The benzodiazepines are 'calmers'. They help to calm you down and can make you sleepy. They are therefore used to help to treat, but not cure, the symptoms of:

• Anxiety

They may also help the symptoms of:

• Psychiatric emergency (with antipsychotics)
• Dementia
• Epilepsy (for their anticonvulsant effects, including for status epilepticus)
• Insomnia
• Mania (usually with antipsychotics or mood stabilisers)
• Panic disorder
• Social anxiety

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When you are anxious, your brain becomes more active. Your brain may produce a chemical messenger (or "neurotransmitter")called Gamma-aminobutyric acid (or GABA) which makes you feel calmer. GABA is thebrains naturally occurring "calmer". Thebenzodiazepines make the action of GABA more powerful and this helps calm the brain down.

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Tablets and capsules: Tablets and capsules should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat.

Liquids: Your pharmacist should give you a medicine spoon. Use it carefully to make sure you measure the correct amount. (Ask your pharmacist for a medicine spoon if you do not have one). Shake the bottle well before use as the drug can settle to the bottom and cause you to receive a lower dose at the start and too high a dose at the end of the bottle.

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Take your benzodiazepine as directed on the medicine label. Try to take them at regular times each day. Taking them at meal times may make it easier to remember as there is no problem about taking any of these drugs with or after food. If the instructions say to take them once a day this is usually best at bedtime as they should make you drowsy and help you to sleep.

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They should start to work fairly soon after you start to take them. After that your doctor may need to change the dose to suit you.

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This should be discussed with your doctor as different people respond differently. Benzodiazepines are very safe drugs if used sensibly. They are best taken in as low a dose as possible for a short time e.g. as a "first aid" measure. Usually this should be no longer than about one month to help you get over your problems and for other treatments to start working. If you need to take them for longer you should discuss this regularly with your doctor. Some people with long-term problems may need to take them for longer.

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Due to the effects that benzodiazepines have on the brain they can produce withdrawal or discontinuation symptoms in some people who have taken them regularly every day for more than about 4 to 6 weeks. About 1 in 3 people get no symptoms, about 1 in 3 get some that last for a few weeks, and about 1 in 3 people get more marked symptoms. In the worst cases the symptoms from stopping benzodiazepines quickly could include anxiety, tension, panic attacks, poor concentration, difficulty in sleeping, nausea, trembling, palpitations, sweating and pains and stiffness in your face, head and neck (not unlike anxiety itself). These withdrawal symptoms could occur several days after stopping your benzodiazepine. They may last from one to three weeks but can go on for months, and are more likely with alcohol dependence. If you have taken a benzodiazepine for a long period you should stop it slowly over several weeks or months. This is best done by reducing your dose a little every few weeks and will reduce the chance of withdrawal effects.

It is also true to say that many people get no withdrawal symptoms when they stop benzodiazepines, even if they have been taking them for many years. You should thus make sure that you discuss your particular treatment with your doctor.

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It is best not to stop taking them suddenly if you have been taking them regularly every day for more than about 4 to 6 weeks. If you do, you may get some of the withdrawal effects mentioned above. If you take them only when really necessary (e.g. for 1 or 2 weeks during a severe attack of anxiety and then have several weeks without them) this is better than taking them all the time and can prevent you becoming addicted. You should talk about this with your doctor.

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Start again as soon as you remember unless it is almost time for your next dose. Do not try to catch up by taking two or more doses at once as you may get more side-effects e.g. sleepiness. If you miss several doses start again when you remember. Tell your doctor about this next time you meet.

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Use the information in the table below to find out about side effects associated with benzodiazepines.

Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission www.ukppg.org.uk

Do not be worried by this list of side effects. You may get none at all. There are other rare side-effects. If you develop any unusual symptoms ask your doctor about them next time you meet.

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Depending on the dose these drugs should help to calm you down but they can calm you down too much and send you to sleep! At a usual dose they may make you feel a bit drowsy anyway. If you are taking them at night you may feel drowsy the next morning so you should not drive (see below) or operate machinery until you know how they affect you. You should be careful as they may affect your reaction times.

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It is not thought that the benzodiazepines cause any changes in weight. If, however, you do start to have problems with your weight tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

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Benzodiazepines do not have any known significant effects. Drowsiness may have some effect. In some people, reduced anxiety may be an advantage.

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If you drink alcohol while taking a benzodiazepine, it will make you feel much more sleepy. This is very important if you need to drive or operate machinery. It may make it more difficult to keep you car on the road. You must seek advice on this. Benzodiazepines and alcohol can slow your reflexes or reaction times. They can also increase the effects of alcohol and so it is best to avoid alcohol.

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The benzodiazepines have a few interaction with other medicines:

• The sedating effects of benzodiazepines can be increased by any other drug causing sedation e.g. alcohol, antihistamines (e.g. promethazine), barbiturates (e.g. phenobarbital), opioids (e.g. codeine, morphine), ritanovir, tricyclics (e.g. dosulepin, imipramine, lofepramine), antipsychotics (e.g. olanzapine, quetiapine, clozapine), mianserin, mirtazapine, pregabalin, cannabis, beta-blockers (e.g. propranolol, atenolol), calcium-channel blockers (e.g. diltiazem, verapamil), itraconazole, ketoconazole, omeprazole, sodium valproate or disulfiram.
• The effects of benzodiazepines can sometimes be decreased by caffeine, aminophylline or theophylline

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions. 

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You should have no problems with "The Pill" and any of the benzodiazepines.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups: # A = Studies show no risk, so harm to the unborn child appears only a remote possibility B = Animal and human studies indicate a lack of risk but are not fully conclusive C = Animal studies indicate a risk but there is no safety data in humans D = a definite risk exists but the benefit may outweigh the risk in some people X = the risk outweighs any possible benefit

The benzodiazepines are classified as follows: alprazolam "D", chlordiazepoxide "D", clonazepam "C", diazepam "D", lorazepam "D" and oxazepam "D". The others are not classified. Although some studies have shown a slightly increased chance of abnormalities with benzodiazepines, alcohol and other drug use may have been the reason for this. The risk of oral clefts is reported to be about 7 in 1000 births with diazepam. Occasional use of shorter-acting benzodiazepines would appear to have a very low risk. Regular use of longer-acting benzodiazepines (e.g. chlordiazepoxide, diazepam) may also lead to some short-term breathing difficulties in newborn babies, and some withdrawal effects e.g. the floppy baby syndrome. You should seek personal advice from your GP, who may then if necessary seek further specialist advice.

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You will not need to have a blood test to check on your benzodiazepine.

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The benzodiazepines can reduce your ability to carry out skilled tasks such as driving or operating machinery. You may also feel drowsy the day after you take them. Until these effects wear off or you know how your drug affects you do not drive or operate machinery. You should be careful as they may affect your reaction times.

Under Section 4 of the Road Traffic Act 1988 anyone driving while unfit to drive, due to illness or any drug, can be prosecuted. Under UK law it does not matter if the drug is a prescribed medicine or an illegal drug. It’s the effect on your driving that is the main thing. If your ability to drive might be reduced due to illness or medicines, under UK law you must let your insurance company know. If you don’t, the insurance might say this is as 'withholding a material fact' (ie not telling them something they ought to know) and might mean that if you have an accident they might not pay up. Your doctor will be able to advise you.

Medical rules for all drivers:
For the full story click here (opens in new window) and go to "Medical standards". Here there is a pdf document (regularly updated) called "At a glance guide to the current medical standards of fitness to drive" that can be downloaded. It is aimed at medical practitioners (GPs).
For the "Customers guide" (ie a guide for the general public) click here (opens in new window) and download the 'Customer service guide for drivers with medical conditions'.

How to tell the UK DVLA:
If you need to tell the DVLA and you already have a license, you need to download the medical questionnaire from the DVLA website. Or you can call the DVLA to ask them to send it to you. You also need to fill out a form to give your consent for doctors from the DVLA doctors to contact your doctor or a specialist. You can either post, fax or email these forms back to:
Drivers Medical Group, DVLA, Swansea, SA99 1TU
Tel: 0870 600 0301
Fax: 0845 850 0095
Email: eftd@dvla.gsi.gov.uk
Web www.direct.gov.uk/motoring (opens in new window)
You should always allow DVLA to contact your doctor, as what your doctor says will help the DVLA decide if you can keep your license. Rarely, the DVLA may ask you to have a (free) medical examination, which will be free. This is called a medical enquiry.

What happens next
If you give the DVLA all the information they need, they can usually sort things out within 15 days. If they need more information from you, your doctor or other sources, they will try to sort it out within 90 days. What they decide will also depend on what you’re doing e.g. driving a bus is different to driving down to the shops. What can happen includes:

• You may be able to keep your license or be issued with a new one.
• If the DVLA’s doctor thinks your fitness to drive needs to be reviewed again, you may be given a license valid for 1, 2 or 3 years.
• Your license may be taken from you (revoked) or your application refused. This will only happen if you do not meet the standards of fitness to drive at the moment. If this happens, you would be told the reasons for the decision. You would also be told when you can apply again.

Driving safely
If you want to carry on driving, you must take sensible steps to reduce any risk:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make an drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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