Last updated: March 30, 2020
Benzodiazepines are a category of depressants used to induce sedation or sleep, relieve anxiety and muscle spasms, and to prevent seizures. Benzodiazepines generally act as hypnotics in higher doses, anxiolytics in moderate doses, and sedatives in lower doses. Of the prescription drugs used in the United States that affect central nervous system function; benzodiazepines are one of the most commonly prescribed medications. Benzodiazepines are controlled in Schedule IV of the Controlled Substances Act (CSA).
Benzodiazepines are classified by the Controlled Substances Act as depressants. Repeated use of high doses or; in some cases, daily use of benzodiazepines is associated with amnesia, hostility, irritability, and vivid or disturbing dreams, as well as tolerance and physical dependence. The withdrawal syndromes are similar to that of alcohol addiction and may require hospitalization. Abrupt cessation of benzodiazepines is not recommended and tapering-down the dose eliminates many of the unpleasant symptoms.
Despite the fact that millions of prescriptions are written for benzodiazepines every year, relatively few people increase dosage on their own or participate in drug-seeking behavior. The few individuals who do abuse benzodiazepines usually maintain their drug supply by requesting prescriptions from several different doctors, forging prescriptions, or buying their drugs from others. Abuse is often associated with adolescents and young adults who take benzodiazepines primarily to get “high,” and is particularly common among heroin and cocaine abusers. The use of alcohol or any other depressant along with benzodiazepines can be life threatening.
Short-acting benzodiazepines are usually prescribed for patients with sleep-onset insomnia (trouble falling asleep) without daytime anxiety. Shorter-acting benzodiazepines used to control insomnia include estazolam (ProSom®), flurazepam (Dalmane®), temazepam (Restoril®), and triazolam (Halcion®). Midazolam (Versed®), another short-acting benzodiazepine, is prescribed for sedation, anxiety, and amnesia in critical care settings and prior to anesthesia. It is available in the United States as an injectable solution or as an orally administered syrup (primarily for pediatric patients).
Benzodiazepines with a longer duration are prescribed to treat insomnia in patients with daytime anxiety. These benzodiazepines include alprazolam (Xanax®), chlordiazepoxide (librium®), clorazepate (Tranxene®), diazepam (Valium®, halazepam (Paxipam®), lorzepam (Ativan®), oxazepam (Serax®), prazepam (Centrax®), and quazepam (Doral®). Clonazepam (Klonopin®), diazepam, and clorazepate are also prescribed as anticonvulsants.