Drugs you should not combine: Benzodiazepines
Modern life is demanding on our physical, mental, and spiritual framework. Many of our lives are naturally full of cares. Professional cares, family cares, home cares, social cares, financial cares, as well as heath concerns. Professional cares can keep us awake at night burning the midnight oil. Financial cares are perhaps primary for many people until they become stable in midlife. Family cares are complex and none is exempt. Taking care of property, paying rent, keeping up with taxes and licenses, and registrations and school fees, and those factors that give us good social standing are endless cares. Then there are unexpected cares. From repair of shoes and clothing to repairs of the car, generator, pump, electronics, it seems there is always some extra work, extra expense, extra demand on our time and life from unexpected sources. No wonder drugs used for anxiety are commonly used in today’s world.
Anxiolytic, antianxiety, sedatives drugs (that calm) and hypnotics drugs (that induce sleep) can be found in most homes today. A very popular group of anxiolytics/hypnotics is the benzodiazepines. Benzodiazepines such as diazepam and lorazepam are used to calm oneself when one has been worked up into a stat of anxiety. Benzodiazepines such as temazepam, lormetazepam, nitrazepam are used to force oneself to sleep when sleep just won’t come.
Benzodiazepines, though they are controlled substances, have become a widely utilized group of drugs. In general, the different drugs in the group benzodiazepines are respectively used for different conditions. Some aresedative-hypnotics for sleep, some are adjuncts to anesthesia to induce relaxation and amnesia (procedural memory loss), some are anxiolytic, some are used for panic disorders, some are used to treat seizures, some are used in the process of alcohol withdrawal, and some are muscle relaxants.
Because these drugs are ubiquitous, we need to educate our households about them. Youths tend to experiment socially with these drugs. Apart from the fact that some of them are used nefariously as date rape drugs, for mind control, and for other crimes, when mistakenly used by innocent members of the household, deaths can occur.
Some of the well utilized benzodiazepine medications are Restoril (temazepam), Halcion (triazolam), Dalmane (flurazepam), ProSom (estazolam), – all used for insomnia to promote sleep; Serax (oxazepam); Versed (midazolam); Tranxene T-Tab (clorazepate), Niravam, Xanax (alprazolam) used for anxiety and Valium (diazepam); Ativan (lorazepam) used for both anxiety and insomnia. Others such as Klonopin (clonazepam).are used for seizures and may not readily be found in households.
As much as possible, benzodiazepines should not be used in conjunction with any other drug. In particular, they should never be used with other commonly used drugs: barbiturates, pain killer opioids, or alcohol -all of which also depress the central nervous system (brain and spinal cord). Benzodiazepines should not be combined with drugs that have central nervous system actions such as tricyclic antidepressants. If these drugs are to be combined, it should be under careful clinical care. A member of the household should not just take a “sleeping pill” or a sedative just because he or she thinks he or she needs it. Some benzodiazepines (diazepam, chlordiazepoxide) are converted to active metabolites in the body and these metabolites remain in the system making these drugs long acting. Temazepam may be more toxic than most benzo diazepines if given in high doses, for too long, or in conjunction with other drugs. The symptoms of a benzodiazepine overdose or drug-drug interaction toxicity may include; drowsiness, slurred speech, nystagmus, hypotension, impaired motor coordination, coma, suppressed breathing, and cardiorespiratory arrest which is fatal.
Impaired motor coordination or lack of voluntary coordination of muscle movements (ataxia) is a dangerous effect of overdose or toxicity due to drug-drug interaction with benzodiazepines. A person who losses control can have a car crash (or trailer crash or bus crash or train crash), machinery accident, fire accident, explosion accident, etc., and can affects not only the person but other victims and property.
Many drugs, including oral contraceptives, some antibiotics, antidepressants, and antifungal agents, inhibit liver enzymes. They reduce the rate of elimination of the benzodiazepines by liver enzymes and thus potentially can cause benzodiazepine toxicity and increase risk of benzodiazepine induced accidents and deaths. These are commonly used drugs which a person may forget that he or she is using when embarking on taking a benzodiazepine.
Benzodiazepines are a widely used and popular group of drugs but they must be kept out of reach of children and out of reach of other members of the household for whom they were not prescribed and must not be used with other drugs by those for whom they were prescribed.
Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis. For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635
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