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Benzodiazepines and Z-drugsThis factsheet is for people who would like more information about taking benzodiazepines and Z drugs. Benzodiazepines and Z-drugs are a group of medicines that are sometimes known as tranquillizers or sleeping tablets. They work on the brain to help bring on sleep. The best-known benzodiazepine is probably diazepam (brand name Valium). Z-drugs have a different chemical structure to benzodiazepines, but work in a similar way to help bring on sleep.
Why would I take them?Benzodiazepines are useful for treating a number of conditions, including muscle spasms and convulsions in epilepsy (fits). They can also be used to reduce a person's anxiety before they have surgery under a general anaesthetic or for "conscious sedation" during minor surgery, dental operations or hospital tests (such as a colonoscopy) that would otherwise be uncomfortable or unpleasant. After conscious sedation, people often remember little or nothing about the procedure they have just had. Because of the risk of dependency, benzodiazepines are not suitable as routine "sleeping tablets", nor are they an effective treatment for depression. What are the main types?Benzodiazepines can be put into two main groups:
How do benzodiazepines and Z-drugs work?Benzodiazepines and Z-drugs work by slowing down brain activity. They do this by increasing the action of a neurotransmitter chemical called gamma-aminobutyric acid (GABA). The normal action of GABA is to tell certain parts of the brain to "go slow". Increasing this "go slow" signal helps to promote sleep and reduce anxiety. Z-drugs do not have an anti-anxiety effect and also tend to stay in the body for a shorter amount of time than benzodiazepines. How to take benzodiazepines and Z drugsBenzodiazepines and Z-drugs are only available on prescription. Many brands of these drugs are not available on the NHS, and can only be prescribed by your doctor in their generic form, which is the chemical name of the drug (ie you can be prescribed diazepam but not Valium). For more information about generic and brand names of medicines with the same active ingredients, please see the separate BUPA health factsheet, Explaining medicines. Benzodiazepines come as tablets or capsules and some also come as solutions, rectal preparations and injections. It is important to take a benzodiazepine only in the doses your doctor has prescribed for you and to stop taking it as instructed. You shouldn't take more than the recommended dose: an overdose of benzodiazepines or Z-drugs can be fatal. Always read the patient information leaflet that comes with your medicine. Side-effectsBenzodiazepines can cause a range of side-effects, including:
Z-drugs cause fewer side-effects, but they can cause:
Less commonly, they can cause confusion, difficulty concentrating, dizziness and changes to your senses of taste or smell the next day. Because of the side-effects that benzodiazepines and Z-drugs can cause, they can impair your ability to drive or operate machinery, even the day after the last dose was taken. DependenceThe main problem with benzodiazepines is that a course taken for more than a few weeks can cause physical and psychological dependence. This means that you may need to take more of the drug for it to have the same effect (this known as tolerance). WithdrawalYou may also find it difficult to stop taking the drug. This is known as the "benzodiazepine withdrawal syndrome". This can occur in people who stop taking the drug after a period of as little as two to four weeks. Symptoms include confusion, insomnia, anxiety, loss of appetite and weight, shaking, sweating and ringing in the ears. If you have been taking a benzodiazepine for some time and you think you might be dependent on it, you shouldn't stop taking it suddenly. This can cause unpleasant, and possibly dangerous, physical symptoms, including fits. With your doctor's help and advice, you will need to stop taking the drug gradually, reducing the dose over a period of weeks. Long and short-acting medicinesSome benzodiazepines that are used to help with sleep are "short acting" (eg temazepam). When used to treat insomnia these are less likely to cause a hangover effect the next day than the long-acting benzodiazepines (eg nitrazepam). However, the short-acting benzodiazepines are more likely to lead to dependence and withdrawal syndrome. The long-acting anxiolytics, such as diazepam, can be given at night to treat insomnia and anxiety in people with both of these problems, because their effects last into the next day. Z-drugs are generally short-acting medicines and so have little or no hangover effect. For a full list of symptoms of these medicines, please read the patient information leaflet that comes with your medicine, and ask your doctor for advice. Interactions with other medicinesCheck with your doctor or pharmacist before you take any other medicines or herbal remedies at the same time as a benzodiazepine or Z-drug. Be aware that all drugs that have a tranquillizing or sedative effect on the brain, including alcohol, will increase the effects of benzodiazepines and Z-drugs. Names of common benzodiazepines and Z-drugsExamples of the main types of benzodiazepines and Z-drugs are shown in the table. The generic name is the chemical name of a medicine. If a manufacturer has rights over a medicinal compound, it is given a brand name. Often there is more than one brand name associated with a generic name. Generic names are normally written with a lower-case initial letter and brand names normally start with an upper-case letter.
Further information
Sources
Published by BUPA's health information team, healthinfo@bupa.com, March 2007.
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