By Frangiska Mylona,
In the previous article, the general pharmacological topics about the drugs known as benzodiazepines were reviewed. To sum up, benzodiazepines are prescribed as anxiolytics, they can also exert hypnotic effects thus, they are prescribed for insomnia, as well as seizures, in status epilepticus, in panic disorders, and for alcohol withdrawal. On top of that, some of them can be used as anesthetics, and some sources state that they can be used as a premedication during dental procedures. Lastly, it is possible, under certain circumstances, the individual to develop dependence and tolerance symptoms while using them. One of the most popular benzodiazepines is Alprazolam (Xanax).
The mixing of benzodiazepines and alcohol could prove to be a fatal combination. In fact, when mingled, alcohol enhances the sedative and depressant effects of benzodiazepines towards the Central Nervous System (CNS). Consequently, when combined with alcohol, the level of consciousness is reduced, the mental state is impaired, muscle coordination inclines and subsequently, it may lead to ataxia, slurred speech, respiratory depression and, ultimately, death.
Luckily, there is an antidote against the CNS depression induced by benzodiazepines known as Flumazenil. However, its administration is not indicated in all cases, since it is possible to induce seizures in patients who are dependent or tolerant towards benzodiazepines, and therefore, it is important to use it with caution when physical dependence is suspected.
Mentioning some more drug-drug interactions, opioids, when combined with benzodiazepines, may increase the risk for respiratory depression, while benzodiazepines’s combination with other CNS depressants, like barbiturates, may lead to even further CNS depression. Also, hormonal contraceptives have the ability to either reduce the metabolism of some benzodiazepines, resulting in a higher chance of toxicity, or boost benzodiazepines’s metabolism, resulting in minimizing their effectiveness.
Regarding their administration during pregnancy, these drugs are generally not recommended, especially during the first trimester. Specifically, they are divided into two categories, Risk Category D, where there is positive evidence that they can cause harm to the fetus, but their benefits can justify their use, like Alprazolam (Xanax) or Diazepam, or Risk Category X, where these drugs are highly contraindicated, like Flurazepam. Additionally, they are not usually recommended during lactation. Other groups of patients for whom these medications are contraindicated include patients with lung diseases.
It is essential for the physician to follow some important parameters before, during and after administering benzodiazepines. For instance, when used as anxiolytics, the levels of the patient’s anxiety should be assessed before and after the drug’s administration in order to establish the drug’s efficacy. During their administration, the patient’s regimen should be revised in order to check if they are simultaneously prescribed with other drugs that can depress the patient’s respiratory system. Moreover, the patient should be informed not to get out of bed, when hospitalized while taking these medications, without the aid of a nurse. Also, when it is time for the drug’s cessation, the dose should be reduced gradually.
When it comes to their vital signs, signs of respiratory depression should be monitored and regular blood tests should be performed to examine their renal, liver and hematopoietic status; this is particularly important for both before and after the drug’s administration.
In conclusion, when prescribing these drugs, the physician must investigate all the parameters that could influence both positively and negatively. The physician is also obliged to inform the patient about each part and each crucial examination during the benzodiazepines administration. It is of vital importance for both of them to have a synergistic relationship so that this regimen to be proven to be as effective as possible.
References
- Lippincott Williams & Wilkins, Cherie R. Rebar PhD MBA RN CNE CNEcl, Nicole M. Heimgartner DNP RN CNE CNEcl COI, Carolyn J. Gersch PhD MSN RN CNE. Pharmacology Made Incredibly Easy (Incredibly Easy! Series®). LWW. Philadelphia. 2022.
- Catrin Page BSc MB ChB, Clive P. Page OBE PhD, Shreelata T Datta MD MRCOG LLM MBBS BSc, Philip Xiu MA. Crash Course Pharmacology. Elsevier. Amsterdam. 2019.
- Benzodiazepines. Pharmwiki. Available here
