FACT SHEET TWELVE

TRANQUILLISERS

Tranquillisers are the common name given to a family of drugs whose generic clinical name is benzodiazepine. All the benzodiazepines are basically similar in composition and effect, though some are formulated in stronger doses and some are longer acting than others. This family of drugs is commonly prescribed in General Practice to alleviate feelings of anxiety and stress, insomnia and, more rarely, the side effects of withdrawal from alcohol. 

When they were first produced, they seemed to offer a safe and effective way of tackling anxiety, however it was soon realised that these new tranquillisers presented hazards of their own; firstly because they are dependence-forming and secondly because withdrawal from these drugs can induce the very symptoms they were intended to relieve.

The British Formulary gives the following advice to doctors:

1. Benzodiazepines may be prescribed 'for short-term relief (2-4wks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness'

2. The use of benzodiazepines to treat short-term 'mild' anxiety is inappropriate and unsuitable.

3. Benzodiazepines should be used to treat insomnia only when it is severe, disabling or subjecting the individual to extreme distress.

4. In bereavement, psychological adjustment may be inhibited by benzodiazepines

5. Anxiolytic (anxiety reducing) treatment should be limited to the lowest possible dose for the shortest possible time. Dependence is particularly likely in patients with a history of alcohol or drug abuse and in patients with marked personality disorders.

THE BENZODIAZEPINE FAMILY has many members, each of which has both a chemical name and at least one proprietary name. Some of the most common ones are listed below, but there are many others. If you suspect that a drug that has been prescribed is a benzodiazepine, ask your GP or pharmacist.

HYPNOTICS (SLEEPING TABLETS)

NITRAZEPAM (Mogadon) Insomnia, short-term use

FLUNITRAZEPAM (Rohypnol) short-term use

FLURAZEPAM (Dalmane) short-term use

(all the above have prolonged action with residual effects the following day, repeated doses tend to be cumulative)

LORMETAZEPAM (Noctamid) short-term use

TEMAZEPAM (Normison/Euhypnos) short-term use

LOPRAZOLAM short-term use

(These three act for a shorter time with little or no hangover effect, withdrawal effects are more common with short acting benzodiazepines)

ANXIOLYTICS (ANXIETY REDUCING DRUGS)

DIAZEPAM (Valium) Anxiety, insomnia, adjunct in acute alcohol withdrawal and epilepsy

ALPRAZOLAM (Xanax) Anxiety, short-term use

BROMAZEPAM (Lexotan) Anxiety, short-term use

CHLORDIAZEPOXIDE (Librium) Anxiety, short-term use, adjunct in acute alcohol withdrawal

CLOBAZAM (Frisium) Anxiety, short-term use, used as adjunct in epilepsy

CLORAZEPATE (Tranxene) Anxiety, short-term use, has a sustained action

MEDAZEPAM (Nobrium) Anxiety, short-term use, has a sustained action

LORAZEPAM (Ativan) Anxiety, insomnia, status epilepsy. It may be preferred in patients with hepatic impairment, but it carries a greater risk of withdrawal

OXAZEPAM (Serenid) Anxiety, short-term use

WARNING SHORT-TERM USE: COMMON SIDE EFFECTS ARE:

1. Impairment of judgement and dexterity. Tranquillisers may affect driving.

2. 'Paradoxical' responses e.g.. mood swings, anxiety.

3. Breathing difficulties in people with pre-existing respiratory complaints

4. Use during pregnancy can cause foetal abnormalities

5. There may be some memory

6. Tranquillisers potentiate (enhance and increase) the effect of alcohol and other CNS depressants, therefore it is dangerous to mix tranquillisers and alcohol! (and some other drugs)

ILLEGAL USES AND LEGAL ISSUES

Because of the interaction between alcohol and benzodiazepines, and the relative cheapness of the latter, there is a growing incidence of abuse and cross-addiction. Benzodiazepines are also used with heroin, amphetamines or cocaine and are sometimes injected in liquid form.

All benzodiazepines are available only on prescription (Medicines act 1968). Unauthorised supplying is an offence (Misuse of drugs act 1971) This means that giving tranquillisers to a friend or relative is a criminal offence.

WARNING LONG-TERM USE:

BENZODIAZEPINES ARE DEPENDENCE FORMING. People who take them for more than a few weeks are at risk of becoming addicted. There is no reliable evidence to suggest that Benzodiazepines continue to lessen anxiety on a long-term basis. Indeed, it seems that the body develops a tolerance to them and adjusts after a few weeks to produce its 'normal' level of anxiety.

Withdrawal from prolonged benzodiazepine use commonly produces a range of unpleasant reactions. Mild withdrawal symptoms are : Increased anxiety, inattention, irritability, insomnia, loss of appetite and loss of weight. Severe withdrawal symptoms can include: Panic attacks, stomach cramps, disorientation, fits and severe paranoid states, sudden withdrawal can be life-threatening. The severity of withdrawal effects is not reliably predictable. It depends on individual metabolism, the strength and duration of effect of the drug, the length of time the drug has been used and the person's attitude to withdrawal. ANYONE WISHING TO WITHDRAW FROM TRANQUILLISER USE SHOULD SEEK MEDICAL ADVICE AND SUPERVISION. GP's can supervise patients on a reducing regime. They can also advise and refer for specialist treatment, patients who are cross-addicted to benzodiazepines and alcohol.

Withdrawal is not merely a question of reducing levels of the drug in the bloodstream. People trying to 'come-off' invariably feel anxious, want more information and would benefit from the support of health care professionals or other people who have had similar problems. Below is a list of useful contacts. 

PEOPLE CONCERNED ABOUT TRANQUILLISERS CAN GET HELP nationally from:

MIND, Granta House, 15-19 Broadway, Stretford, London E15 4BQ

Tel 0208 519 2122

and locally from

Your GP

Radford Tranx Helpline 0115 970 3100 (Mon, Wed, Fri 10.30am-2.30pm)

Tranx release Helpline 0115 930 4287 (Mon-Fri 10am-3pm)

West Bridgford Tranx Helpline 0115 981 3586 (Mon-Fri 9am-9pm & Sat 11am-4pm)

ADVICE FOR PEOPLE WHO USE TRANQUILLISERS

apas has telephone advice workers on hand to provide information on tranquilliser and alcohol addiction. For further information Contact apas.