Side effects of benzodiazepines

Benzodiazepines (alprazolam) COCs may inhibit oxidative metabolism Increase side effects of benzodiazepines... 

Side effects of benzodiazepines include sedation, dizziness, poor coordination, and, at higher doses, amnesia. Benzodiazepines also increase the effects of alcohol therefore, alcohol use should be avoided or markedly curtailed. Benzodiazepines can also exacerbate the breathing problems of patients with sleep apnea and other respiratory disorders such as emphysema. Like the barbiturates, long-term use of benzodiazepines can lead to physical dependence, and abrupt discontinuation can produce an unpleasant, or even dangerous, withdrawal syndrome. 

Side effects of benzodiazepines include drowsiness and reduced respiratory function. In patients who are severely medically ill, especially those with lung disease, this side effect can be problematic. However, benzodiazepines are much safer in this regard than their predecessors, the barbiturates, and untreated delirium tremens, the most severe form of alcohol withdrawal, can be fatal. 

Saizman C. Behavioral side effects of benzodiazepines. In Kane JM, Lieberman JA, eds. Adverse effects of psychotropic drugs. New York Guilford Press, 1992 139-152. 

The most common side-effects of benzodiazepines in routine clinical use are drowsiness, muscle weakness, lightheadedness, dizziness, ataxia, dysarthria, blurring of vision, confusion and apathy. Because of pharmacokinetic changes... 

Tolerance, dependence and abuse arc associated with the benzodiazepines, but the problems produced arc far milder than those connected with other depressant drugs. Over the years, however, a number of other problems associated with benzodiazepine use have emerged. As with other depressants, the significant side effects of benzodiazepines are drowsiness and motor impairment. Although even these side effects arc rare with benzodiazepines alone (sec Cappcll et al., 1986, for a review), they may become particularly problematic when benzodiazepines are taken, as they often arc, in combination with alcohol or other depressant drugs (sec Contemproary Issue Box 13.6). 

The most important side effects of benzodiazepines include the following ... 

Other relatively common side effects of benzodiazepines are weakness, headache, blurred vision, vertigo, nausea and vomiting, epigastric distress, and diarrhea joint pains, chest pains, and incontinence are much more rare. 

Side effects associated with benzodiazepines in PD patients are similar to those observed in other disorders. Sedation, fatigue, and cognitive impairment are the most commonly reported side effects.49 Benzodiazepines should be avoided in patients with current substance abuse, a history of such, dependence, or sleep apnea. Additionally, caution should be used in older adults because they have more pronounced psychomotor and cognitive effects. 

Buspirone does not share any of the problematic benzodiazepine properties such as sedation, motor impairment, addiction, physical dependence, or withdrawal. The most common side effects of buspirone include dizziness, nausea, headache, fatigue, and dry mouth. Despite its activity in the serotonin system, buspirone is not associated with the sexual side effects that plague the SSRIs, SNRIs, MAOIs, and TCAs. 

Buspirone (Buspar). Buspirone is a nonbenzodiazepine anxiety-reducing medication. It can be an effective treatment for demented patients with chronic anxiety. Buspirone is not sedating like the benzodiazepines and in fact probably has the fewest side effects of any available psychiatric medication. Buspirone does have a delayed onset of action therefore, it is not useful for acute treatment of anxiety or agitation. 

Buspirone is an extremely specific drug that could possibly represent a new chemical class of anxiolytics—azaspirones. As an anxiolytic, its activity is equal to that of benzodiazepines however, it is devoid of anticonvulsant and muscle relaxant properties, which are characteristic of benzodiazepines. It does not cause dependence or addiction. The mechanism of its action is not conclusively known. It does not act on the GABA receptors, which occurs in benzodiazepine use however, it has a high affinity for seratonin (5-HT) receptors and a moderate affinity for dopamine (D2) receptors. Buspirone is effective as an anxiolytic. A few side effects of buspirone include dizziness, drowsiness, headaches, nervousness, fatigue, and weakness. This drug is intended for treatment of conditions of anxiety in which stress, muscle pain, rapid heart rate, dizziness, fear, etc. are observed in other words, conditions of anxiety not associated with somewhat common, usual, and everyday stress. Synonyms for buspirone are anizal, axoren, buspar, buspimen, buspinol, narol, travin, and others. 

Drowsiness occurs readily and unfortunately is usually a problem at therapeutic doses. The other hmiting side effect of the benzodiazepines is the rapid development of tolerance to their anticonvulsant effects. 

The distinction among the anxiety disorders brought social phobia to the limelight. It has been documented [see Miner et ah. Chapter 25, in this volume] that benzodiazepines are also highly effective as treatment for this disorder. However, because of dependency and other undesirable side effects of the benzodiazepines, MAOls [especially selective reversible MAOls], P-blockers, and especially SRIs have been introduced as treatment modalities with quite promising efficacy. 

Most sedative drugs, including narcotics and alcohol, potentiate the sedative effects of benzodiazepines. In addition, medications that inhibit hepatic cytochrome P450 (CYP) 3A3/4 increase blood levels and hence side effects of clonazepam, alprazolam, midazolam, and triazolam. Lorazepam, oxazepam, and temazepam are not dependent on hepatic enzymes for metabolism. Therefore, they are not affected by hepatic disease or the inhibition of hepatic enzymes. 

In general, side effects of zolpidem and zaleplon are similar to those of short-acting benzodiazepines. These agents should not be considered free of abuse potential. 

The generally excellent tolerability of these preparations has contributed greatly to the widespread use of anxiolytics. The commonest side effects (Table 1.11) are tiredness and muscle relaxation and these usually can be avoided or attenuated by reducing the dose. Ataxia and paradoxical reactions such as irritability and increased agitation occasionally arise in the elderly but are rare in younger patients. Much attention has been focused on the negative effects of benzodiazepines on memory and other cognitive functions (see Chapter 7). 

As mentioned in Chapter 2, another side effect of these newer types of antidepressants is that they can cause people to show signs of REM behavior disorder, which is characterized by periodic moments of acting out dreams. Rather than having the person stop taking the antidepressant altogether to avoid this, many times a doctor will prescribe a benzodiazepine such as clonazepam (Klonopin) that helps to suppress the REM behavior disorder symptoms. 

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