Benzodiazepines
Benzodiazepines are a group of medications used to treat anxiety, agitation, and tension. They have sedating, anxiolytic, muscle-relaxing, and anticonvulsant effects.
Diazepam (Valium)
Section titled “Diazepam (Valium)”How Does Diazepam Work?
Section titled “How Does Diazepam Work?”Diazepam belongs to the group of sleeping and sedative medications and is also used to treat seizures. Diazepam enhances the effect of a neurotransmitter (gamma-aminobutyric acid, GABA) in the brain that dampens brain activity.
This gives the medication the following effects:
- Anxiolytic (anxiety-reducing)
- Sedating
- Anticonvulsant
- Muscle-relaxing
It can also be used for severe cramps such as epileptic seizures or febrile convulsions.
Indications
Section titled “Indications”- Anxiety, agitation, and tension states
- Sedation and anxiety relief before operations or examinations
- Conditions with increased muscle tension (e.g., severe cramps)
Warnings
Section titled “Warnings”Contraindications - When Is Diazepam Not Suitable?
Section titled “Contraindications - When Is Diazepam Not Suitable?”- Acute increase in intraocular pressure (glaucoma attack)
- Known hypersensitivity to benzodiazepines
- Nerve disease with movement disorders (ataxia)
- Pathological muscle weakness (myasthenia gravis)
- Medication, drug, and alcohol dependence
- Severe liver dysfunction
- Impaired respiratory function (use with caution)
Pregnancy and Breastfeeding
Section titled “Pregnancy and Breastfeeding”- During pregnancy, the medication should preferably not be used unless the doctor considers it absolutely necessary
- During breastfeeding, the medication must not be used
Side Effects
Section titled “Side Effects”Listed are the most important known side effects. They may occur but do not have to, as every person responds differently to medications.
- Headaches
- Gastrointestinal complaints
- Visual disturbances
- Confusion
- Hypersensitivity reactions
- Drowsiness
- Emotional numbness
- Restlessness, sleep disturbances, anxiety (especially in children and elderly persons)
- Reduced breathing
- Dizziness
Interactions
Section titled “Interactions”- The effect of other sedating and drowsiness-causing medications as well as alcohol is intensified
- Diazepam intensifies the effect of painkillers and muscle-relaxing medications
- The effect of blood pressure-lowering medications, beta-blockers, and anticoagulants can be affected in unpredictable ways
- The effect of diazepam is intensified by certain acid-suppressing medications (cimetidine)
Lorazepam (Ativan/Tavor)
Section titled “Lorazepam (Ativan/Tavor)”How Does Lorazepam Work?
Section titled “How Does Lorazepam Work?”Lorazepam acts, depending on the dose taken:
- Sedating
- Anxiolytic
- Muscle-relaxing
- Anticonvulsant
Dosage (Guidelines)
Section titled “Dosage (Guidelines)”The exact dosage is determined by the treating physician according to the individual clinical picture.
| Application | Dosage |
|---|---|
| Anxiety states and psychovegetative disorders | 1-3 mg per day in 2-3 divided doses (main dose in the evening) |
| Sleep disorders | 1 mg before bedtime |
| Epileptic seizure | 4 mg slowly intravenous (administered by a physician) |
Usage Instructions
Section titled “Usage Instructions”Lorazepam must only be tapered gradually, never stopped suddenly!
If stopped suddenly, withdrawal symptoms can occur:
- Weakness and dizziness
- Perceptual disturbances
- Anxiety and insomnia
- Restlessness, trembling, and cramps
Due to the sedating effect, prolonged drowsiness and reduced driving ability may also occur the day after taking the medication.
Contraindications
Section titled “Contraindications”Lorazepam must not be taken in cases of:
- Medication, drug, and alcohol dependence
- Known hypersensitivity to the active substance
- Muscle weakness (myasthenia gravis)
Use with caution in cases of:
- Addiction disorders
- Narrow-angle glaucoma
- Chronic bronchitis and asthma
Side Effects
Section titled “Side Effects”- Confusion
- Paradoxical reactions with agitation
- Muscle weakness and balance disorders
- Rarely: respiratory paralysis and slowed heartbeat
- With prolonged use: physical and psychological dependence
Interactions
Section titled “Interactions”- Lorazepam intensifies the effect of other sedating medications as well as alcohol
- When taken simultaneously with medications that inhibit a certain breakdown system in the liver (e.g., cimetidine, estrogens, isoniazid), the duration of lorazepam’s effect may be prolonged
Pregnancy and Breastfeeding
Section titled “Pregnancy and Breastfeeding”- Medications containing lorazepam should not be taken during pregnancy
- If taken before or during childbirth, effects on the newborn are possible (drowsiness, poor feeding)
- The active substance passes into breast milk — do not take during breastfeeding
Children and Adolescents
Section titled “Children and Adolescents”Medications containing lorazepam should only be given to children and adolescents under 18 after very strict benefit-risk assessment.
Medications Containing Lorazepam
Section titled “Medications Containing Lorazepam”All of these medications are prescription-only:
- Tavor 0.5 / 1.0 / 2.5 tablets
- Tavor Expidet (wafers to dissolve under the tongue)
- Lorazepam-ratiopharm 1mg / 2.5mg
- Lorazepam-neuraxpharm 1 / 2.5
- Various generics from different manufacturers
Benzodiazepines for Borderline Personality Disorder
Section titled “Benzodiazepines for Borderline Personality Disorder”When used at all, benzodiazepines for borderline are only prescribed:
- In acute crisis situations
- For very short periods
- Under close medical supervision
Alternatives to Benzodiazepines
Section titled “Alternatives to Benzodiazepines”For anxiety and tension states, there are alternatives with lower addiction potential:
- Antidepressants (SSRIs): Anxiolytic without addiction risk
- Buspirone: Anti-anxiety medication without addiction potential
- Low-dose antipsychotics: In certain situations
- Non-pharmacological approaches: Relaxation techniques, skills (DBT), psychotherapy