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Benzodiazepines

Benzodiazepines are primarily prescribed to treat anxiety and insomnia in the short term. They are not suitable for long term use as they can be addictive. 

  1. Primarily treat anxiety.
  2. May also treat insomnia.
  3. Not suitable for long term use. 

If you are concerned about anxiety or insomnia symptoms and would like to speak to a registered clinician, our online video consultation service is available from 9.30am-4.30pm, Monday to Friday. 

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Product information

What are Benzodiazepines? 

Benzodiazepines are sedative treatments that are used to control anxiety related symptoms in the short term. They may also be used to help manage insomnia. They should not be taken continuously beyond a period of two to four weeks as there is a significant risk of addiction.

What is generalised anxiety disorder? 

Generalised anxiety disorder is a persistent sense of fear or worry that becomes excessive. It’s perfectly normal to feel anxiety in life, particularly when a daunting event is about to occur, such as an important exam or job interview, but to feel this discomfort continually can affect your life profoundly, as well as increase many physical health risks. 

What symptoms does generalised anxiety disorder cause?

Symptoms of generalised anxiety disorder may only present with a few mild signs in some cases, while other people may experience a number of severe symptoms. These can include a feeling of dread, restlessness, tetchiness and difficulties concentrating. Physical symptoms can also present, such as fatigue, dizziness, shaking, nausea, pins and needles, insomnia, palpitations, sweating, problems breathing, aches, pains and a dry mouth. These symptoms can also manifest as panic disorders, phobias, social anxiety and post-traumatic stress disorder (PTSD).

There may be many causes that lead to someone feeling persistently anxious, and some of the conditions listed above are the most common. In some cases, however, it’s unclear as to why symptoms occur. 

How is generalised anxiety disorder diagnosed?

Diagnosis for anxiety conditions requires talking with your GP, who will try to understand whether your symptoms are related to other conditions, such as depression, or if anxiety is occurring independently. They will ask you about your psychological and physical symptoms, as well as any issues in your personal life and general fears. Blood tests may also be carried out to see whether your symptoms are related to a lack of vitamins (such as iron) or other conditions, such as hyperthyroidism. If your symptoms continue for six months or more it is likely you will be diagnosed with generalised anxiety disorder.

How is generalised anxiety disorder treated? 

Because generalised anxiety disorder is a long-term condition, treatment is prolonged and requires a degree of patience. Talking therapies and medication can be highly effective in terms of managing symptoms and helping you gain control of your life when your anxiety becomes overwhelming. Lifestyle changes can also be of benefit. 

Cognitive behavioural therapy (CBT) is typically the most effective psychological treatment, and involves changing your thought patterns and the way you deal with situations. This can help prevent catastrophising and increase your understanding of the types of thoughts that lead to anxiety. There is also a therapy called applied relaxation, which entails focusing on your muscles, and learning how to relax them in situations in which your anxiety is triggered. 

What medication is available for treating generalised anxiety disorder?

There are numerous forms of medication for managing anxiety, from antidepressants to benzodiazepines. Antidepressants need to be taken for at least six months in order to be effective, while benzodiazepines (sedatives) are for short term use only: no longer than three to four weeks at a time. Antidepressants come in many forms, and include older types, such as monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) as well as more recent treatments, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). If these options are not suitable for you, an anticonvulsant, usually prescribed to treat epilepsy called pregabalin, may be suggested as it is less likely to affect sex drive and cause nausea.

If you would like to discuss benzodiazepines or any related conditions with a GMC-registered clinician, our online video consultation service is available from 9.30am-4.30pm, five days a week. Our clinicians can also issue referrals to specialists for treatment and fit notes, where suitable. 

Page last reviewed:  01/07/2020
Side effects and warnings

What side effects can benzodiazepines cause?

All medications can cause side effects, and as such, you should read the patient information leaflet that comes with your treatment, or ask your prescribing clinician for advice before starting treatment to understand the risks involved.

The most common benzodiazepine is Diazepam, also known as Valium. The following information relates to this medication and may not be relevant for your particular treatment.  

You should stop taking diazepam immediately and seek medical attention if you notice any of the following:

Uncommon (may affect up to 1 to 100 people): respiratory depression.

Rare (may affect up to 1 in 1,000 people): respiratory arrest and unconsciousness.

Very rare (may affect up to 1 in 10,000 people): swelling of the lips, tongue, throat or body, rash, fainting or difficulties swallowing. 

Other side effects include:

Very common (may affect more than 1 in 10 people): drowsiness

Common (may affect up to 1 in 10 people): fatigue, withdrawal symptoms, confusion and loss of coordination.

Uncommon (may affect up to 1 in 100 people): muscle weakness, memory loss, difficulty concentrating, loss of balance disorders, dizziness, headaches, slurred speech, nausea, vomiting, constipation, diarrhoea, increased salivation and itchy skin. 

Rare (may affect up to 1 in 1,000 people): excitation, agitation, restlessness, irritability, aggressiveness, memory loss, inappropriate behaviour, delusion, rages, psychoses, nightmares or hallucinations, loss of alertness, depression, emotional withdrawal, insomnia, slow heartbeat, heart failure, cardiac arrest, low blood pressure, fainting, increased mucus in the lungs, dry mouth, increased appetite, changes in certain liver enzymes, inability to urinate, loss of bladder control, breast enlargement in men, impotence, changes in sexual drive and blood disorders. 

Very rare (may affect up to 1 in 10,000 people): low white blood cell levels and higher levels of specific enzymes in the blood.

The following side effects have been reported but their frequency has not yet been established: blurred vision, double vision and involuntary eye movements. 

Is it safe to use benzodiazepines alongside other medications?

Different types of benzodiazepines have their own specific suitability and risks regarding other medications. You should therefore inform your prescribing clinician of any treatments you are currently taking before starting a course of treatments with benzodiazepines, so they can ensure that the treatment being offered is safe. 

The following medications relate to diazepam and may not be relevant to the medication you are being offered. It’s particularly important to inform your doctor if you are taking any of the following: sodium oxybate, antidepressants, antipsychotics, antihistamines, general anaesthetics, sedatives, hypnotics, erythromycin, muscle relaxants, opioids, barbiturates, hypertension medications, diuretics, nitrates and antacids. 

Diazepam may not be suitable to use alongside the following medications, as they may affect your psychological status, cause extreme sleepiness and lower blood pressure: disulfiram, epilepsy medications, phenobarbital, phenytoin, carbamazepine, sodium valproate, theophylline, cimetidine, omeprazole, esomeprazole, rifampicin, St John’s wort, amrenavir, atazanavir, ritonavir, delavirdine, efavirenz, indinavir, nelfinavir, zidovudine or saquinavir, fluconazole, itraconazole, ketoconazole, voriconazole, isoniazid, oral contraceptives, cisapride, corticosteroids, levodopa, valproic acid, ketamine, lofexidine, nabilone, alpha blockers, beta blockers and moxonidine.

Warnings and precautions when using benzodiazepines

If you are currently experiencing any health conditions, or are prone to any health conditions, you should inform your prescribing clinician before the start of treatment with these medications.

In the case of Diazepam, you may need to avoid use if any of the following apply to you: allergies to any benzodiazepine medication, breathing problems, depression, hyperactivity, other mental illnesses, myasthenia gravis, sleep apnoea or severe liver disorders and porphyria. 

The following conditions may also make use of Diazepam unsuitable: a history of alcoholism or drug abuse, heart problems, issues with your lungs, severe kidney failure, grieving, low levels of albumin, personality disorder, poor blood supply to the brain, elderly, breathing difficulties, smoking, suicidal thoughts, epilepsy or a history of seizures.

What types of benzodiazepines are available?

There are several types of benzodiazepines, each with their own advantages and disadvantages, as well as risks of side effects and addiction. These include: 

Diazepam (Valium), alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), estazolam, flurazepam (Dalmane), oxazepam, temazepam (Restoril) and triazolam.

Is it safe to take benzodiazepines if you are pregnant?

It’s important that you inform your doctor if you are pregnant, thinking of becoming pregnant, suspect you may be pregnant or are breastfeeding before you start taking benzodiazepines, as they can harm your baby.

Page last reviewed:  01/07/2020
Questions and Answers

Can benzodiazepines affect my ability to drive? 

Because benzodiazepines are sedatives, they can impact on driving, and result in you becoming sleepy and drowsy, and lead to poor coordination. It’s therefore essential that you fully understand how this medication affects you before operating any form of heavy machinery. If you are unsure, you should speak to your clinician, and read the patient information leaflet that comes with your treatment. 

Can benzodiazepines trigger allergic reactions?  

If you have any allergies, you should ask your doctor for advice before starting treatment. This may depend on the medication itself or the form it comes in. For example, diazepam tablets contain lactose, which many people may be intolerant of. You can also check the ingredients of your medication on the patient information leaflet that comes with your treatment. 

Can I buy benzodiazepines over the counter? 

Benzodiazepines are not available to buy over the counter in the UK. It’s also likely that your use of this medication will need to be monitored by your doctor, as there is a significant risk of addiction when taken over the medium to long-term. 

How can I buy benzodiazepines online?

Our GPhC-registered clinicians can discuss benzodiazepines with you and any related conditions via our online video consultation service. You can book an appointment with them between 9.30am-4.30pm, Monday to Friday. Our clinicians are also able to provide referral to specialists for treatment and fit notes, where appropriate.  

Page last reviewed:  01/07/2020

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