5. Key points
- Benzodiazepines are highly effective short-term treatment (no longer than 2–4 weeks) for anxiety and insomnia; their sedative effect is of value in alcohol withdrawal and they have useful muscle relaxant and antiepileptic properties.
- Single doses of a benzodiazepine are of value in arresting a convulsion or for the sedative and amnesic properties in surgery and painful or distressing clinical procedures.
- Benzodiazepine adverse effects arise mainly from CNS depression and important ones include persisting drowsiness (‘hangover’), muscle weakness, and ataxia.
- The effects of benzodiazepine as well as the underlying disease can have marked affect the ability to drive, to operate machinery, or to undertake other tasks requiring alertness and fine coordination.
- The elderly and the frail are especially susceptible to adverse effects of benzodiazepines and to drug accumulation.
- Concurrent use of alcohol or sedative medicines with a benzodiazepine can significantly increase the risk for serious adverse effects.
- Tolerance develops to most effects of benzodiazepines.
- With continuous use beyond a few weeks individuals develop physical and mental dependence; the dose and duration of benzodiazepine use are important determinants for dependence.
- Long-term use of a benzodiazepine may be associated with more serious and intractable adverse effects including emotional blunting, reduced mental acuity, and memory impairment—quality of life can be significantly affected.
- Benzodiazepine withdrawal is associated with severe effects—the withdrawal process should be personalised for each individual and should recruit the support of a team of health professionals as well as family and carers.