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Benzodiazepines are widely used as anxiolytics and hypnotics. Some are employed
for muscle relaxant and anticonvulsant properties - note especially intravenous
diazepam in the treatment of status epilepticus.
Benzodiazepines are a group of drugs which potentiates the activity of the
inhibitory neurotransmitter gamma-aminobutyric acid (GABA) (1). It exerts its
effect as hypnotics, anxiolytics, anticonvulsants, and muscle relaxants (1).
According to the British National Formulary (BNF), benzodiazepines can be grouped
- hypnotics - used for the short-term treatment of insomnia, e.g. - nitrazepam,
flunitrazepam, flurazepam, loprazolam, lormetazepam and temazepam
- anxiolytics - e.g. - diazepam, oxazepam, lorazepam, alprazolam and chlordiazepoxide
In 1988, the Committee on Safety in Medicines (CSM) published guidelines on
appropriate use of benzodiazepines. It recommends that the use of benzodiazepines
should be limited in the following ways:
- as anxiolytics
- benzodiazepines are indicated for the short-term relief (two to four
weeks only) of anxiety that is severe, disabling or subjecting the individual
to unacceptable distress, occurring alone or in association with insomnia
or short-term psychosomatic, organic or psychotic illness.
- the use of benzodiazepines to treat short-term 'mild' anxiety is inappropriate
- as hypnotics
- benzodiazepines should be used to treat insomnia only when it is severe,
disabling, or subjecting the individual to extreme distress (2).
- the lowest dose which can control the symptoms should be used. It should
not be continued beyond four weeks.
- long-term chronic use is not recommended
- treatment should always be tapered off gradually
- patients on benzodiazepines for a long time may require a longer period
during which doses are reduced.
- when a benzodiazepine is used as a hypnotic, treatment should, if possible,
Note that alcohol potentiates their effects, and there are problems with the
increase in aggression in some patients.
Last reviewed 01/2018