Module 2: Basic Pharmacology of Controlled Drugs and Substances

Lesson 1

Benzodiazepines – Precautions

Some benzodiazepines are eliminated slowly and accumulate in body tissues with regular or continuous use. Chronic abuse of benzodiazepines may result in impairment in thinking, memory and judgment, confusion, disorientation, and impaired motor coordination. Prolonged use may also lead to the paradoxical effect of increased (rather than reduced) aggressiveness in some people. Tolerance to the sedative, but not the anxiety relieving effects of benzodiazepines, can develop with regular use over a few months, as can psychological and physical dependence (Canadian Pharmacists Association, 2014).

Factors that influence the severity of dependence include:

• Duration of continuous treatment
• Half-life of the benzodiazepine
• Daily dose
• Personality characteristics of the patient (Edmunds & Mayhew, 2014)

Stopping use abruptly may result in symptoms of sleep disturbances, headache, tension, difficulty concentrating, trembling, anxiety, and feeling tired. During withdrawal from very high doses there is a risk of seizure, depression, paranoia, agitation, and delirium. Withdrawal symptoms may be greater for benzodiazepines that are eliminated rapidly from the body (Canadian Pharmacists Association, 2014).

The elderly, children, debilitated patients, and those with liver disease or low serum albumin are particularly sensitive to CNS effects (Canadian Pharmacists Association, 2014).

Some benzodiazepines are used in children for the same indications as adults. Moreover, the same precautions that apply to adults are also applicable to children. However, benzodiazepines can also cause paradoxical excitation in children. NPs and family physicians should consult with a specialty team-based program who treat children prior to prescribing a benzodiazepine to a child.