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Benzodiazepines and Z-drugs

Published by Bupa's health information team, April 2009.

This factsheet is for people who are taking benzodiazepines and Z-drugs, or who would like information about them.

Benzodiazepines and Z-drugs are a group of medicines that are also known as tranquillisers or sleeping tablets. They work on the brain to help with getting to sleep. Benzodiazepines also reduce anxiety. The best-known benzodiazepine is diazepam (eg Valium).

Why should I take benzodiazepines and Z-drugs?
What are the main types of benzodiazepines and Z-drugs?
How do benzodiazepines and Z-drugs work?
How to take benzodiazepines and Z-drugs
Special care
Side-effects of benzodiazepines and Z-drugs
Dependence
Withdrawal
Interactions of benzodiazepines and Z-drugs with other medicines
Names of common benzodiazepines and Z-drugs
Further information
Questions and answers
Related topics
Sources

Why should I take benzodiazepines and Z-drugs?

Your GP may prescribe benzodiazepines or Z-drugs if you have severe short-term difficulties with sleeping (insomnia). Benzodiazepines may also be used for the short-term treatment of severe anxiety. You shouldn't use benzodiazepines or Z-drugs for long-term treatment because there are problems with long-term use of these medicines (see Dependence and Withdrawal). They aren't an effective treatment for depression.

Benzodiazepines can also be used to reduce anxiety before surgery under a general anaesthetic or for sedation during minor surgery, dental operations or hospital tests (such as a colonoscopy) that might otherwise be uncomfortable or unpleasant. After sedation, you're likely to remember little or nothing about the procedure. Benzodiazepines are occasionally used to treat muscle spasms in back pain and convulsions (fits) in epilepsy.

What are the main types of benzodiazepines and Z-drugs?

There are two main groups of benzodiazepines:

anxiolytics, which are mainly used for treating anxiety
hypnotics, which are mainly used for treating insomnia or as sedatives

Z-drugs have a different chemical structure to benzodiazepines, but work in a similar way to help you get to sleep. Z-drugs are only used for treating insomnia or as sedatives.

Some benzodiazepines that treat insomnia (eg loprazolam, lorazepam, loretazepam and temazepam) are short-acting, which means they are less likely to cause a hangover effect the next day than the long-acting benzodiazepines (eg diazepam and nitrazepam). However, the short-acting benzodiazepines are more likely to lead to dependence and withdrawal problems than long-acting benzodiazepines (see Dependence and Withdrawal).

The long-acting anxiolytics (eg diazepam) can be given at night to treat insomnia and anxiety in people who have both of these problems because their effects last into the next day.

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 your brain to "go slow". Increasing this "go slow" signal helps to promote sleep and reduce anxiety. Z-drugs don't have an anti-anxiety effect and tend to stay in your body for a shorter length of time than benzodiazepines.

How to take benzodiazepines and Z-drugs

You can only get benzodiazepines and Z-drugs on prescription from your GP.

Benzodiazepines come as tablets or capsules and some also come as solutions, rectal preparations (rectal tubes or suppositories) and injections. You should only take benzodiazepines and Z-drugs in the doses prescribed for you and stop taking them if you're told to by your GP.

You shouldn't take more than the recommended dose - an overdose of benzodiazepines or Z drugs can be fatal.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Special care

Older people shouldn't take hypnotic benzodiazepines as these medicines can cause confusion and loss of coordination, resulting in falls and injuries.

Side-effects of benzodiazepines and Z-drugs

Benzodiazepines can cause a range of side-effects, including:

confusion
stumbling
memory loss
drowsiness
light-headedness
a hangover effect (feeling the effects of the medicine the next day)
aggression

Z-drugs lead to fewer side-effects than benzodiazepines, but can cause:

drowsiness
feeling sick
memory loss

Less commonly, Z-drugs can cause confusion, difficulty concentrating, dizziness and changes to your senses of smell, hearing, speech and vision.

Benzodiazepines and Z-drugs can temporarily affect your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. Short-acting Z-drugs and benzodiazepines are less likely than long-acting benzodiazepines to cause sedation the following day, but you may still feel some effects.

If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations and always follow your GP's advice.

Dependence

The main problem with benzodiazepines is that if you take them for more than a few weeks, they can cause physical and psychological dependence. This means you may find it difficult to stop taking them. In addition, you may need to take more of your medicine for it to have the same effect (this is known as tolerance).

Withdrawal

If you take benzodiazepines for more than a few weeks, you may have unpleasant symptoms when you stop taking them. This is known as benzodiazepine withdrawal syndrome. 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 GP's help and advice, you will need to stop taking the benzodiazepine gradually, reducing the dose over a period of weeks.

Interactions of benzodiazepines and Z-drugs with other medicines

Check with your GP or pharmacist before you take any other medicines or herbal remedies at the same time as a benzodiazepine or Z-drug.

You should be aware that all substances that have a tranquillising or sedative effect on the brain, including alcohol, will increase the effects of benzodiazepines and Z-drugs.

Names of common benzodiazepines and Z-drugs

Examples of the main types of benzodiazepines and Z-drugs are shown in the table.

You may have noticed that your medicine has two or more names. All medicines have a generic name, which is its official medical name. Many medicines also have at least one brand name, which is the trade name. Generic names are written in lower case and brand names start with a capital letter.

Generic names	Examples of common brand names
*Benzodiazepines mainly for anxiety (anxiolytics)*
alprazolam	Xanax*
chlordiazepoxide	Librium, Tropium
diazepam	Valium, Dialar
lorazepam	Ativan
oxazepam
*Benzodiazepines mainly used as sleeping tablets or sedatives (hypnotics)*
flurazepam	Dalmane*
loprazolam
lormetazepam
nitrazepam	Mogadon, Remnos
temazepam
*Z-drugs*
zaleplon	Sonata
zolpidem	Stillnoct
zopiclone	Zimovane

* These branded medications aren't available on the NHS - only the generic version can be prescribed.

Names of common benzodiazepines and Z-drugs

Further information

electronic Medicines Compendium
www.emc.medicines.org.uk
Royal College of Psychiatrists
020 7235 2351
www.rcpsych.ac.uk