Sleeping Pills and tranquillisers are Benzodiazepines. Benzodiazepines are available on prescription only in Australia, and are mainly used for problems relating to anxiety and sleep.
Approximately 10 million scripts are written annually in Australia. Apart from a fall in prescribing in the early 1990s, prescribing rates have remained fairly constant, with a slight increase in the last few years.
It is estimated that one in 50 Australians are currently taking a benzodiazepine and have been taking the drug for longer than 6 months.
Women are prescribed benzodiazepines at twice the rate as for men, and older people (over 65) receive most of the benzodiazepine scripts for sleeping problems.
Some of the more common drugs in this group are:
- Diazepam (e.g. Valium, Antenex, Ducene)
- Temazepam (e.g. Normison, Temaze, Temtabs, Euhypnos)
- Flunitrazepam (e.g. Hypnodorm)
- Nitrazepam (e.g. Mogadon, Alodorm)
- Oxazepam (e.g. Serepax, Alepam, Murelax)
- Alprazolam (e.g. Xanax, Kalma)
- Clonazepam (e.g. Rivotril, Paxam)
- Lorazepam (e.g. Ativan)
Benzodiazepines may be legally prescribed by doctors but it is illegal to obtain them under false pretences or to give/sell them to anyone else.
Benzodiazepines areabsorbed in the stomach and small intestine, and metabolised by the liver (when taken orally) . They are highly fat soluble and accumulate in fatty tissue and are excreted through sweating, saliva, urine, faeces and breast milk.
The Short-term effects of Sleeping Pills are:
- relaxation, drowsiness, lethargy, fatigue
- anxiety, panic attacks, hyperventilation, tremor
- sleep disturbance, muscle spasms, loss of appetite and weight loss
- visual disturbance, sweating
- mood changes (lack of enjoyment)
- memory impairment (especially short-term memory)
- impairment of motor coordination, thinking and memory (decreased reaction time and increased accident risk)
- staggering, blurred vision, vertigo
- slurred speech
- altered mood (depression or euphoria), confusion
- sensitivity reactions (e.g. rashes, to noise)
- high doses may lead to paradoxical effects such as rage or uncharacteristic behaviour, a person may feel invisible, invulnerable and invincible
- drug interactions - especially with other depressant drugs (e.g. alcohol, opioids - deaths from respiratory depression have occurred with these combinations)
The Long-term effects of Sleeping Pills are:
- lethargy, sleepiness and lack of motivation
- emotional blunting (inability to feel the normal highs and lows, inability to grieve), depression, irritability
- impairment of memory
- muscle weakness
- headaches, nausea, weight gain
- menstrual irregularities, breast engorgement, reduced libido
The unwanted effects of Sleeping Pills include:
- Benzodiazepine tolerance is common among people who take these drugs - this means they need more of the drug to achieve the same effect they used to get with smaller amounts. Tolerance to the sleep-inducing and relaxing effects develops quickly.
- Regular users of benzodiazepines can develop dependence after only 3-6 weeks at normal prescribed doses and the likelihood of dependence increases with duration of use and amount taken. Dependence means that benzodiazepine use becomes central to a person's life and a lot of time may be spent thinking about, obtaining and using them. Dependent users may have difficulty controlling or stopping their use despite experiencing problems.
Someone who is dependent on benzodiazepines is likely to experience withdrawal symptoms if they stop taking them abruptly. It is recommended that a gradual reduction be undertaken, in consultation with a doctor. Withdrawal symptoms can be divided into three main groups and they may include a return of symptoms that the drugs were taken for in the first place.
Benzodiazepines and Pregnancy
Benzodiazepines cross the placenta easily and can affect the fetus.
There have been reports of a small increase in the rates of congenital malformations when benzodiazepines are taken in early pregnancy - these include cleft lip and palate, urinary tract and nervous system malformations.
When benzodiazepines are taken later in pregnancy the baby may become addicted and experience withdrawal after birth. Also, babies may be floppy and sleepy with low temperature and respiratory depression if benzodiazepines are taken just before delivery. Benzodiazepines can cross into breast milk, resulting in sedation in the baby as their body can't break them down very efficiently.
Benzodiazepines and the Elderly
The elderly who take benzodiazepines are at higher risk of falls and fractures.
Benzodiazepines are more likely to accumulate in an elderly person as their liver is slower to break them down - this may cause drowsiness and confusion.
The elderly are more likely to take other medications - benzodiazepines can interact with these, increasing the risks of unwanted side effects and/or dependence.
Benzodiazepines and Driving
Benzodiazepines should not be taken before driving. They affect alertness, concentration, coordination and judgment, and may also cause dizziness and blurred vision. The effects are worse if alcohol or other sedative drugs such as opiates are taken.
It is an offence to drive while under the influence of drugs, including benzodiazepines.
Benzodiazepines and Other Drugs
Benzodiazepines can interact with a number of other drugs - this may result in an increased effect of the benzodiazepines or other drug (possibly leading to death with opioids, alcohol or other sedatives) or may interfere with its action making it less effective.
Other drugs should not be taken without first consulting the prescribing doctor/pharmacist. Drinking alcohol is not recommended while taking benzodiazepines as the effects are increased.
Injecting Drug Users
Injecting benzodiazepines can be very dangerous as these drugs do not dissolve well in water and can result in:
- collapsed veins
- amputation of fingers/toes or limbs (from blocked blood vessels)
When injected with other substances such as heroin, morphine or methadone there is a higher likelihood of overdose and death.
All injecting drug use carries risks of catching blood-borne viruses (e.g. Hepatitis C, HIV) and also bacterial infections that can cause endocarditis (infection in the heart).
Reducing the Risk
Benzodiazepines should only be taken when and as directed by a doctor and generally only for a short time. Longer-term use is appropriate for a very small number of people and this is usually on the advice of a psychiatrist. Benzodiazepines should be safely stored so they do not pose a hazard to others (e.g. young children) and they must not be given or sold to anyone else.
For further help and information please visit us today and speak to one of our experienced, professional Pharmacists.
The information in this publication is a guide only. Readers are encouraged to seek appropriate professional advice before relying upon any of the material contained in it. While care has been taken to ensure the material contained in this publication is up-to-date at the time of printing, your Pharmacist accepts no responsibility for the accuracy or completeness of the material in the publication and expressly disclaims all liability for any loss or damage arising from reliance upon any information contained within it.