Benzodiazepines: What You Should Know

If you've been prescribed a benzodiazepine, such as Xanax, Ativan, Klonopin, or Valium, it's usually because you needed relief quickly. These medications work well for what they're designed to do. But they also come with real risks that grow the longer they're used, and understanding those risks upfront is one of the best ways to use them safely.

What Benzodiazepines Are Used For

Benzodiazepines can provide fast relief of severe anxiety, panic, or short-term sleep problems. Because of this, they're generally intended for short-term or occasional use. Sometimes they're prescribed temporarily while other treatments, such as antidepressants or therapy, have time to start working.

Take Them Exactly as Prescribed

Do not increase your dose or take the medication more often than prescribed. Over time, your body can develop tolerance, meaning the medication may become less effective at the same dose.

Regular or long-term use can cause physical dependence, even when the medication is taken exactly as prescribed. Dependence does not necessarily mean addiction, but it can make stopping the medication difficult, which is why the FDA requires a boxed warning, its strongest safety warning, on every benzodiazepine.

Possible Side Effects

Benzodiazepines are sedating by design, which means side effects are common and worth watching for:

• Drowsiness or fatigue
• Dizziness
• Problems with concentration or memory
• Slower reaction time
• Poor coordination or balance

These effects can increase the risk of falls, accidents, and injuries. Do not drive or operate machinery if you feel sleepy, dizzy, impaired, or less alert.

Mixing With Alcohol or Other Medications

Avoid alcohol while taking benzodiazepines. The combination can cause excessive sedation and dangerous breathing problems. Tell your healthcare provider about any opioids, sleep medications, antihistamines, or other medications you take that cause drowsiness.

Taking benzodiazepines with opioids or other central nervous system depressants can increase the risk of overdose and death. This risk is significant enough that the FDA requires its strongest boxed warning on both opioid and benzodiazepine labels specifically because of this combination.

They Treat Symptoms, Not the Underlying Cause

Benzodiazepines may provide symptom relief, but they do not treat the underlying cause of anxiety or chronic insomnia. For long-term anxiety or sleep problems, your treatment plan may include therapy, behavioral strategies, sleep interventions, or other medications better suited for ongoing use.

Never Stop Suddenly

Never stop a benzodiazepine suddenly if you have been taking it regularly. Stopping suddenly can cause withdrawal symptoms, including increased anxiety, insomnia, tremors, sweating, agitation, and, in severe cases, seizures or confusion.

If you and your healthcare provider decide to stop the medication, it should generally be tapered gradually and individualized to your needs. This is one of the most well-documented aspects of benzodiazepine treatment in clinical research, and it's not something to manage on your own.

Safe Storage and Use

Keep benzodiazepines securely stored and never share them with another person. Take the medication only as prescribed and only for the reason it was prescribed.

The Bottom Line

Benzodiazepines can be helpful when used appropriately, but longer use can increase risks. The goal is usually the lowest effective dose for the shortest appropriate period while addressing the underlying condition.

References

U.S. Food and Drug Administration. (2020, September 23). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. fda.gov

U.S. Food and Drug Administration. (2016, September). FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. fda.gov

Soyka, M. (2017). Treatment of benzodiazepine dependence. New England Journal of Medicine, 376 , 1147–1157. https://doi.org/10.1056/NEJMra1611832

Ready to Take the Next Step?

If you have questions about a benzodiazepine you've been prescribed, or you're looking for a treatment plan for anxiety or sleep that doesn't rely on short-term medication alone, our team, including psychiatric nurse practitioner Yolanda Stanley, is here to help.

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