Benzodiazepines

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What are benzodiazepines?

Minor tranquillisers and sleeping pills

Properties: Relieve anxiety Sedative Anti-convulsant Muscle relaxant

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List of benzodiazepinesHalf life (hrs)

Generic name Brand names

10-14 Alprazolam Xanax, Kalma

22-54 Clonazepam Rivotril, Paxam

20-48 Diazepam Valium, Antenax, Ducene

25-30 Flunitrazepam Rohypnol, Hypnodorm

15-38 Nitrazepam Mogadon, Alodorm

6-10 Oxazepam Serepax, Murelax, Alepam

5-10 Temazepam Normison, Temaze, Euhypnos, Temtabs, Nocturne

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Indications for valid prescribing of benzodiazepines Anxiety disorders Sleep Muscle Relaxant Medical procedures Alcohol withdrawal

They are not validly prescribed for: o Grief, anger, depression, drug withdrawal.

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RACGP Guidelines Should be prescribed for the shortest

possible time, lowest possible dose Ideally no more than 7 days Maximum 2-4 weeks “limited to patients whose symptoms are

disabling or who are subjected to unacceptable distress”

Only when other treatments have failed

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Benzodiazepine Dependency Estimated 50-80% of people using

benzodiazepines continuously to 6-12 months will become dependent.

Those who become dependent will experience withdrawal, although severity will vary.

For long term users, withdrawal symptoms may be present while on the regular dose (“Breakthrough withdrawal”)

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Benzodiazepine binding sites Most commonly found in areas of the brain

controlling our consciousness, coordination, emotions, memory, muscle tone and thinking.

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Benzodiazepines are prescribed for; Most often women Older people Migrant population

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Benzodiazepine withdrawal Wide range of distressing symptoms

Anxiety and insomnia are common withdrawal symptoms –often the presenting problem

Can be protracted – weeks or months

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Benzodiazepine Withdrawal Onset: 2-3 days for short-acting

5-7 days for long-acting Symptoms typically last 2-4 weeks, up to a

few months Symptoms can be more intense at the

beginning and end of reduction Symptoms typically fluctuate Symptoms vary from mild to severe

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Common withdrawal symptoms Anxiety & panic attacks Insomnia Heightened sensitivity of the senses Muscle twitching and spasm Pins and needles Nausea Dizziness Depression Loss of memory Loss of appetite Hallucinations

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Specific Risks for Polydrug Users Greatly increased risk of overdose Increased risk taking behaviour – sharing

needles, sexual promiscuity, unsafe sex Disinhibition – more aggressive, socially

inappropriate, increased risk of sexual assault

Increased offending (with memory loss) Specific harms from IV use of benzos

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Overdose statistics (Victorian Institute of

Forensic Medicine 2005)

In all deaths involving heroin 2001-2005, benzodiazepines were found in 60% of cases (Cf 31% alcohol, 20% heroin alone)

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IV use of benzodiazepines Many of the benzodiazepines are an irritant,

essentially burning the vein lining. Veins narrow and block, reducing blood flow May cause severe infection of skin and bone. Particles in the tablets/capsules do not break

down small enough to inject If the vein is missed, tissue surrounding the

injection site may become infected, causing swelling, infection, abscesses or ulcers.

Can cause blood clots in the lungs

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Older people and medication Older people

37% sleeping tablets

15% antidepressants

Adult population

4% sleeping tablets

5% antidepressants

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Effects of benzodiazepines for older people Over sedation Falls and hip fractures Impaired blood pressure regulation Cognitive impairment & memory loss Nocturnal urinary incontinence Emotional changes- worsening depression Worsening sleep Respiratory problems