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• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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The benzodiazepines are licensed and officially approved to help treat the symptoms of:

• Anxiety (GAD or Generalised Anxiety Disorder)
• Alcohol Withdrawal
• Epilepsy
• Insomnia
• Panic disorder
• Psychiatric emergency

The benzodiazepines can also sometimes be used to help the symptoms of:

• Bipolar mood disorder
• Bipolar mania or hypomania
• Dementia
• Depression
• Psychosis
• Schizophrenia
• PTSD (Post-Traumatic Stress Disorder)
• Social anxiety

The benzodiazepines are also sometimes used as muscle relaxants. There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

^{Updated 11.11}

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The usual dose of oxazepam in adults for anxiety is 15-30mg three or four times a day.

In older people the dose should be about half e.g. 10-20mg three or four times a day. This is because it can cause more drowsiness and dizziness in older people. 

For insomnia caused by anxiety is 15-25mg (maximum 50mg) an hour before going to bed.

It is not recommended in children but this is only because it has not been studied rather than because of any concerns about safety.

^{Updated 10.11}

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Alcohol withdrawal - main options, main medicines and handy chart
• Anxiety - main options, main medicines and handy chart
• Bipolar mood disorder - main options, main medicines and handy chart
• Bipolar mania - main options, main medicines and handy chart
• Dementia - main options, main medicines and handy chart
• Depression - main options, main medicines and handy chart
• Epilepsy - main options, main medicines
• Insomnia - main options, main medicines and handy chart
• Panic disorder - main options, main medicines and handy chart
• PTSD - main options, main medicines and handy chart
• Psychiatric emergency - main options, main medicines and handy chart
• Psychosis - main options, main medicines and handy chart
• Schizophrenia - main options, main medicines and handy chart
• Social anxiety - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on the condition above.

^{Updated 1.12}

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When you are anxious, your brain becomes more active. Your brain may produce a chemical messenger (or "neurotransmitter") called gamma-aminobutyric acid (or GABA) which is inhibitory, and makes you feel calmer. GABA is the brain's naturally occurring "calmer". The benzodiazepines boost the action of GABA and this helps calm the brain down. If you cannot sleep because your brain is too active or alert, then boosting GABA will help calm it down, and so help you get to sleep.

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Take your benzodiazepine as directed on the medicine label. Try to take them at regular times each day. Taking it at meal times may make it easier to remember as there is no problem about taking any of the benzodiazepines with or after food. If the instructions say to take them once a day this is usually best about half an hour before going to bed as they should make you drowsy and help you to sleep.

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Tablets and capsules: Tablets and capsules should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat.

Liquids: Your pharmacist should give you a medicine spoon. Use it carefully to make sure you measure the correct amount. (Ask your pharmacist for a medicine spoon if you do not have one). Shake the bottle well before use as the drug can settle to the bottom and cause you to receive a lower dose at the start and too high a dose at the end of the bottle.

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This may depend on what you are taking a benzodiazepine for. Click the link below for the answer for that condition:

• Alcohol withdrawal
• Anxiety (GAD or Generalised Anxiety Disorder)
• Bipolar mood disorder
• Bipolar mania or hypomania
• Dementia
• Depression
• Epilepsy
• Insomnia
• Panic disorder
• Psychiatric emergency
• Psychosis
• Schizophrenia
• PTSD (Post-Traumatic Stress Disorder)
• Social anxiety

Generally they should start to work fairly soon after you start to take them. After that your doctor may need to change the dose to suit you.

^{Updated 10.11}

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This will depend on what you are taking a benzodiazepine for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Anxiety (GAD or Generalised Anxiety Disorder)
• Alcohol withdrawal
• Bipolar mood disorder
• Bipolar mania or hypomania
• Dementia
• Depression
• Epilepsy
• Insomnia
• Panic disorder
• Psychiatric emergency
• Psychosis
• Schizophrenia
• PTSD (Post-Traumatic Stress Disorder)
• Social anxiety

Benzodiazepines are very safe drugs if used sensibly. They are best taken in as low a dose as possible for a short time e.g. often as a "first aid" measure. Usually this should be no longer than about one month to help you get over your problems and for other treatments to start working. If you need to take them for longer you should discuss this regularly with your doctor. Some people with long-term problems may need to take them for longer.

^{Updated 10.11}

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Due to the effects that benzodiazepines have on the brain they can produce withdrawal or discontinuation symptoms in some people who have taken them regularly every day for more than about 4 to 6 weeks. About 1 in 3 people get no symptoms, about 1 in 3 get some that last for a few weeks, and about 1 in 3 people get more marked symptoms. In the worst cases the symptoms from stopping benzodiazepines quickly could include anxiety, tension, panic attacks, poor concentration, difficulty in sleeping, nausea, trembling, palpitations, sweating and pains and stiffness in your face, head and neck (not unlike anxiety itself). These withdrawal symptoms could occur several days after stopping your benzodiazepine. They may last from one to three weeks but can go on for months, and are more likely with alcohol dependence. If you have taken a benzodiazepine for a long period you should stop it slowly over several weeks or months. This is best done by reducing your dose a little every few weeks and will reduce the chance of withdrawal effects.

It is also true to say that many people get no withdrawal symptoms when they stop benzodiazepines, even if they have been taking them for many years. You should thus make sure that you discuss your particular treatment with your doctor.

To be academic, for a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation.

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose. Do not try to catch up by taking two or more doses at once as you may get more side-effects e.g. sleepiness. If you miss several doses start again when you remember. Tell your doctor about this next time you meet. Missing the occasional dose (e.g. once a week) isn't usually a big problem.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by your bed etc.

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It is best not to stop taking a benzodiazepine suddenly if you have been taking it regularly every day for more than about 4 to 6 weeks. If you do, you may get some of the withdrawal effects mentioned above. If you take them only when really necessary (e.g. for 1 or 2 weeks during a severe attack of anxiety and then have several weeks without them) this is better than taking them all the time and can prevent you becoming dependent. You should talk about this with your doctor.

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The table below will show you some of the main side effects you might get from a benzodiazepine.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

^{Updated 11.12}

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Depending on the dose the benzodiazpines should help to calm you down, but they can calm you down too much and send you to sleep. At a usual dose they may make you feel a bit drowsy or sleepy anyway, especially to start with. If you are taking it at night you may feel drowsy the next morning so you should not drive (see below) or operate machinery until you know how they affect you. You should be careful as they may affect your reaction times.

^{Updated 11.11}

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It is not thought that benzodiazepines cause any changes in weight. If, however, you do start to have problems with your weight tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Benzodiazepines do not have any known effects on any of these stages. Drowsiness may have some effect. In some people, reduced anxiety may be an advantage.

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You should have no problem with any foods or drinks, other than alcohol (see separate question). Caffeine is a stimulant and can cancel out the calming effects of benzodiazepines. This can happen at fairly low doses e.g. 250mg of caffeine a day (which is about 2-3 mugs of tea or coffee, either instant or "real").  

^{Updated 1.12}

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

If you drink alcohol while taking a benzodiazepine, it will make you feel much more sleepy. This is very important if you need to drive or operate machinery. It may make it more difficult to keep you car on the road. You must seek advice on this. Benzodiazepines and alcohol can slow your reflexes or reaction times. They can also increase the effects of alcohol and so it is best to avoid alcohol.  

It is not safe to drive after drinking alcohol, with or without a benzodiazepine. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

^{Updated 11.11}

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The benzodiazepines have a few interaction with other medicines:

• The sedating effects of benzodiazepines can be increased by any other drug causing sedation e.g. alcohol, antihistamines (e.g. promethazine), barbiturates (e.g. phenobarbital), opioids (e.g. codeine, morphine), ritonavir, tricyclics (e.g. dosulepin, imipramine, lofepramine), antipsychotics (e.g. olanzapine, quetiapine, clozapine), mianserin, mirtazapine, pregabalin, cannabis, beta-blockers (e.g. propranolol, atenolol), calcium-channel blockers (e.g. diltiazem, verapamil), itraconazole, ketoconazole, omeprazole or esomeprazole (but not pantoprazole) for stomach ulcers, sodium valproate or disulfiram.
• The effects of benzodiazepines can sometimes be decreased by caffeine, aminophylline or theophylline

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It is just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

^{Updated 1.12}

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking.

The benzodiazepines are those types of medicines. The amount of a benzodiazepine in the body can drop a little if you smoke, giving less effect or meaning you might need a higher dose to get the same effect (although probably not with chlordiazepoxide). It also means that if you stop smoking, the levels will rise so you might get more side effects.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, the benzodiazepines do not seem to be affected so there seem to be no extra problems if smoking cannabis with a benzodiazepine. You might feel a little more drowsy and you are also smoking so you need to see that section too.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with a benzodiazepine and cocaine, although this doesn't mean it's safe.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with a benzodiazepine and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). There are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with a benzodiazepine, except that you might feel more drowsy and higher doses of either or both could make it much harder to breathe. This can be dangerous. If this happens you should phone for an ambulance straight away or get to the A&E or emergency department of your nearest hospital immediately.

^{Updated 1.12}

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You should have no problems with "The Pill" and any of the benzodiazepines.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking a benzodiazepine, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

^{Reviewed 9.11}

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily the benzodiazepines don't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

^{Updated 11.11}

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

The benzodiazepines are classified as follows: alprazolam "D", chlordiazepoxide "C", clonazepam "D", diazepam "D", lorazepam "D" and oxazepam "D". The others are not classified. Although some studies have shown a slightly increased chance of abnormalities with benzodiazepines, alcohol and other drug use may have been the reason for this. The risk of oral clefts is reported to be about 7 in 1000 births with diazepam. Occasional use of shorter-acting benzodiazepines would appear to have a very low risk. Regular use of longer-acting benzodiazepines (e.g. chlordiazepoxide, diazepam) may also lead to some short-term breathing difficulties in newborn babies, and some withdrawal effects e.g. the floppy baby syndrome. You should seek personal advice from your GP, who may then if necessary seek further specialist advice.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.

• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.

• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter

• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit

• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half

• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that all the benzodiazepines get into breast milk so you must be very careful if you breast-feed. Some of the benzodiazepines can build up in the milk and should be avoided e.g. diazepam and chlordiazepoxide. Oxazepam and possibly lorazepam and temazepam seem to be the best choices. You should discuss this with your doctor, nurse or health visitor because they will be able to make regular checks on your baby to make sure there are no problems, such as poor feeding, drowsiness and weight loss.

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The benzodiazepines can reduce your ability to carry out skilled tasks such as driving or operating machinery. You may also feel drowsy after you take them. People who take benzodiazepines are more likely to have road accidents, possibly because it can be more difficult to "maintain road position" ^{(Rapoport 2009)}. Until these effects wear off or you know how your benzodiazepine affects you do not drive or operate machinery. You should be careful as they may affect your reaction times.

If you are taking any medicines (including benzodiazepines), the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

^{Updated 11.11}

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You will not usually need to have any tests to check on your benzodiazepine.

^{Reviewed 9.11}

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