Benzodiazepines: Difference between revisions

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==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>Development of a rational scale to assess the harm of drugs of potential misuse (ScienceDirect) | http://www.sciencedirect.com/science/article/pii/S0140673607604644</ref>]]

Benzodiazepines have a [[Toxicity::low toxicity]] relative to dose.<ref>Benzodiazepine metabolism: an analytical perspective (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/18855614</ref> However, ~~they are~~ [[Toxicity::potentially [[respiratory depression|~~lethal~~]] when mixed with [[depressants]] like [[alcohol]] or [[opioids]]]].

Benzodiazepines have a [[Toxicity::low toxicity]] relative to dose, and are considered to be effectively non-lethal on their own.<ref>Benzodiazepine metabolism: an analytical perspective (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/18855614</ref> However, their potential [[Toxicity::potentially [[respiratory depression|lethality]] increases significantly when mixed with [[depressants]] like [[alcohol]] or [[opioids]]]].

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

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

===Tolerance and addiction potential===

Benzodiazepines are [[Addiction potential::extremely physically and psychologically addictive]].

Benzodiazepines are known to be [[Addiction potential::extremely physically and psychologically addictive]].{{citation needed}}

Tolerance will develop to the sedative-hypnotic effects [[Time to full tolerance::within a couple of days of continuous use]].<ref>Principles and Practice of Psychopharmacotherapy | http://books.google.com/books?id=_ePK9wwcQUMC&pg=PA535</ref> After cessation, the tolerance returns to baseline in [[Time to zero tolerance::7-14 days]]. Withdrawal symptoms or rebound symptoms may occur after ceasing one's usage abruptly following a few weeks or longer of steady dosing, and may necessitate a gradual dose reduction.<ref>Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature | http://onlinelibrary.wiley.com/doi/10.1111/j.1527-3458.2004.tb00003.x/pdf</ref><ref>The American Psychiatric Publishing Textbook of Substance Abuse Treatment | http://books.google.com/books?id=6wdJgejlQzYC&pg=PA222&hl=en#v=onepage&q&f=false</ref>

===~~=Discontinuation=~~===

===Overdose===

Benzodiazepine discontinuation is notoriously difficult; it is potentially life-threatening for individuals using regularly to discontinue use without tapering their dose over a period of weeks. There is an increased risk of [[high blood pressure]], [[seizures]], and death.<ref>A fatal case of benzodiazepine withdrawal. (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/19465812</ref> Drugs which lower the seizure threshold such as [[tramadol]] should be avoided during withdrawal. Abrupt discontinuation also causes rebound stimulation which presents as [[anxiety]], [[wakefulness|insomnia]] and restlessness.

It is safest to reduce the dose each day by a very small amount, for a couple of weeks until close to abstinence. If using a short half-life benzodiazepine, a longer acting variety such as [[diazepam]] can be substituted. Symptoms may still be present, but their severity will be reduced significantly. For more information on tapering from benzodiazepines in a controlled manner, please see [http://www.benzo.org.uk/manual/bzcha02.htm this guide]. Small amounts of [[alcohol]] can also help to reduce the symptoms.

===Discontinuation===

The duration and severity of withdrawal symptoms depends on a number of factors including the half-life of the drug used, tolerance and the duration of abuse. Major symptoms will usually start within just a few days after discontinuation and persist for around a week for shorter lasting benzodiazepines. Benzodiazepines with longer half-lives will exhibit withdrawal symptoms with a slow onset and extended duration.

===Dangerous interactions===

==Preparation methods==

@@ Line 275: / Line 275: @@
 ==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>Development of a rational scale to assess the harm of drugs of potential misuse (ScienceDirect) | http://www.sciencedirect.com/science/article/pii/S0140673607604644</ref>]]
-Benzodiazepines have a [[Toxicity::low toxicity]] relative to dose.<ref>Benzodiazepine metabolism: an analytical perspective (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/18855614</ref>  However, they are [[Toxicity::potentially [[respiratory depression|lethal]] when mixed with [[depressants]] like [[alcohol]] or [[opioids]]]].
+Benzodiazepines have a [[Toxicity::low toxicity]] relative to dose, and are considered to be effectively non-lethal on their own.<ref>Benzodiazepine metabolism: an analytical perspective (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/18855614</ref>  However, their potential [[Toxicity::potentially [[respiratory depression|lethality]] increases significantly when mixed with [[depressants]] like [[alcohol]] or [[opioids]]]].
-It is strongly recommended that one use [[responsible drug use|harm reduction practices]] when using this class of compounds.
+It is strongly recommended that one use [[responsible drug use|harm reduction practices]] when using this class of substances.
 ===Tolerance and addiction potential===
-Benzodiazepines are [[Addiction potential::extremely physically and psychologically addictive]].
+Benzodiazepines are known to be [[Addiction potential::extremely physically and psychologically addictive]].{{citation needed}}
 Tolerance will develop to the sedative-hypnotic effects [[Time to full tolerance::within a couple of days of continuous use]].<ref>Principles and Practice of Psychopharmacotherapy | http://books.google.com/books?id=_ePK9wwcQUMC&pg=PA535</ref> After cessation, the tolerance returns to baseline in [[Time to zero tolerance::7-14 days]]. Withdrawal symptoms or rebound symptoms may occur after ceasing one's usage abruptly following a few weeks or longer of steady dosing, and may necessitate a gradual dose reduction.<ref>Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature | http://onlinelibrary.wiley.com/doi/10.1111/j.1527-3458.2004.tb00003.x/pdf</ref><ref>The American Psychiatric Publishing Textbook of Substance Abuse Treatment | http://books.google.com/books?id=6wdJgejlQzYC&pg=PA222&hl=en#v=onepage&q&f=false</ref>
-====Discontinuation====
+===Overdose===
-Benzodiazepine discontinuation is notoriously difficult; it is potentially life-threatening for individuals using regularly to discontinue use without tapering their dose over a period of weeks. There is an increased risk of [[high blood pressure]], [[seizures]], and death.<ref>A fatal case of benzodiazepine withdrawal. (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/19465812</ref> Drugs which lower the seizure threshold such as [[tramadol]] should be avoided during withdrawal. Abrupt discontinuation also causes rebound stimulation which presents as [[anxiety]], [[wakefulness|insomnia]] and restlessness.
+{{BenzoOD}}
-It is safest to reduce the dose each day by a very small amount, for a couple of weeks until close to abstinence. If using a short half-life benzodiazepine, a longer acting variety such as [[diazepam]] can be substituted. Symptoms may still be present, but their severity will be reduced significantly. For more information on tapering from benzodiazepines in a controlled manner, please see [http://www.benzo.org.uk/manual/bzcha02.htm this guide]. Small amounts of [[alcohol]] can also help to reduce the symptoms.
+===Discontinuation===
+{{BenzoDiscontinuation}}
-The duration and severity of withdrawal symptoms depends on a number of factors including the half-life of the drug used, tolerance and the duration of abuse. Major symptoms will usually start within just a few days after discontinuation and persist for around a week for shorter lasting benzodiazepines. Benzodiazepines with longer half-lives will exhibit withdrawal symptoms with a slow onset and extended duration.
+===Dangerous interactions===
+{{DangerousInteractions/Depressants}}
 ==Preparation methods==