Benzodiazepine Sedative Hypnotic Sleeping Pill.

Benzodiazepines are the oldest and the most commonly prescribed sleeping pills and the most likely to cause dependence. Diazepam (eg, Valium and Calmpose) is a benzodiazepine and these drugs help to induce sleep and cause less awakening at night.

How They Act|Mode of Action.

Gama-aminobutyric acid (GABA) is a brain chemical – an amino  acid - that blocks the transmission of signals between the brain cells, thereby decreasing the excitability of the neurons and calming nervous activity.  Benzodiazepines enhance the effect of GABA which results in a sedative and hypnotic effect.

Uses of Benzodiazepines.

Benzodiazepines are usually used to treat

• Insomnia

• Anxiety
• Agitation
• As an anti psychotic
• Muscle spasm
• Seizures
• Alcohol withdrawal treatment|Alcohol detoxification.
• Where sedation is required in minor surgical or dental procedures.

List of Benzodiazepines.

Examples of benzodiazepines include diazepam (Valium), estazolam (ProSom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion)..

How to Use Benzodiazepines.

Benzodiazepines are relatively fast acting and begin to act within a few hours, sometimes even less. Initially low doses are started to begin with and the dosage is gradually increased till symptoms disappear. Dose of this drug varies from case to case. Depending on the merits of each case, benzodiazepines are given two or three times a day or sometimes only one dose may be administered at night.

Benzodiazepines are to be taken about 30 minutes before going to sleep and in cases where stomach upset occurs, this pill is to be taken after food or with milk.

If you have been taking this drug over some time, it should not be stopped abruptly but its dose should be gradually tapered off. This is because abrupt withdrawal can lead to withdrawal syndrome symptoms.

Secondly its dose or period of prescription should not be increased as it can cause tolerance and increasing doses may be required which is not advisable. Nowadays non-benzodiazepines are more used because of the drawbacks of using benzodiazepines

Availability of benzodiazepines.

Benzodiazepines are available as tablets or pills (sleeping pills) and as intramuscular and intravenous injections. They are available in drug stores on prescription only.

Side Effects and Drawbacks of using Benzodiazepines.

• Benzodiazepine Withdrawal Syndrome. Physical and psychological dependence develops and sudden stopping of these pills gives rise to withdrawal symptoms such as anxiety and rebound insomnia. These pills have to withdrawn in tapering doses.
• When regularly taken, these sleeping pills lose their effectiveness within about 4 weeks and a subsequent larger dose may be required. This is because the brain receptors lose their sensitivity and become resistant to this drug.
• The quality of sleep is hampered with promotion of light sleep and loss of deep sleep and the REM sleep.
• During the next day, you experience grogginess and drowsiness with hindered mental alertness which can be more than that of loss of sleep.
• There is impaired memory loss of coordination and reduced reaction time when you use these pills.
• Use of these sleeping pills can cause a hangover.
• These drugs can worsen sleep apnea if present.
• Benzodiazepines do not cure insomnia and only help you to fall asleep and once stopped, you are again faced with sleeplessness.
• Overdose can cause dangerous deep unconsciousness.

Contraindications or Precautions when using Benzodiazepines.

Benzodiazepines are not to be taken if you are associated with the following conditions or having history of the following diseases.

• During pregnancy and lactation – abnormalities have been seen in babies when pregnant mothers have resorted to Benzodiazepines.
• Liver and/or kidney diseases.
• Bronchitis, Asthma and Chronic Obstructive Pulmonary Disease (COPD) –because of their muscle relaxant effect.
• Myasthenia gravis (for the same reason)
• Apnea,
• Epilepsy,
• Glaucoma
• Depression (can cause suicidal tendencies)
• Allergy to the drug.

Drug Interactions with Benzodiazepines.

Inform your doctor if you are taking any other medicines as benzodiazepines are to be avoided with certain medicines – OTC drugs or by prescription.

• Antidepressants.
• Antiepileptic drugs.
• With other drugs which cause sedation such as opioids and barbiturates.
• Narcotic medications for pain such as codeine.
• Anesthetics.
• Antihistamines.
• Muscle relaxants.
• Prescription analgesics (pain killers)

Benzodiazepines can cause severe nervous system depression when combined with the above medications.

• Oral contraceptives increase the blood levels of Benzodiazepines and thereby the risk of potential side effects.
• Cimitidene (used to treat ulcers) too similarly increases risk of side effects.
• Some antibiotics and antifungal agents because they decrease the rate of excretion of benzodiazepines which can cause the drug to accumulate in the body.
• These drugs should not be taken by the elderly as there is increased risk of dependence, memory impairment and loss of motor coordination.

Benzodiazepines and Alcohol.

You should abstain from alcohol when taking benzodiazepines as these two interact and can cause life threatening complications. Benzodiazepines cause severe nervous system depression when combined with alcohol as alcohol intensifies the depressive action of benzodiazepines.

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