs may interact with other medications. If your doctor or dentist prescribes any medication, inform him or her about the drug you are taking. Check with your pharmacist before using any over-the-counter medication, including herbal products, cold or allergy tablets, or cough syrups.
When taken on their own, the risk of overdose with benzodiazepines is low; however, combining these drugs with other sedatives, such as alcohol, or with medications containing codeine or other opioid drugs, can result in overdose and possible death. Symptoms of overdose include slurred speech, confusion, severe drowsiness, weakness and staggering, slow heartbeat, breathing problems and unconsciousness.
What if I drink alcohol or coffee while taking benzodiazepines?
Benzodiazepines can be dangerous when combined with alcohol. Benzodiazepines increase the effects of alcohol, making you more sleepy, dizzy or lightheaded. One danger of this is the increased risk of stumbling, falling and related injuries. Another is the increased risk of overdose. Both alcohol and benzodiazepines slow down the central nervous system, which controls breathing. In overdose, breathing can stop.
Drinking too many caffeinated beverages (i.e., more than four cups of coffee or six cups of tea daily) may counteract the anxiety-reducing effects of benzodiazepines.
What if I use street drugs while taking benzodiazepines?
If you are taking benzodiazepines to help reduce the distress of a mental health problem, chances are that you want to feel less anxious and get a good night’s sleep. Street drugs, such as marijuana or cocaine, have effects that can worsen symptoms of anxiety and interfere with sleep—making you feel worse, rather than better.
Taking benzodiazepines to enhance the effect of other sedative drugs, such as opioids, is dangerous and increases the risk of overdose and injury.
Will benzodiazepines affect my ability to drive safely?
Benzodiazepines can affect your ability to drive a vehicle and increase the risk of a crash, especially if taken in combination with alcohol or other sedative drugs. The risk is highest when you first start taking benzodiazepines, before you are used to their effect. Avoid driving or operating other machinery if you feel drowsy or slowed down.
Will benzodiazepines affect my sex drive and function?
There is no clear evidence that benzodiazepines have any effect on sex drive or function.
is it safe to take benzodiazepines while pregnant or breastfeeding?
The risk of birth defects from taking benzodiazepines while pregnant is not known, though it is thought to be very small. If benzodiazepines are used regularly close to the delivery date, the baby may be born drowsy or may have withdrawal symptoms such as restlessness and feeding problems.
Small quantities of benzodiazepines can be passed through breast milk from the mother to the baby. This may cause drowsiness in the baby.
If you are pregnant or breastfeeding, or thinking about becoming pregnant, talk to your doctor about the risks and benefits of continuing or stopping benzodiazepines. If your doctor recommends that you stop taking benzodiazepines, he or she will help you to slowly reduce your dose over time, to avoid withdrawal symptoms.
Children, teens and benzodiazepines
Benzodiazepines are not recommended for use by children and teens, except to bring sedation prior to surgery or for brief medical procedures. Extra caution should be used when considering giving benzodiazepines to children as these drugs may cause children to become irritable rather than calm.
Older adults and benzodiazepines
Sensitivity to the effects of benzodiazepines increases with age. When older adults take these drugs, they may become confused and have reduced muscle co-ordination, putting them at greater risk of falls, hip fractures and motor vehicle crashes.
If an older person has been taking benzodiazepines regularly for a very long time, the process required to stop taking them may be long and difficult. In some cases, a doctor may decide to leave the older person on the medication, with regular assessment of daytime side-effects.
Copyright © 2009, 2012 Centre for Addiction and Mental Health