There are three types of benzodiazepines – long-acting, intermediate and short-acting. Short-acting medications tend to be more addictive and have a stronger withdrawal and 'come down' effect.
Alprazolam (e.g., Xanax), lorazepam (e.g., Ativan), clonazepam (e.g., Klonopin), diazepam (e.g., Valium), and temazepam (e.g., Restoril) are the five most prescribed, as well as the most frequently encountered benzodiazepines on the illicit market.
Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan). Also used are bromazepam (Lectopam), oxazepam (Serax), chlordiazepoxide (once marketed as Librium), clorazepate (Tranxene) and diazepam (Valium).
Benzodiazepines are depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms, and reduce seizures. The most common benzodiazepines are the prescription drugs Valium®, Xanax®, Halcion®, Ativan®, and Klonopin®.
Some benzodiazepines act on your brain and body for longer than others. The half-life of each drug is a helpful way to understand how long a drug's effects may last. Short-acting benzodiazepines have a shorter half-life. This means that the drugs are processed and leave your body more quickly.
Temazepam 10mg is approximately equivalent to diazepam 5mg. Temazepam is used short-term for the treatment of insomnia, and as pre-medication before minor surgical and investigative procedures. The dose is taken at bedtime (for insomnia), or half to one hour before the procedure (as pre-medication).
Oxazepam, temazepam, and chlordiazepoxide which are low potency benzodiazepines are well tolerated with low toxicity levels.
The most common benzodiazepines prescribed in Australia are temazepam, nitrazepam, diazepam, oxazepam and alprazolam. Other benzodiazepines available are bromazepam, clobazam, clonazepam, flunitrazepam, lorazepam, and triazolam.
In a New Zealand study (2003) of 200 deaths, Zopiclone, a benzodiazepine receptor agonist, had similar, although less overdose potential compared to temazepam, which is the most toxic benzodiazepine.
The most prominent of anti-anxiety drugs for the purpose of immediate relief are those known as benzodiazepines; among them are alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan).
The benzodiazepine medications approved for insomnia treatment in the United States are estazolam, flurazepam, quazepam, temazepam, and triazolam (table 6). Among these, temazepam may have the best safety profile for use in insomnia.
As mentioned before, benzodiazepines are not meant to be used for long periods of time. By using benzodiazepines for an extended time, there is an increased risk of the development of certain health conditions. The amount of time considered “long-term” in regard to benzodiazepine abuse is around three to six months.
Remimazolam, one of the newest benzodiazepines, was discovered by Glaxo Smith Kline. It is an ultra-short acting benzodiazepine that is currently under investigation in phase II and III clinical trials.
Long-acting benzodiazepines include diazepam (with the fastest onset of action), clorazepate (also fast onset), chlordiazepoxide (intermediate onset), f1urazepam (slow onset), and prazepam (slowest onset).
As effective as benzodiazepines can be in managing anxiety symptoms , they can also be very habit forming. Because of this risk, most doctors will only prescribe benzodiazepines for short-term use, such as in the recent aftermath of a traumatic event, or severe anxiety associated with anticipating an upcoming event.
Diazepam (Valium), alprazolam (Xanax), and triazolam (Halcion) are examples of benzodiazepines. Long-acting benzodiazepines like diazepam may be better for individuals experiencing early wakefulness or those who need help with anxiety throughout their day.
Some non-addictive alternatives to benzodiazepines for anxiety available by prescription include: SSRIs (antidepressants) SNRIs (antidepressants) Beta-Blockers (blood pressure medications)
Clonazepam, the most potent benzodiazepine, is used to treat seizures and anxiety disorders. Xanax can be considered the most potent benzodiazepine to treat anxiety. Alprazolam is one of the strongest short-acting benzodiazepines and is often prescribed by doctors because its half-life is shorter than 26 hours.
Alprazolam – indications for use
The approved indications for alprazolam, as listed on the Australian Register of Therapeutic Goods, are: anxiety – short-term symptomatic treatment of anxiety, including treatment of anxious patients with some symptoms of depression.
For example, if you have general anxiety, a long-lasting benzo, like diazepam or clonazepam, might be the best first choice.
Taking benzodiazepines regularly for a few weeks or more can lead to addiction. Doctors recommend that you only take them for 2-4 weeks. Intermittent use may help to avoid addiction.