Many beneficial effects of<unk>  (e.g., sedative, muscle relaxant, anti-anxiety, and amnesic effects) may become adverse effects when unwanted. Adverse effects can include sedation and low blood pressure; the effects of<unk>  are increased in combination with other CNS depressant drugs. Other adverse effects include confusion, ataxia, inhibiting the formation of new memories, pupil constriction and hangover effects. With long-term benzodiazepine use it is unclear whether cognitive impairments fully return to normal after stopping<unk>  use; cognitive deficits persist for at least six months after withdrawal, but longer than six months may be required for recovery of cognitive function.<unk>  appears to have more profound adverse effects on memory than other benzodiazepines; it impairs both explicit and implicit memory. In the elderly, falls may occur as a result of benzodiazepines. Adverse effects are more common in the elderly, and they appear at lower doses than in younger people. Benzodiazepines can cause or worsen depression. Paradoxical effects can also occur, such as worsening of seizures, or paradoxical excitement; paradoxical excitement is more likely to occur in the elderly, children, those with a history of alcohol abuse, and in people with a history of aggression or anger problems.<unk> 's effects are dose-dependent, meaning the higher the dose, the stronger the effects (and side effects) will be. Using the smallest dose needed to achieve desired effects lessens the risk of adverse effects. Sedative drugs and sleeping pills, including<unk> , have been associated with an increased risk of death. Sedation is the side effect people taking<unk>  most frequently report. In a group of around 3,500 people treated for anxiety, the most common side effects complained of from<unk>  were sedation (15.9%), dizziness (6.9%), weakness (4.2%), and unsteadiness (3.4%). Side effects such as sedation and unsteadiness increased with age. Cognitive impairment, behavioural disinhibition and respiratory depression as well as hypotension may also occur. * Paradoxical effects: In some cases, paradoxical effects can occur with benzodiazepines, such as increased hostility, aggression, angry outbursts, and psychomotor agitation. These effects are seen more commonly with<unk>  than with other benzodiazepines. Paradoxical effects are more likely to occur with higher doses, in people with pre-existing personality disorders and those with a psychiatric illness. Frustrating stimuli may trigger such reactions, though the drug may have been prescribed to help the person cope with such stress and frustration in the first place. As paradoxical effects appear to be dose-related, they usually subside on dose reduction or on complete withdrawal of<unk> . * Suicidality: Benzodiazepines are associated with increased risk of suicide, possibly due to disinhibition. Higher dosages appear to confer greater risk. * Amnesic effects: Among benzodiazepines,<unk>  has relatively strong amnesic effects, but people soon develop tolerance to this with regular use. To avoid amnesia (or excess sedation) being a problem, the initial total daily<unk>  dose should not exceed 2 mg. This also applies to use for night sedation. Five participants in a sleep study were prescribed<unk>  4 mg at night, and the next evening, three subjects unexpectedly volunteered memory gaps for parts of that day, an effect that subsided completely after two to three days' use. Amnesic effects cannot be estimated from the degree of sedation present, since the two effects are unrelated. * High-dose or prolonged parenterally administered<unk>  with its associated solvent can cause propylene glycol intoxication and poisoning. In September 2020, the U.S. Food and Drug Administration (FDA) required the boxed warning be updated for all benzodiazepine medicines to describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class. Contraindications<unk>  should be avoided in people with: * Allergy or hypersensitivity – Past hypersensitivity or allergy to<unk> , to any benzodiazepine, or to any of the ingredients in<unk>  tablets or injections * Respiratory failure – Benzodiazepines, including<unk> , may depress central nervous system respiratory drive and are contraindicated in severe respiratory failure. An example would be the inappropriate use to relieve anxiety associated with acute severe asthma. The anxiolytic effects may also be detrimental to a person's willingness and ability to fight for breath. However, if mechanical ventilation becomes necessary,<unk>  may be used to facilitate deep sedation. * Acute intoxication –<unk>  may interact synergistically with the effects of alcohol, narcotics, or other psychoactive substances. It should, therefore, not be administered to a drunk or intoxicated person. * Ataxia – This is a neurological clinical sign, consisting of unsteady and clumsy motion of the limbs and torso, due to the failure of gross muscle movement coordination, most evident on standing and walking. It is the classic way in which acute alcohol intoxication may affect a person. Benzodiazepines should not be administered to people already-ataxic. * Acute narrow-angle glaucoma –<unk>  has pupil-dilating effects, which may further interfere with the drainage of aqueous humor from the anterior chamber of the eye, thus worsening narrow-angle glaucoma. * Sleep apnea – Sleep apnea may be worsened by<unk> 's central nervous system depressant effects. It may further reduce the person's ability to protect his or her airway during sleep. * Myasthenia gravis – This condition is characterized by muscle weakness, so a muscle relaxant such as<unk>  may exacerbate symptoms. * Pregnancy and breastfeeding –<unk>  belongs to the Food and Drug Administration (FDA) pregnancy category D, which means it is likely to cause harm to the developing baby if taken during the first trimester of pregnancy. The evidence is inconclusive whether<unk>  if taken early in pregnancy results in reduced intelligence, neurodevelopmental problems, physical malformations in cardiac or facial structure, or other malformations in some newborns.<unk>  given to pregnant women antenatally may cause floppy infant syndrome in the neonate, or respiratory depression necessitating ventilation. Regular<unk>  use during late pregnancy (the third trimester), carries a definite risk of benzodiazepine withdrawal syndrome in the neonate. Neonatal benzodiazepine withdrawal may include hypotonia, reluctance to suck, apneic spells, cyanosis, and impaired metabolic responses to cold stress. Symptoms of floppy infant syndrome and the neonatal benzodiazepine withdrawal syndrome have been reported to persist from hours to months after birth.<unk>  may also inhibit fetal liver bilirubin glucuronidation, leading to neonatal jaundice.<unk>  is present in breast milk, so caution must be exercised about breastfeeding. Specific groups * Children and the elderly – The safety and effectiveness of<unk>  is not well determined in children under 18 years of age, but it is used to treat acute seizures. Dose requirements have to be individualized, especially in people who are elderly and debilitated in whom the risk of oversedation is greater. Long-term therapy may lead to cognitive deficits, especially in the elderly, which may only be partially reversible. The elderly metabolize benzodiazepines more slowly than younger people and are more sensitive to the adverse effects of benzodiazepines compared to younger individuals even at similar plasma levels. Additionally, the elderly tend to take more drugs which may interact or enhance the effects of benzodiazepines. Benzodiazepines, including<unk> , have been found to increase the risk of falls and fractures in the elderly. As a result, dosage recommendations for the elderly are about half of those used in younger individuals and used for no longer than two weeks.<unk>  may also be slower to clear in the elderly, leading potentially to accumulation and enhanced effects.<unk> , similar to other benzodiazepines and nonbenzodiazepines, causes impairments in body balance and standing steadiness in individuals who wake up at night or the next morning. Falls and hip fractures are frequently reported. The combination with alcohol increases these impairments. Partial, but incomplete, tolerance develops to these impairments. * Liver or kidney failure –<unk>  may be safer than most benzodiazepines in people with impaired liver function. Like oxazepam, it does not require liver oxidation, but only liver glucuronidation into<unk> -glucuronide. Therefore, impaired liver function is unlikely to result in<unk>  accumulation to an extent causing adverse reactions. Similarly kidney disease has minimal effects on<unk>  levels. * Surgical premedication – Informed consent given only after receiving<unk>  premedication could have its validity challenged later. Staff must use chaperones to guard against allegations of abuse during treatment. Such allegations may arise because of incomplete amnesia, disinhibition, and impaired ability to process cues. Because of its relatively long duration of residual effects (sedation, ataxia, hypotension, and amnesia),<unk>  premedication is best suited for hospital inpatient use. People should not be discharged from the hospital within 24 hours of receiving<unk>  premedication unless accompanied by a caregiver. They should also not drive, operate machinery, or use alcohol within this period. * Drug and alcohol dependence – The risk of abuse of<unk>  is increased in dependent people. *Comorbid psychiatric disorders also increase the risk of dependence and paradoxical adverse effects. Tolerance and dependence Dependence typified by a withdrawal syndrome occurs in about one-third of individuals who are treated for longer than four weeks with a benzodiazepine. Higher doses and longer periods of use increase the risk of developing a benzodiazepine dependence. Potent benzodiazepines with a relatively short half life,
Lorazepam
Halazepam
Oxazepam
Quazepam
Gidazepam
Triazolam
Nimetazepam
Nordazepam