What Are Benzodiazepines? A Patient Education Guide

Auscare Store – Sydney Medicinal Cannabis & Wellness Dispensary

Introduction

If you or someone you care about has been prescribed medication for anxiety, insomnia, or seizures, you may have heard the term benzodiazepines (often called “benzos”). These are a class of prescription medicines widely used in Australia and around the world.

This guide provides educational information only to help you understand what benzodiazepines are, how they work, their benefits and risks, and important safety considerations. Always consult your doctor or pharmacist for medical advice tailored to your situation .

What Are Benzodiazepines?

Benzodiazepines are a group of drugs called minor tranquillisers that slow down the activity of the brain and central nervous system . They work by enhancing the effect of a brain chemical called GABA (gamma-aminobutyric acid) , which has a calming effect .

In Australia, benzodiazepines are available only with a prescription and are used to treat:

• Anxiety disorders – short-term relief of severe anxiety

• Insomnia – difficulty sleeping (short-term use only)

• Seizures and epilepsy – including acute seizure management

• Alcohol withdrawal – under medical supervision

• Muscle spasms – as a muscle relaxant

• Palliative care – to manage agitation and discomfort 

Common Benzodiazepines in Australia

There are about 30 different types (generic names) of benzodiazepines available globally . The most commonly prescribed in Australia include:

Some benzodiazepines are also used in hospital settings for intravenous administration during procedures or for emergency seizure control .

How Do Benzodiazepines Work?

Benzodiazepines bind to specific receptors in the brain called GABAA receptors. GABA is the brain’s main “inhibitory” neurotransmitter it helps calm overactive nerve signals. By enhancing GABA’s effects, benzodiazepines produce:

• Anxiolysis (anxiety reduction)

• Sedation (calming and sleepiness)

• Hypnosis (sleep induction)

• Muscle relaxation

• Anticonvulsant effects (seizure prevention)

• Amnesia (memory disruption useful for procedures) 

The effects you feel depend on factors like:

• The specific benzodiazepine and dose

• Whether the medication is genuine or counterfeit

• Your age, weight, and general health

• How long you have been taking it

• Whether you use it with other drugs or alcohol 

Recommended Duration of Use

Benzodiazepines are intended for short-term use only.

The Royal Australian College of General Practitioners (RACGP) and international guidelines recommend that benzodiazepines should not be taken regularly for longer than 2–4 weeks .

Why so short?

• Tolerance develops quickly – After a few weeks, the medication may stop working effectively, leading some people to increase their dose .

• Dependence can occur rapidly – Physical dependence can develop after as little as 2–4 weeks of daily use .

• Withdrawal symptoms – Stopping suddenly can cause serious withdrawal effects .

• Long-term risks increase – including falls, fractures, memory problems, and cognitive impairment .

When longer use may be considered

In some circumstances, longer-term use may be clinically justified—for example:

• Severe epilepsy where benzodiazepines provide effective seizure control

• Palliative care for symptom management

• Patients under specialist supervision where alternatives have failed 

These situations require regular specialist review to ensure benefits continue to outweigh risks.

Side Effects of Benzodiazepines

Like all medicines, benzodiazepines can cause side effects. Some people experience none, while others may be significantly affected.

Immediate effects can include:

• Drowsiness, sleepiness, or fatigue

• Confusion or dizziness

• Poor coordination and balance

• Slurred speech or stuttering

• Blurred or double vision

• Memory problems (can’t remember things from just a short time ago)

• Mood swings

• Feeling “really good” (euphoria)

• Reduced ability to judge distances or movement properly 

Long-term effects can include:

• Persistent fatigue and lack of energy

• Depression

• Headaches

• Skin rashes

• Increased appetite and weight gain

• Loss of interest in sex or sexual dysfunction

• Menstrual problems (in women)

• Memory and concentration difficulties

• Increased risk of falls and fractures (especially in elderly)

• Increased risk of seizures upon withdrawal 

Paradoxical reactions

Sometimes benzodiazepines can cause the opposite effect to what’s expected especially in children, the elderly, or people with developmental disabilities. This may include:

• Restlessness and agitation

• Hyperactivity

• Aggressive outbursts

• Difficulty sleeping 

If you experience any unusual reactions, contact your doctor immediately.

Risks of Long-Term Use

1. Tolerance

Tolerance means you need to take more of the drug to feel the same effects you used to have with smaller amounts. With benzodiazepines, tolerance to the sleep-inducing effects can develop in just days . This can lead people to increase their dose which increases risks without providing additional benefit.

2. Dependence

Dependence means the drug takes up a lot of your thoughts, emotions, and activities. You spend time thinking about using them, obtaining them, and recovering from their effects. You find it difficult to stop or control your use .

Dependence can lead to:

• Health problems

• Financial difficulties

• Relationship issues

• Work problems

• Legal consequences 

3. Withdrawal

If you are physically dependent and stop suddenly or reduce your dose too quickly, you may experience withdrawal symptoms. These can include:

• Rebound anxiety and insomnia (worse than before)

• Panic attacks

• Muscle spasms and aches

• Flu-like symptoms

• Fatigue

• Gastrointestinal issues

• Perceptual disturbances

• Sensitivity to light and sound

• Confusion and memory problems 

Severe withdrawal can include:

• Psychosis

• Seizures (which can be life-threatening) 

IMPORTANT: Never stop benzodiazepines abruptly. Withdrawal should always be done gradually under medical supervision .

4. Cognitive Impairment

Long-term benzodiazepine use is associated with:

• Memory problems

• Reduced concentration

• Difficulty learning new information

• Increased risk of dementia in older adults 

Serious Safety Concerns

Overdose Risk

While it’s unusual to fatally overdose on benzodiazepines alone, mixing them with other drugs dramatically increases risk .

Signs of overdose include:

• Person cannot be woken

• Very slow breathing

• Slow heartbeat

• Cold, clammy skin

• Bluish lips

• Coma 

If someone overdoses:

1. Call Triple Zero (000) immediately

2. Stay with the person

3. If unconscious, place them in the recovery position

4. Clear their airway and check breathing

5. Perform mouth-to-mouth resuscitation if trained 

Mixing with Other Drugs

Taking benzodiazepines with other central nervous system (CNS) depressants can be fatal. These include:

• Alcohol – extremely dangerous combination

• Opioids (heroin, morphine, oxycodone, methadone)

• Other sleeping pills

• Cannabis (including medicinal cannabis)

• Antihistamines (some cause drowsiness)

• Antipsychotics

• Tricyclic antidepressants 

The combination can cause:

• Profound sedation

• Respiratory depression (breathing slows or stops)

• Loss of consciousness

• Coma

• Death 

Driving and Operating Machinery

In NSW and most Australian states, it is illegal to drive with any detectable THC in your system (for medicinal cannabis patients). For benzodiazepines:

• They can impair your ability to drive safely

• You may be breaking the law if you drive while affected

• Police can conduct roadside testing

• Penalties include fines, licence suspension, and criminal charges 

Always check with your doctor about whether it’s safe for you to drive while taking benzodiazepines.

Falls and Fractures

Benzodiazepines significantly increase the risk of falls—especially in older adults. Research shows:

• Twofold higher risk of falls in patients taking benzodiazepines 

• 50–110% increased risk of fractures 

• Population risk of serious falls attributable to long-term benzodiazepine use: 3% 

Pregnancy and Breastfeeding

Benzodiazepines can harm an unborn baby. Use during pregnancy may result in:

• “Floppy infant syndrome” (poor muscle tone)

• Withdrawal symptoms in the newborn

• Respiratory difficulties at birth 

If you are pregnant, planning pregnancy, or breastfeeding, discuss this with your doctor before taking benzodiazepines.

Benzodiazepine Use in Australia: Key Statistics

• 4.5 million benzodiazepine prescriptions were dispensed in Australia between June 2023 and July 2024 

• 1.4 million Australians received these prescriptions 

• Benzodiazepines were involved in 694 deaths (39% of drug overdose deaths) in 2023 

• 4.9 million prescriptions were dispensed in 2021–22, with diazepam accounting for almost half 

• About 35% of patients taking benzodiazepines have been on them for more than 1 year far longer than recommended