Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives
Abstract
:1. Introduction
1.1. History of Benzodiazepines
1.2. Common Uses Today
2. Evidence for Benzodiazepine Prescription
2.1. Evidence-Based Indications
2.2. Theoretical Basis
3. Evidence against Benzodiazepine Prescription
3.1. Conditions and Durations with No Evidence of Efficacy
3.2. Contraindicated Comorbid Conditions
3.3. Adverse Effects
3.3.1. Vulnerable Populations
3.3.2. Tolerance
3.3.3. Cognitive, Emotional and Behavioral Adverse Effects
3.3.4. Physical Adverse Effects
3.3.5. Dependence, Misuse, Abuse and Addiction
3.4. Drug–Drug Interactions
4. Alternatives
4.1. First-Line Treatments for Anxiety and Insomnia
4.2. Additional Pharmacologic Alternatives
5. Conclusions
Author Contributions
Conflicts of Interest
References
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Benzodiazepine | Anxiety | Insomnia, Short-Term | Alcohol Withdrawal | Seizure | Other |
---|---|---|---|---|---|
flurazepam | + | ||||
chlordiazepoxide | + | + | Preoperative anxiety | ||
diazepam | + | + | + | Muscle spasms, preoperative sedation | |
clorazepate | + | + | + | ||
clobazam | Lennox-Gastaut syndrome (adjunct) | ||||
clonazepam | + | + | Panic disorder; periodic limb movement disorder; neuralgia | ||
estazolam | + | ||||
temazepam | + | ||||
lorazepam | + | + | + | Preoperative sedation; chemotherapy-related nausea/vomiting | |
oxazepam | + | + | |||
alprazolam | + | Panic disorder | |||
triazolam | + | ||||
midazolam | Procedural sedation |
Benzodiazepine Adverse Effects | Overlap with Anxiety | Example of Mental Disorders with Similar Symptoms |
---|---|---|
Physical | ||
dizziness (vertigo, lightheadedness/syncope) | + | panic, somatic, dissociative |
nausea/vomiting | + | panic, somatic |
speech (dysarthria, slurred) | ||
motor (incoordination/unsteadiness, ataxia, poor reaction time, tremors, weakness, hyperreflexia, nystagmus, diplopia) | + | panic, somatic |
restlessness/psychomotor agitation | + | GAD, PTSD, mood, somatic |
muscle pain/tension/spasms | + | GAD, PTSD, somatic |
sensory (visuospatial impairments, photophobia, hyperacusis, strange tastes, tinnitus, paresthesia/ numbness/burning) | + | panic, somatic |
coryza/nasal congestion | ||
rash | + | somatic |
sexual (dysfunction, menstrual irregularities) | + | somatic, depressive, SUD, sexual |
blood dyscrasias | ||
autonomic (brady- vs. tachy-cardia, hypo- vs. hyper-tension, dyspnea/ respiratory depression vs. hyperventilation, diaphoresis, fever/hyperpyrexia) | + | panic, PTSD, somatic |
dependence (tolerance, withdrawal) | SUD | |
seizures | + | Somatic |
Cognitive | ||
sedation/drowsiness/fatigue | + | GAD, depressive, SUD, NCD |
inattention/poor concentration | + | GAD, depressive, SUD, NCD |
nightmares/intrusive thoughts | + | PTSD |
memory impairments/amnesia | + | PTSD, dissociative, SUD, NCD |
impaired judgment | SUD, NCD, psychotic, bipolar | |
perceptual (illusions, dissociation, de-realization, hallucinations) | + | PTSD, panic, psychotic, dissociative, SUD, NCD |
suicidal ideations | depressive, SUD, personality | |
homicidal ideations | SUD, personality | |
paranoia/hypervigilance | + | PTSD, SUD, psychotic |
delirium/stupor/coma | SUD, NCD | |
Emotional | ||
depression/dysphoria | + | PTSD, depressive, SUD |
numbness/emotional anesthesia | + | PTSD, depressive, SUD, dissociative |
anger/irritability/mood lability | + | PTSD, GAD, SUD, personality, bipolar |
anxiety/phobias/panic | + | anxiety, PTSD, SUD |
excitement/activation/euphoria | + | anxiety, SUD, bipolar |
mania | SUD, bipolar | |
Behavioral | ||
appetite/weight (anorexia, weight gain) | + | depressive, eating, SUD |
insomnia | + | PTSD, GAD, depressive, SUD |
avoidance/agoraphobia | + | anxiety, PTSD |
impulsivity/disinhibition | + | PTSD, SUD, personality, bipolar |
suicidality | + | PTSD, depressive, SUD, personality |
aggression/hostility/rage/violence | + | PTSD, SUD, personality, bipolar |
abuse/misuse/drug reinforcement | + | PTSD, SUD, personality |
Disorder with Onset During Intoxication | Disorder with Onset During Withdrawal | Persisting Disorder | |
---|---|---|---|
Psychotic Disorder | + | + | |
Bipolar Disorder | + | + | |
Depressive Disorder | + | + | |
Anxiety Disorder | + | ||
Sleep Disorder | + | + | |
Sexual Dysfunction | + | + | |
Delirium | + | + | |
Neurocognitive Disorder | + | + | + |
Benzodiazepine Use Disorder | Benzodiazepine Intoxication | Benzodiazepine Withdrawal |
---|---|---|
Duration of at least 2 signs/symptoms within a 12-month period | Onset during or shortly after use | Onset following cessation or reduction in prolonged use |
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© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Guina, J.; Merrill, B. Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. J. Clin. Med. 2018, 7, 17. https://doi.org/10.3390/jcm7020017
Guina J, Merrill B. Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. Journal of Clinical Medicine. 2018; 7(2):17. https://doi.org/10.3390/jcm7020017
Chicago/Turabian StyleGuina, Jeffrey, and Brian Merrill. 2018. "Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives" Journal of Clinical Medicine 7, no. 2: 17. https://doi.org/10.3390/jcm7020017