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How safe are benzodiazepines?

This summary is based on the Rapid Response Report developed by the Canadian Agency for Drugs and Technologies in Health: High dose and watchful dosing of benzodiazepines: a review of the safety and guidelines

Key Findings
  • No “watchful dose” for benzodiazepines was identified.
  • Benzodiazepines may be used in higher than 10 mg diazepam-equivalent doses in some circumstances, but data were limited.
Benzodiazepines are compounds that enhance the activity of gamma-aminobutyric acid (GABA)-A receptors by increasing the affinity of the receptors for GABA. Therefore, benzodiazepines are prescribed as anxiolytic medications. In Canada, the labeled indications include, the treatment of anxiety disorders, panic disorder, insomnia, seizure disorders, skeletal muscle spasticity, and alcohol withdrawal.
The relative safety and effectiveness of the benzodiazepines led to their widespread use. However, the use of benzodiazepines have also been associated with several adverse effects, including ataxia, dizziness, over-sedation, anterograde amnesia, and dependence. 
The current review evaluates the evidence regarding benzodiazepine dosing and the evidence supporting benzodiazepine watchful doses. Watchful doses are doses above which additional assessment and patient monitoring are required.
Key Questions
  • What is the clinical evidence for safety of high-dose (>10 mg diazepam equivalent) benzodiazepine use?
  • What is the clinical evidence regarding the safety of different watchful doses of benzodiazepines?
  • What are the evidence-based guidelines regarding watchful dosing or high-dose of benzdiazepines?


The JCDA Oasis Team is collaborating with the Canadian Agency for Drugs and Technologies in Health to provide you with the latest clinical information.

Do you need further information related to this subject? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Post a reply“ below. You are welcome to remain anonymous and your email address will not be posted.

1 Comment

  1. Haynes Darlington April 17, 2013

    The pro-drug of benzodiazepine first pass metabolism can influence the bio-availability, induced by enzyme CYP3A4.
    M. Sc. Pharm. D


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