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Antianxiety Drugs

Introduction

Antianxiety drugs are prescription drugs used to calm and relax people with excessive anxiety and induce sleep (sedatives or sleep aids).

The most commonly used drugs are benzodiazepines.

They are indicated for the short-term relief of severe anxiety.

Prescription Medications

Benzodiazepines

The most commonly used benzodiazepines in treating anxiety are:- Alprazolam, Diazepam and Lorazepam.

Benzodiazepines have replaced the barbiturates because they have a lower abuse potential and relatively lower adverse reactions (death is a relatively common result in barbiturate overdoses) and interactions.

Duration of action

Benzodiazepines are commonly divided into groups according to their half-lives:

  1. Short-acting compounds
    • Act for less than six hours
    • Have few residual effects if taken before bedtime, but rebound
    • Insomnia may occur and they might cause wake-time anxiety
    • Usually best for their hypnotic effects
  2. Intermediate-acting compounds
    • Have an effect for 6-10 hours
    • May have mild residual effects but rebound insomnia is not common
  3. Long-acting compounds
    • Have strong sedative effects that persist
    • Accumulation of the compounds in the body may occur the elimination half-life may greatly vary between individuals, especially the elderly
    • Usually better for their anxiolytic effects

Benzodiazepines with shorter half-lives tend to be able to produce an addiction quicker as the drug does not last in the system for as long.

Alprazolam

Is being prescribed as an anxiolytic more than a hypnotic, despite possessing a short half-life

Lorazepam

Potentially aggravating forgetfulness and confusion

Not the best choice for longer term treatment in the elderly due to its stronger amnesic effects

May be a better choice for short term treatment of a younger, non-drinking patient as it is relatively less sedating

Side effects

  • Drowsiness, ataxia, confusion, vertigo, impaired judgement, and a number of other effects are common.
  • Benzodiazepines may impair the ability to drive vehicles and to operate machinery. The impairment is worsened by consumption of alcohol, because both act as central nervous system depressants.
  • Consuming any benzodiazepine with alcohol can result in a potentially fatal overdose.
  • The effects of long-acting benzodiazepines can also linger over to the following day.
  • Long term use may actually worsen anxiety in some people with or without prior psychiatric history

Adverse Effects

2 types of adverse effects may occur as a result of prolonged use of antianxiety drugs:

  1. Dependence
    • These drugs can cause dependence within 2 weeks of continual use
  2. Withdrawal
    • Abrupt withdrawal from antianxiety drugs and sedatives can produce a severe, frightening, and potentially life-threatening reaction, much like alcohol withdrawal (delirium tremens).
    • The time course of withdrawal reactions varies from drug to drug. Within the first 12 to 24 hours, the person may become nervous, restless, tremulous, and weak.
    • Seizures may occur in those taking high doses. Occasionally, a seizure may occur even 1 to 3 weeks after withdrawal.
    • The benzodiazepine withdrawal syndrome may develop at any time up to 3 weeks after stopping a long-acting benzodiazepine, but may occur within a few hours in the case of a short-acting one.
    • Other effects that can occur during withdrawal include dehydration, delirium, insomnia, confusion, and visual and auditory hallucinations (seeing and hearing things that are not there).

Precautions

Do not increase your dose or take more often than prescribed.

Although the possibility of liver damage may be limited when these drugs are prescribed at the recommended dosage, it should still be considered in all individuals; especially those utilizing other medications including over the counter analgesics and/or alcohol.

Special Instructions

  • Take with food or milk if stomach upset occurs. Tolerance may develop to this medication making it less effective with prolonged use.
  • Do not stop taking this medication without your doctor’s approval.
  • Your dose may have to be gradually decreased if you have been taking it for some time.

General Informations

  • Before using this drug, tell your doctor your medical history, especially of: liver or kidney disease, drug allergies.
  • Alcohol or other sedative-type drugs can lead to extreme drowsiness.
  • Limit alcohol consumption.
  • Elderly persons are usually more sensitive to the effects of this medication. Use cautiously.
  • This medication is not recommended for use during pregnancy. Discuss the risks and benefits with your doctor.
  • Since this medication may appear in breast milk, consult with your doctor before breast-feeding.

Storage Conditions

  • Because these drugs are often abused, extra caution should be taken in storing them.
  • Do not mix them with other medicines.
  • Keep medicines in a cool, dry place and out of a child’s reach.

 

Last reviewed : 20 April 2012
Writer : Kamariah Shamsinar bt. Kamarul Baharin
Reviewer : Rabi’ah bt. Mamat