Global Health
Benzodiazepines: how do they work?

Benzodiazepines are a category of medicines used to treat generalized anxiety disorder, anxiety disorder, insomnia, panic disorder, procedural/surgical sedation or amnesia, skeletal muscle spasm, tremor, and delirium (Comerford and Durkin, 2022). The exact actions of benzodiazepines are usually not fully understood, but they’ve been found to act selectively on polysynaptic neuronal pathways throughout the central nervous system (CNS). Let’s take a better have a look at the mechanism of motion of benzodiazepines.
Action mechanism
Benzodiazepines enhance or facilitate the motion of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter within the CNS that suppresses nerve activity. These drugs appear to act on the limbic, thalamic, and hypothalamic levels of the CNS, producing anxiolytic, sedative, hypnotic, skeletal muscle relaxant, and anticonvulsant effects (Comerford and Durkin, 2022).
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At the cellular level, the speed of impulses from the presynaptic neuron through the synapse is influenced by the variety of chloride ions within the postsynaptic neuron. The passage of chloride ions into the postsynaptic neuron depends upon the inhibitory neurotransmitter GABA. When GABA is released from the presynaptic neuron, it travels across the synapse and binds to GABA receptors on the postsynaptic neuron. This binding opens chloride channels, allowing chloride ions to flow into the postsynaptic neuron, which causes nerve impulses to decelerate. The result’s a distinct sort of depression. Benzodiazepines bind to receptors on or near the GABA receptor, enhancing the consequences of GABA and allowing more chloride ions to flow into the postsynaptic neuron. This weakens nerve impulses, causing them to decelerate or stop.
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Medicines and indications
Alprazolam | Xanax® | Anxiety, anxiety states |
Chlordiazepoxide | Librium® | Anxiety, alcohol withdrawal |
Clobazam | Onfi®, Sympazan® | Panic disorder |
Clonazepam | Klonopin® | Anxiety, anxiety, epileptic seizures |
Clorazepate | Tranxene® | Anxiety, seizure disorders |
Diazepam | Valium® | Anxiety, muscle relaxant, procedural anxiety/surgical sedation, seizure disorders |
Estazolam | Not applicable | Insomnia |
Flurazepam | Not applicable | Insomnia |
Lorazepam | Ativan® | Anxiety, procedural anxiety/surgical sedation, seizure disorders |
Midazolam | Oriented® | Procedural anxiety/surgical sedation, seizure disorder |
Oxazepam | Serax®® | Bow |
Quazepam | Doral® | Insomnia |
Remimazolam | Byfavo® | Composure |
Temazepam | Restoril® | Anxiety, insomnia |
Triazolam | Halcion® | Anxiety, insomnia |
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Contraindications (Facts and comparisons, 2021)
The use of benzodiazepines is contraindicated in patients with known hypersensitivity to any of the ingredients of the drug; severe hypersensitivity to dextran or products containing dextran; pregnancy; acute narrow angle glaucoma; untreated open angle glaucoma; significant liver disease; infants younger than 6 months; myasthenia gravis; concomitant administration with CYP3A inhibitors; sleep apnea; and severe respiratory problems.
Side effects and monitoring (Comerford and Durkin, 2022)
The principal unintended effects of benzodiazepines include drowsiness, impaired motor function, visual disturbances, and cardiovascular abnormalities. Toxic doses may cause short-term memory problems, confusion, severe depression, dizziness, slurred speech, bradycardia, respiratory depression, respiratory arrest, or severe weakness. Long-term or frequent use may result in the event of dependence and withdrawal symptoms when the dose is reduced or therapy is discontinued. The antidote to benzodiazepine overdose is intravenous flumazenil.
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Full details may be present in the leaflet that comes with the medication or within the Nursing2022 Medicines Manual + medicines updates.
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Facts and Comparisons (2022, July 7). Benzodiazepines. . https://fco.factsandcomparisons.com/lco/action/doc/retrieve/docid/fc_dfc/5545912
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U.S. Food and Drug Administration (2020, September 23). Information about benzodiazepine drugs.
https://www.fda.gov/drugs/information-drug-class/benzodiazepine-drug-information
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Comerford, K. C., and Durkin, M. T. (2022). (forty second ed.) Philadelphia: Wolters Kluwer.
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