Benzodiazepines: Difference between revisions

>Keys
>Keys
I added general information, emphasizing how benzos alone are rarely deadly, if at all. Meanwhile once coingestants are involved, particularly GABAergics (due to GABAa activity) such as barbiturates and most commonly, alcohol, the risk for life-threatening respiratory depression can significantly increase. Furthermore, I replaced missing or (one) incorrect citation/s with reliable sources and added IEEE in-text citations, and the corresponding full references.
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==Subjective effects==
==Subjective effects==
{{Preamble/SubjectiveEffects}} These effects are listed and defined in detail within their own dedicated articles below:
{{Preamble/SubjectiveEffects}} These effects are listed and defined in detail within their own dedicated articles below:
{{effects/base
{{effects/base


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{{effects/paradoxical|
{{effects/paradoxical|


Paradoxical reactions to [[benzodiazepines]] such as increased seizures (in epileptics), aggression, increased anxiety, violent behavior, loss of impulse control, irritability and suicidal behavior can occur (although they are rare in the general population, with an incidence rate below 1%).<ref>{{cite journal | vauthors=((Saïas, T.)), ((Gallarda, T.)) | journal=L’Encephale | title=[Paradoxical aggressive reactions to benzodiazepine use: a review] | volume=34 | issue=4 | pages=330–336 | date= September 2008 | issn=0013-7006 | doi=10.1016/j.encep.2007.05.005}}</ref><ref>{{cite journal | vauthors=((Paton, C.)) | journal=Psychiatric Bulletin | title=Benzodiazepines and disinhibition: a review | volume=26 | issue=12 | pages=460–462 | date= December 2002 | url=https://www.cambridge.org/core/journals/psychiatric-bulletin/article/benzodiazepines-and-disinhibition-a-review/421AF197362B55EDF004700452BF3BC6 | issn=0955-6036 | doi=10.1192/pb.26.12.460}}</ref><p>
Paradoxical reactions to [[benzodiazepines]] such as increased seizures (in epileptics), aggression, increased anxiety, violent behavior, loss of impulse control, irritability and suicidal behavior sometimes occur (although they are rare in the general population, with an incidence rate below 1%).<ref>{{cite journal | vauthors=((Saïas, T.)), ((Gallarda, T.)) | journal=L’Encephale | title=[Paradoxical aggressive reactions to benzodiazepine use: a review] | volume=34 | issue=4 | pages=330–336 | date= September 2008 | issn=0013-7006 | doi=10.1016/j.encep.2007.05.005}}</ref><ref>{{cite journal | vauthors=((Paton, C.)) | journal=Psychiatric Bulletin | title=Benzodiazepines and disinhibition: a review | volume=26 | issue=12 | pages=460–462 | date= December 2002 | url=https://www.cambridge.org/core/journals/psychiatric-bulletin/article/benzodiazepines-and-disinhibition-a-review/421AF197362B55EDF004700452BF3BC6 | issn=0955-6036 | doi=10.1192/pb.26.12.460}}</ref><p>
These paradoxical effects occur with greater frequency in recreational abusers, individuals with mental disorders, children, and patients on high-dosage regimes.<ref>{{cite journal | vauthors=((Bond, A. J.)) | journal=CNS Drugs | title=Drug- Induced Behavioural Disinhibition | volume=9 | issue=1 | pages=41–57 | date=1 January 1998 | url=https://doi.org/10.2165/00023210-199809010-00005 | issn=1179-1934 | doi=10.2165/00023210-199809010-00005}}</ref><ref>{{cite journal | vauthors=((Drummer, O. H.)) | journal=Forensic Science Review | title=Benzodiazepines - Effects on Human Performance and Behavior | volume=14 | issue=1–2 | pages=1–14 | date= February 2002 | issn=1042-7201}}</ref></p>
These paradoxical effects occur with greater frequency in recreational abusers, individuals with mental disorders, children, and patients on high-dosage regimes.<ref>{{cite journal | vauthors=((Bond, A. J.)) | journal=CNS Drugs | title=Drug- Induced Behavioural Disinhibition | volume=9 | issue=1 | pages=41–57 | date=1 January 1998 | url=https://doi.org/10.2165/00023210-199809010-00005 | issn=1179-1934 | doi=10.2165/00023210-199809010-00005}}</ref><ref>{{cite journal | vauthors=((Drummer, O. H.)) | journal=Forensic Science Review | title=Benzodiazepines - Effects on Human Performance and Behavior | volume=14 | issue=1–2 | pages=1–14 | date= February 2002 | issn=1042-7201}}</ref></p>


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==Toxicity and harm potential==
==Toxicity and harm potential==
[[File:harmchart.png|thumb|right|300px|Radar plot showing relative physical harm, social harm, and dependence of benzodiazepines in comparison to other drugs.<ref>{{cite journal | vauthors=((Nutt, D.)), ((King, L. A.)), ((Saulsbury, W.)), ((Blakemore, C.)) | journal=The Lancet | title=Development of a rational scale to assess the harm of drugs of potential misuse | volume=369 | issue=9566 | pages=1047–1053 | date=24 March 2007 | url=https://www.sciencedirect.com/science/article/pii/S0140673607604644 | issn=0140-6736 | doi=10.1016/S0140-6736(07)60464-4}}</ref>]]
[[File:harmchart.png|thumb|right|300px|Radar plot showing relative physical harm, social harm, and dependence of benzodiazepines in comparison to other drugs.<ref>{{cite journal | vauthors=((Nutt, D.)), ((King, L. A.)), ((Saulsbury, W.)), ((Blakemore, C.)) | journal=The Lancet | title=Development of a rational scale to assess the harm of drugs of potential misuse | volume=369 | issue=9566 | pages=1047–1053 | date=24 March 2007 | url=https://www.sciencedirect.com/science/article/pii/S0140673607604644 | issn=0140-6736 | doi=10.1016/S0140-6736(07)60464-4}}</ref>]]
Benzodiazepines have a [[Toxicity::low toxicity]] relative to dose, and are considered to be effectively non-lethal on their own.<ref>{{cite journal | vauthors=((Mandrioli, R.)), ((Mercolini, L.)), ((Raggi, M. A.)) | journal=Current Drug Metabolism | title=Benzodiazepine metabolism: an analytical perspective | volume=9 | issue=8 | pages=827–844 | date= October 2008 | issn=1389-2002 | doi=10.2174/138920008786049258}}</ref> However, their potential [[Toxicity::potentially [[Respiratory depression|lethality]] increases significantly when taken together with other [[depressants]] such as [[opioids]] and particularly [[GABA#GABA%20receptors|GABAergic substances]] such as Alcohol]].
Benzodiazepines have a low toxicity relative to dose and are considered to be non-lethal when used alone.<ref>Kang, Michael, et al. “Benzodiazepine Toxicity.” ''StatPearls - NCBI Bookshelf'', Jan. 2024, www.ncbi.nlm.nih.gov/books/NBK482238. Accessed 9 May 2024.</ref> However, their potential [[Toxicity::potential [[Respiratory depression|lethality]] increases significantly when taken together with other central nervous system (CNS) [[Depressant|depressants]] such as [[opioids]] or, most commonly, [[alcohol]].<ref>Kang, Michael, et al. “Benzodiazepine Toxicity.” ''StatPearls - NCBI Bookshelf'', Jan. 2024, www.ncbi.nlm.nih.gov/books/NBK482238. Accessed 9 May 2024.</ref>
 
Particularly, [[GABA#GABA%20receptors|GABAergic substances]] such as [[alcohol]] or [[barbiturates]] can substantially increase the risk for life-threatening [[Respiratory depression|respiratory depression]] when combined with benzodiazepines.<ref>Roper, Laura, et al. “Benzodiazepine Toxicity.” ''Medscape'', 17 Jan. 2024, [https://emedicine.medscape.com/article/813255-overview?form=fpf emedicine.medscape.com/article/813255-overview?form=fpf]. Accessed 9 May 2024.</ref> This significant increase in [[Respiratory depression|lethality]] results due to enhanced [[GABA|GABA<sub>A</sub>]] receptor affinity, attributed to benzodiazepine-induced hyperpolarization of [[GABA|GABA<sub>A</sub>]] receptors.<ref>Kang, Michael, et al. “Benzodiazepine Toxicity.” ''StatPearls - NCBI Bookshelf'', Jan. 2024, www.ncbi.nlm.nih.gov/books/NBK482238. Accessed 9 May 2024.</ref>


It is strongly recommended that one use [[responsible drug use|harm reduction practices]] when using this class of substances.
It is strongly recommended to use [[Responsible drug use|harm reduction practices]] when using this class of substances.


===Tolerance and addiction potential===
===Tolerance and addiction potential===