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. People typically take them 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 tablet form. Some less widely used variations include:

  • Injections
  • Nasal sprays
  • Rectal gel

Most of these forms are intended for very short-term use.

Uses 

Benzodiazepines are primarily used to treat generalized anxiety disorder, social anxiety disorder, and panic disorder. People take these drugs as-needed. They aren’t a long-term preventative but 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 like benzodiazepines, a doctor will evaluate your condition. They'll also review your medical history to decide if the benefits outweigh the potential health risks.

A doctor is unlikely to prescribe these drugs to people with a history of addiction. Because of the potential side effects and high risk of abuse, doctors typically suggest or prescribe other anxiety treatments before prescribing this class of medications.

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) meds, supplements, or non-prescription substances like alcohol.

Precautions and Contraindications

If you are pregnant or breastfeeding you should not take benzodiazepines. People with a history of substance abuse should not take benzodiazepines. They carry with them a risk of addiction.

It’s important to follow your doctor’s instructions when taking benzodiazepines. Benzodiazepines are not meant for continuous use. You should use them as needed to help with severe anxiety symptoms.

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 slowly increase the dosage to find one that effectively 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. 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 lower the dose if you have a specific condition or fall into a particular age group. Older adults often need to take a lower dosage because they don’t metabolize the drugs as quickly. 

People with mild kidney disease don’t typically have to make dosage adjustments, but they should still talk to their doctor to make sure. 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

Take benzodiazepines as directed by your doctor. Don’t increase the dosage before talking to your doctor.

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

If you think you’ve taken more than the recommended dose, call Poison Control. These symptoms require emergency attention:

  • Difficulty breathing
  • Seizure
  • Non-responsive

Side Effects 

As mentioned above, benzodiazepines are often prescribed as a second-line treatment because they can be addictive. They can also have side effects. 

Common 

Common symptoms of taking 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 of the two can cause fatal effects.

You should also avoid mixing benzodiazepines with alcohol. These drugs can also cause serious central nervous system depression that may lead to death.

As mentioned previously, benzodiazepines can be highly addictive. It’s essential to take them as directed by your doctor. Most of the time, doctors only prescribe anti-anxiety medication for a short period.

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, such as seizures.

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

  2. National Institute of Mental Health. Mental health medications

  3. Medline Plus. Lorazepam. 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