Unwanted effects

Benzodiazepines, even in overdose, are not toxic. Apart from drowsiness, they may have a few unwanted effects in the young, healthy person, but the elderly may experience marked side-effects of which the neurological and psychiatric ones are most important. These include confusion, depression, drowsiness, amnesia, impaired psychomotor performance including an effect on driving, ataxia, dysarthria, and headache. Some subjects experience 'paradoxical' effects of excitement, aggression, or insomnia. Benzodiazepines potentiate the effects of alcohol and other cerebral depressants.

Use in pregnancy should be avoided. In late pregnancy, benzodiazepines can cause the 'floppy infant syndrome' of hypotonia, respiratory embarrassment, and hypothermia, and the baby may develop withdrawal symptoms after delivery. Benzodiazepines readily enter breast milk.

Tolerance and dependence may develop with regular use. Psychological dependence is common. Physical dependence develops in around 20 per cent of those who take benzodiazepines long-term. Suddenly stopping the drugs in such patients causes a withdrawal syndrome of insomnia, tremor, fits, anorexia, vomiting, sweating, and cramps.

This syndrome, which is most often seen after the withdrawal of a short-acting drug such as alprazolam, lorazepam, or temazepam, may be mistaken for recurrence of the original anxiety for which the drug was prescribed. Withdrawal symptoms can be avoided by tapering the drug gradually, while introducing psychological anxiety management techniques. Some authorities recommend converting the benzodiazepine-dependent patient to the equivalent dose of diazepam, which can then be reduced by 1 mg per week over a period of 1-12 months.

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