Benzodiazepines

Benzodiazepines indications

first line in status epilepticus and alcohol withdrawal

sedation in palliative care for interventions

short-term treatment of severe, disabling or distressing anxiety or insomnia

Benzodiazepines MOA

target GABA receptor change the shape of the receptor to facilitate and enhance binding of GABA to the GABAA receptor (allosteric modulation). This has a widespread depressant effect on synaptic transmission.

Benzodiazepines important adverse effects

cause dose-dependent drowsiness, sedation, and coma

in overdose can lead to airway obstruction and death

in dependence, abrupt withdrawal similar to alcohol

Benzodiazepines warning and interactions

dose reduction in old people

avoided in significant respiratory impairment or neuromuscular diseases or liver failure

for alcohol withdrawal lorazepam may be preferred as less dependent on liver elimination

have additive sedative effects and dependent on cyp450 so avoid concurrent use of cyp450 inhibitors

Benzodiazepines diazepam, midazolam, lorazepam, chlordiazepoxide practical prescribing prescription and admin

For seizures, a long-acting drug is preferred, usually lorazepam (initial dose 4 mg IV) or diazepam (10 mg IV). Oromucosal midazolam is an alternative

alcohol withdrawal, oral chlordiazepoxide (long-acting) but diazepam and lorazepam acceptable; dosage regimens depend on symptom severity and alcohol intake.

procedural sedation, midazolam is preferred, because its short duration

insomnia and anxiety, an intermediate-acting drug at the lowest effective dose (e.g. temazepam 10 mg orally) is used for the shortest possible period (usual maximum 2 weeks).

IV administration used in specialist areas

Benzodiazepines diazepam, midazolam, lorazepam, chlordiazepoxide practical prescribing monitoring and extra

they should not drive or operate complex or heavy machinery after taking the drug, noting that sometimes sleepiness may persist to the next day.

avoid dependence

Close monitoring of clinical status and vital signs is essential following IV or high-dose oral administration of a benzodiazepine, including the settings of seizures, alcohol withdrawal, and sedation.

In insomnia and anxiety, enquiry about symptoms and side effects is the best form of monitoring.

should not exceed 4 weeks of treatment dosage reduction at 2 weeks if longer allow gradual tapering