Benzodiazepines are fast-acting sedating medications such as alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan) and diazepam (Valium). They can help with severe anxiety, panic, seizures and some other conditions, usually for a limited time. Their main risks are physical dependence, withdrawal when stopped too quickly, misuse and addiction, and dangerous sedation when combined with opioids or alcohol.
Part of our guide: A Patient’s Guide to Psychiatric Medication
If you already take one, the most important message is this: do not stop it suddenly or lower the dose on your own. The FDA warns that doing so can cause serious withdrawal reactions. Talk with your prescriber first, including if you are worried about dependence. Needing help to come off a benzodiazepine is not a personal failure.
If you are thinking about suicide or self-harm, or are worried about someone else: call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.
Call 911 or go to the emergency room for trouble breathing or seizures.
What benzodiazepines are used for
The FDA says benzodiazepines are approved to treat generalized anxiety disorder, insomnia, seizures, social phobia and panic disorder, and are sometimes given before medical procedures. Individual medications have their own approved uses:
| Medication | Examples of labeled uses |
|---|---|
| Alprazolam (Xanax) | Acute treatment of generalized anxiety disorder; panic disorder |
| Clonazepam (Klonopin) | Certain seizure disorders; panic disorder |
| Lorazepam (Ativan) | Anxiety disorders; short-term relief of anxiety symptoms |
| Diazepam (Valium) | Anxiety; acute alcohol withdrawal; muscle spasm; add-on for seizures |
| Temazepam (Restoril) | Short-term treatment of insomnia (generally 7 to 10 days) |
The National Institute of Mental Health describes them as used to treat some short-term anxiety symptoms and useful as needed to reduce severe anxiety in the short term. They are generally not the long-term plan for an anxiety disorder. For panic disorder or social anxiety disorder, NIMH says providers typically start with SSRIs or other antidepressants as the initial treatment.
What the FDA boxed warning says
In 2020, the FDA required an updated boxed warning for all benzodiazepines. A boxed warning is the agency's most prominent type of warning. The current alprazolam label shows three parts, which also appear on other benzodiazepine labels such as clonazepam:
- Use with opioids. Taking benzodiazepines and opioids together may result in profound sedation, respiratory depression, coma and death.
- Abuse, misuse and addiction. Use of these medications exposes people to these risks, which can lead to overdose or death. The FDA says this can happen even when they are taken at recommended dosages.
- Dependence and withdrawal. Continued use may lead to clinically significant physical dependence. Stopping abruptly or lowering the dose quickly after continued use may cause acute withdrawal reactions, which can be life-threatening. The risks of dependence and withdrawal increase with longer treatment and higher daily doses.
FDA data give a sense of scale. In 2019, an estimated 92 million benzodiazepine prescriptions were dispensed in the United States. Benzodiazepine-involved overdose deaths rose from 1,298 in 2010 to 11,537 in 2017, and from 2013 to 2017, 55% of those deaths also involved prescription opioids. The FDA reports these death figures separately from prescription counts, so they do not tell you the risk for any one person taking the medication as prescribed.
Dependence, addiction and tolerance are different things
These words get used interchangeably, but they mean different things, and the difference matters.
- Physical dependence means your body has adapted to the medication, so withdrawal symptoms can occur if it is stopped quickly. The FDA says this can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed.
- Tolerance means the same amount has less effect over time. NIMH notes that taking benzodiazepines over long periods may lead to drug tolerance or even dependence.
- Addiction, as the alprazolam label describes it, can include a strong desire to take the drug, difficulty controlling use and continuing despite harmful consequences. The label defines it separately from physical dependence, and it is a real risk in its own right.
What withdrawal can look like
The FDA lists withdrawal symptoms that may occur even when the dose is lowered gradually, including abnormal involuntary movements, anxiety, blurred vision, memory problems, irritability, insomnia, muscle pain, panic attacks and tremors. More severe reactions include seizures, hallucinations and suicidal thoughts. The alprazolam label calls withdrawal reactions potentially life-threatening, names seizure as the most important symptom and describes a protracted withdrawal syndrome in some people, with symptoms lasting weeks to more than 12 months.
This is why stopping is planned. The FDA states that no standard benzodiazepine tapering schedule is suitable for all patients, and it tells clinicians to create a patient-specific plan and monitor the person along the way. Your prescriber should set that plan with you, so this article does not give a schedule. For general background on coming off psychiatric medication, see getting off psychiatric medications safely.
How long they are meant to be used
Labels show limited evidence for long-term use. The Xanax Medication Guide says it is not known if it is safe and effective for anxiety disorder for longer than 4 months or for panic disorder for longer than 10 weeks. The Ativan label says effectiveness beyond 4 months has not been assessed by systematic clinical studies and that the physician should periodically reassess its usefulness. NIMH says providers usually prescribe benzodiazepines for short periods and taper them slowly.
Some people do take them longer under supervision. If that is your situation, a regular review of why you are taking it, whether it still helps and what the alternatives are is a reasonable thing to ask for. This article on medication reviews explains what one can cover.
Who needs extra care
The alprazolam label tells prescribers to assess each person's risk of abuse, misuse and addiction before prescribing and throughout treatment. Be open about any past or current alcohol or drug use, and about anything else you take for pain, sleep or anxiety. This information helps your prescriber weigh the decision and is not a reason for judgment. If you have felt pulled to use more than prescribed, say so early, since that is exactly when a change of plan can help most.
Other safety points to know
- Alcohol. The FDA says not to drink alcohol while taking benzodiazepines, since it can increase the risk of life-threatening side effects. More in mixing psychiatric medication with alcohol or cannabis.
- Driving and machinery. The alprazolam label cautions against hazardous activities such as driving until you know how the medication affects you.
- Older adults. The label says older patients may be especially sensitive to the effects of benzodiazepines.
- Pregnancy. Use late in pregnancy can result in sedation and withdrawal symptoms in the newborn, according to the label. Tell your prescriber if you are pregnant or planning to be, and do not stop suddenly.
- All your medications. The FDA advises telling all your health care professionals about every medicine and substance you use, including alcohol and over-the-counter products.
Questions to ask your prescriber
- What is this for, and what is the longer-term plan for my anxiety or sleep problem?
- How long do you expect me to take it, and how will we decide when to stop?
- What are the alternatives, including therapy and other medications?
- What should I do if it feels like it is working less well, given that I should not take extra on my own?
- Does my history of alcohol or drug use, or any opioid prescription, change this decision?
Other options for long-term anxiety treatment exist. NIMH describes buspirone as usable over longer periods, though it is not effective as-needed, and SSRIs and SNRIs as common choices. See medication options for severe health anxiety and how medication can support panic disorder treatment.
If you want a careful review of a benzodiazepine you take now or are considering, medication management at Mind Body Seven is one place to start. You can request a consultation, and the intake team confirms fit, scheduling and costs.
FAQs
Are benzodiazepines the same as sleeping pills?
Some are used for sleep. The temazepam label, for example, lists short-term treatment of insomnia. Not all sleep medications are benzodiazepines, so check with your prescriber or pharmacist about what you take. This article on sleep medication vs behavioral treatment looks at other options.
Can a benzodiazepine be taken only when needed?
Sometimes. NIMH describes as-needed use for severe short-term anxiety. Follow your prescriber's directions and ask how often is too often, since regular use over time is what raises dependence risk.
Can I get off a benzodiazepine if I have taken one for years?
Raise it with your prescriber. Coming off should be planned and monitored, and the FDA says no standard tapering schedule suits all patients, so the right pace varies. Never stop suddenly on your own.
Are benzodiazepines safe with antidepressants?
They are sometimes prescribed together, but some combinations add sedation. For example, the mirtazapine label says benzodiazepines and alcohol should be avoided with it. Ask your prescriber or pharmacist about your exact medications.
