Benzodiazepines
PREGNANCY CATEGORY D OR X
CONTROLLED SUBSTANCE C-IV
Therapeutic Actions
Benzodiazepines are anxiolytics, antiepileptics, muscle relaxants, and sedative-hypnotics. Their exact mechanisms of action are not understood, but it is known that benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter.
Indications
Management of anxiety disorders, short-term relief of symptoms of anxiety
Short-term treatment of insomnia
Alone or as adjunct in treatment of Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures
May be useful in patients with absence (petit mal) seizures who have not responded to succinimides; up to 30% of patients show loss of effectiveness of drug within 3 mo of therapy (may respond to dosage adjustment)
Unlabeled use: Treatment of panic attacks, treatment of IBS, acute alcohol withdrawal syndrome, chemotherapy-induced nausea and vomiting, psychogenic catatonic depression, PMS
Contraindications and Cautions
Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, pregnancy (risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery (“floppy infant” syndrome reported), or lactation (infants become lethargic and lose weight).
Use cautiously with impaired hepatic or renal function, debilitation.
Adverse Effects
CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, hostility, episodes of mania and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment
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