Hepatotoxicity benzodiazepines

There appears to be little difference between benzodiazepines and kava extract in anxiolytic activity. However, kava extracts seem to have fewer side effects. Two studies with more than 3000 patients each found unwanted events in about 2% of patients during treatment with kava extract. The more frequently reported side effects were gastrointestinal complaints, allergic skin reactions, headache, and photosensitivity (Pittler and Ernst, 2000). There have been isolated reports of hepatotoxicity and acute liver failure (Escher et ah, 2001). Kava may potentiate the sedative effects of other medications including barbiturates and benzodiazepines. Kava can also cause behavioral disinhibition in a minority of individuals, including children. The most common problem, which is usually associated with persistent and excessive usage, is a scaly skin rash called kava dermopathy, which is reversible. 

Andrade RJ, Lucena MI, Aguilar J, Lazo MD, Camargo R, Moreno P, Garcia-Escano MD, Marquez A, Alcantara R, Alcain G. Chronic liver injury related to use of bentazepam an unusual instance of benzodiazepine hepatotoxicity. Dig Dis Sci 2000 45(7) 1400-4. 

Alpidem, like zolpidem, is an imidazopyridine, chemically distinct from the benzodiazepines. It binds selectively to a subset of benzodiazepine receptors (1), which may account for its apparently milder withdrawal effects and a relative dominance of anxiolytic over sedative and cognitive effects (2). Its effects are reversed by flumazenil (3). Alpidem was withdrawn in 1953 in France, the only country in which it was marketed, because of hepatotoxicity (4). 

A variety of allergic, hepatotoxic, and hematologic reactions to the benzodiazepines may occur, but the incidence is quite low these reactions have been associated with the use of flurazepam and triazolam but not with temazepam. Large doses taken just before or during labor may cause hypothermia, hypotonia, and mild respiratory depression in the neonate. Abuse by the pregnant mother can result in a withdrawal syndrome in the newborn. 

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