Overview of the Problems - The Alliance for Benzodiazepine Best Practices

The Problems of Benzodiazepines and Z-Drugs

Medical decision-making about the use of any medication requires balancing the potential efficacy with potential harm and to do this in relation to the potential risks and benefits of alternative medication and non-medication approaches. Each benzodiazepine and non-benzodiazepine (Z-drug) has its own set of adverse reactions and contraindications, which are described on each drug’s label and the medication guide written for patients that accompanies each prescription. Determination of the use of a medication should be shared by the clinician and the patient who has expertise about themselves and often about benzodiazepines. Prescribers are encouraged (but not required) to tell the patient about adverse reactions, this is called informed consent. Yet most patients receive little or no information about the problems with chronic use of benzodiazepines or Z-drugs. Per the World Health Organization,

“Key concerns about the use of benzodiazepines are that many people develop tolerance to their effects, gain little therapeutic benefit from chronic consumption, become dependent on them and suffer a withdrawal syndrome when they stop taking them (50% of all users suffer withdrawal syndromes).”^[1]

Drugs in these two classes share a common set of problems. These problems can be divided into the following categories:

Benzodiazepines and non-benzodiazepines frequently lose efficacy over time.
Both classes of drugs often lead to physiological dependence and its associated withdrawal syndrome.
Benzodiazepines are ineffective for many common off-label applications.
Both classes of drugs can induce new or increase current neural symptoms.
Both classes of drugs can cause a wide range of side effects, including death.
Both classes of drugs have adverse reactions related to interactions with other drugs.
Both classes of drugs can make the use of life-saving antibiotics (fluoroquinolones) a very painful experience.