Benzodiazepine Side Effects

This is a list of side effects that may result from the use of benzodiazepines

So-called "Paradoxical" Effects

According to professor Malcolm Lader, 5% of those using benzodiazepines may be affected by so-called "paradoxical" reactions in response to the drugs rather than the desired tranquillising effects.  Such reactions include increased aggressiveness (in some individuals even violent behaviour), depression (with or without suicidal thoughts or intentions), and sometimes personality changes. In some instances, reactions such as hallucinations, depersonalization, derealization and other psychotic symptoms occur.

Ativan (lorazepam) and Halcion (triazolam) in particular may produce dissociation and other psychiatric symptoms.

"Paradoxical" side effects occur in all age groups but are more likely to be found in children and in the elderly where they may be fairly frequent yet erroneously diagnosed as various psychiatric disorders.  The risk of such reactions is generally greater with short-acting compounds but may occur with all benzodiazepine drugs.  It is important to remember that the "paradoxical" reactions can also be encountered in short-term use and, in rare cases, even following the first ingestion of the drug.


Long-term Side Effects

All the psychological changes mentioned above may occur as long-term side effects when the use (or abuse) has become chronic i.e. has been going on for many months or even years.  The frequency of such side effects is significantly higher than the frequency of "paradoxical" side effects.  The long-term effects include depression, querulousness or aggression, and subtle personality changes.   Further, fatigue, passivity and symptoms of memory and cognitive impairment may ensue.

Tolerance with inter-dose withdrawal exists when the originally prescribed dosage no longer produces the original effect, and the patient experiences drug withdrawal although he/she is still taking the preparation.  This may lead to an increase of dosage, or more often, result in long-term use.  Over time, the above-mentioned long-term side effects may develop.  The risk of this course of events is greater with compounds with short half-lives such as Ativan (lorazepam), Halcion (triazolam), Xanax (alprazolam), Rohypnol (flunitrazepam) and even Serax/Serenid (oxazepam).  In addition to the symptomatology described under "Paradoxical Effects", phobias, OCD, and various neurological symptoms such as tinnitus may occur as long-term side effects.

Psychomotor Side Effects

Benzodiazepines may cause psychomotor impairment, and several studies have shown an increased risk of road accidents in drivers under the influence of benzodiazepine drugs.  The risk of other accidents, for example in industrial workshops, may be increased as well.  The elderly are particularly vulnerable to these psychomotor effects and may also develop dysarthria and ataxia.   The risk of falls and fractures is pronounced in this population when tranquillisers are used on a regular basis.

Cognitive Side Effects

Memory functioning is markedly and measurably impaired, especially the ability to store acquired knowledge into long-term memory.  This memory impairment is highly relevant to students.  The risk of acute amnesia is more pronounced with short-acting drugs.  Ativan (lorazepam), Halcion (triazolam), Xanax (alprazolam) and Rohypnol (flunitrazepam) are especially likely to induce such memory impairment.