What to Know About Anxiolytics

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Anxiolytics are a type of medication primarily used to treat anxiety. They’re commonly referred to as anti-anxiety drugs. Benzodiazepines, colloquially known as benzos, are the most common type of anti-anxiety medication. They are usually prescribed in pill form.

Because they carry a high risk of addiction compared to other anxiety treatments, doctors usually prescribe other treatments first. Other drugs used to treat anxiety include antidepressants, beta-blockers, buspirone, and some anticonvulsants. 

Bottle of pills with pills spilling out

Cappi Thompson / Getty Images

What Are the Different Benzodiazepines?

Types of benzodiazepines used to treat anxiety include:

Doctors commonly prescribe anti-anxiety drugs in pill form. Some less widely used variations include:

  • Injections
  • Nasal sprays
  • Rectal gel

Uses 

Benzodiazepines are primarily used to treat generalized anxiety disorder, social anxiety disorder, and panic disorder.

They aren’t prescribed as long-term preventative drugs, as they can help with short-term anxiety symptoms. They have sedative effects because they work to slow brain activity.

The Food and Drug Administration (FDA) also approves benzodiazepines for the treatment of insomnia and seizures.

Doctors sometimes prescribe benzodiazepines for non-approved uses like:

Some benzodiazepines, like lorazepam, have specific off-label uses, like treatment for chemotherapy-related nausea and vomiting.

Recently, the FDA announced that they would update warnings on benzodiazepine drugs to include a boxed warning. It’s a prominent warning that will clearly outline the risks of addiction and abuse, along with severe withdrawal reactions of these drugs.

Before Taking 

Before prescribing anxiolytics for you, your doctor will evaluate your condition. They'll also review your medical history to determine if the benefits of the medication would outweigh the potential health risks.

You should let your doctor know about any medications you’re taking because these drugs may interact with other medications. Don't forget to tell them if you're using any over-the-counter (OTC) medications, herbs, or supplements.

Precautions and Contraindications

It’s important to follow your doctor’s instructions when taking benzodiazepines.

  • If you are pregnant or breastfeeding, you should not take benzodiazepines.
  • A doctor is unlikely to prescribe these drugs to people with a history of addiction.

People who take these drugs over a long period may need to take larger doses to reach the same effects. In this case, suddenly stopping the medication can cause withdrawal symptoms.

Dosage 

Your doctor will work with you to find an appropriate dosage. Doctors will typically start you off on a low dose and may slowly increase the dosage to reach a dose that reduces symptoms. 

Here’s an overview of recommended adult dosages for commonly prescribed benzodiazepines:

  • Xanax, tablet ER, tablet ODT: 0.25-1 milligrams (mg), maximum of 4 mg per day
  • Klonopin, tablet ODT: 0.5-1 mg, maximum of 20 mg per day
  • Valium, tablet: 5-25 mg, maximum of 40 mg per day
  • Ativan, tablet: 0.5-1 mg, up to 4 times per day

Note that these doses are according to the manufacturers' recommendations. The prescription from your doctor will have specific dosage information that applies to you. If you’re not sure that you’re taking the correct amount, talk to your doctor or pharmacist. 

Modifications

Not all benzodiazepines have the same dosage recommendations. Your doctor may need to prescribe a lower dose if you have a health condition that affects the drug's metabolism (breakdown and action on the body). Older adults often need to take a lower dosage because they don’t metabolize the drugs as quickly. 

Tell your doctor if you have kidney disease. If you have a liver condition, your doctor may need to adjust your dosage, depending on the specific drug you’re taking.

How to Take and Store

These medications should be stored somewhere that isn’t too humid, and that’s out of the sun.  Storage of these types of drugs may vary depending on the specific brand.

Keep them away from children and pets.

Don’t increase your dosage before talking to your doctor.

An overdose can cause symptoms that require emergency attention, including:

  • Difficulty breathing
  • Seizure
  • Non-responsive

If you think you’ve taken more than the recommended dose, call Poison Control (1-800-222-122).

Side Effects 

Benzodiazepines can have side effects, even when taken at the recommended dose. 

Common 

Common side effects of anti-anxiety medications include:

  • Drowsiness
  • Weakness
  • Nausea
  • Headache 
  • Fatigue
  • Nightmares 

Severe 

These side effects may warrant a visit to your doctor, especially if they are severe or not going away:

  • Excessive fatigue
  • Dizziness
  • Difficulty with balance and coordination
  • Memory problems
  • Aches and pains in muscles or joints
  • Frequent bathroom visits
  • Blurry vision
  • Excess saliva production
  • Low libido

Get emergency help if you’re experiencing:

  • Signs of an allergic reaction including hives, swelling, and difficulty breathing
  • Changes in your voice
  • Seizures
  • Jaundice
  • Trouble talking
  • Suicidal ideation

Warnings and Interactions 

If you’re taking opioids for another condition, you should avoid taking anti-anxiety drugs. The combination can cause fatal effects.

You should also avoid mixing benzodiazepines with alcohol. Talk to your doctor if you are using marijuana (cannabis).

Do not drive, use machinery, or do anything that requires alertness until you can do it safely. These drugs can also cause serious central nervous system depression that may lead to death.

You’re more likely to become dependent on these drugs if you take them consistently over a period of days or weeks. Even if you’re taking them as directed, you should talk to your doctor before stopping them cold-turkey to avoid serious withdrawal symptoms.

Symptoms of withdrawal include:

  • Catatonia
  • Tremors
  • Irregular heartbeat
  • Sweating
  • Seizures
  • Hallucinations and psychosis
  • Depression
  • Suicidal ideation
  • Mania
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Article Sources
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  1. National Institute of Mental Health. Mental health medications

  2. Medline Plus. Lorazepam. September 23, 2020. 

  3. Food and Drug Administration. FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class. September 23, 2020.

  4. Locke A B, et al. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American Family Physician. 2015; 91(9): 617-624.  

  5. Johns Hopkins Medicine. Benzodiazepines