Benzodiazepines and related agents
Terms
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- BDZ administered i.m. or i.v.
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Chlordiazepoxide
Chlorazepate
Diazepam
Midazolam
Lorazepam - BDZs T1/2
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Long (>1 day): flurazepam, chlordiazepoxide, clorazepate, diazepam
Intermediate (6-24 hrs): temazepam
Short (<6 hrs): triazolam - Benzodiazepines
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Mechanism: positive allosteric of GABA
Clinical Use: Anxiloytic effect, sedation, muscle relaxant, anticonvulsant, hypnosis
Side Effects: Ataxia, Sedation, tolerance (not to anxiolytic effects), psychological dependence, short T1/2= withdawal symptoms - Flurazepam
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Mechanism: benzodiazepine, long T1/2
Clinical Use: Insomnia
Side Effects: impaired driving, tolerance after 3 wks - Temazepam
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Mechanism: benzodiazepine, intermediate T1/2
Clinical Use: Insomnia
Side Effects: impaired driving at high dose - Triazolam
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Mechanism: benzo, short T1/2
Clinical Use: initial insomnia
Side Effects: some wake up early and can't go back to bed, heightened anxiety following day -
Alprazolam
Clonazepam
Lorazepam -
Mechanism: benzo, long T1/2
Clinical Use: Anxiety with automnomic signs e.g. panic disorder, agoraphobia -
Midazolam
Lorazepam - Preanesthetic
- Clonazepam
- Abscence seizures
- Flumanezil
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Mechanism: BDZ antagonist
Clinical Use: reversal of BDZ effect durign general anesthesia, overdose
Side Effects: may precipitate withdrawal - Buspirone
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Mechanism: partial 5-HT1A agonist
Clinical Use: non-sedative anxiolytic, not as effective as BDZ in severe anxiety
Side Effects: no withdrawal, well tolerated