In-Depth BZD Information for Prescribers
This information will help medical providers to address problems related to benzodiazepines and Z- drugs (collectively benzodiazepine receptor agonists, or BZRAs) in a stepwise process. This includes modifications to taking a history, performing an exam and relevant studies, making an assessment (differential diagnosis), and establishing a plan.
BZRA-Specific Considerations
Benzodiazepines have been FDA-approved for very few specific uses. However, they are often used to treat many different symptoms and indications. Unfortunately, the use of these drugs off-label poses the danger of worsening the treated symptom and can lead to a painful withdrawal.
BZs and Z-drugs present risk-benefit trade-offs that are not well known.
The common guidelines for the existing sources are extracted and analyzed.
The BZRAs are FDA-approved for very few uses. BZRAs are used to treat many different symptoms and indications. Unfortunately, they don’t work for most off-label uses. And they can make a given problem much worse.
Aside from the danger of being used with other respiratory depressants, the biggest risk posed by BZRAs is the neurological changes that may result in dependence requiring a difficult withdrawal. These changes can be debilitating and long-term.
The BZRA-dependent patient often has suffered baffling neural damage. This poses communications challenges for the prescriber.
Neuropharmacology
Specific Benzodiazepine Receptors
Specific Benzodiazepine Receptors
Pharmacokinetics
BZRA Efficacy
Benzodiazepines have been FDA-approved for very few specific uses. However, they are often used to treat many different symptoms and indications. Unfortunately, the use of these drugs off-label poses the danger of worsening the treated symptom and can lead to a painful withdrawal.
It has been shown that benzodiazepines work quite well in the short-term for several common uses, including in the treatment of anxiety and insomnia. However, when a benzodiazepine is used long-term, not only does it lose its efficacy, but there is a significant risk of physiological dependence as well as the development of side effects.
Longer-Term Study Compares Alprazolam vs CBT
Which do you think has better outcomes?
Other Anxiety and Panic Disorder Studies
Several studies of BZs and other treatments are analyzed.
The Efficacy of Off-Label Uses
16 common off-label uses of benzos are analyzed for efficacy.
BZRA Problems
Like all medications, BZRAs have well-known side effects. In addition, long-term studies show that benzodiazepines lose their efficacy over time and that dependence is high in long-term users.
This is a quick summary of the types of problems commonly encountered with the use of BZRAs.
While most BZRA studies have been short-term, the longer-term studies show that BZRAs lose their effectivity over time.
Physiological Dependence and Addiction
Dependence is common in long-term users, with various studies showing from 20% to 100% of subjects becoming dependent.
Benzodiazepine Withdrawal Syndrome (BZWS)
Dependent patients often suffer a protracted withdrawal syndrome.
Over 100 symptoms are associated with Benzodiazepine Withdrawal Syndrome. These are listed and categorized as psychological, neurophysiologic, or somatic withdrawal symptoms.
Benzodiazepine-Induced or Increased Symptoms
Longer-term use of BZRAs has been shown to induce new symptoms or increase the symptoms that were originally presented.
Side Effects of Benzos and Z-Drugs
It is hard for the prescriber to keep track of the side effects of medications. With over 120 documented for BZs and almost 200 for Z-drugs, this is a particularly daunting task for BZRAs. Lists are presented.
Drug-Drug Interactions with Benzos and Z-Drugs
Drug-drug interactions often amplify the effects and side effects of the medications involved and may introduce new and unexpected reactions. A few of the major interactions of concern are outlined.
This class of antibiotics can cause severe problems in both current and former BZRA users.