benzodiazepinen

Benzodiazepines are a class of psychoactive medications that act as positive allosteric modulators of the gamma-aminobutyric acid type A (GABA-A) receptor. By enhancing the inhibitory effects of GABA, they produce sedation, anxiolysis, anticonvulsant effects, muscle relaxation and amnesia.

Medical use varies with the individual drug but typically includes short-term treatment of anxiety disorders, insomnia (short-term), prevention and management of seizures, relief of muscle spasms, and preoperative sedation or anesthesia. They are also used in the management of alcohol withdrawal and certain acute agitation states.

Pharmacokinetics differ widely within the class. Some agents are short-acting, others long-acting, with durations ranging from several hours to days. They are primarily metabolized in the liver, often forming active metabolites that extend effects. In older adults or people with liver impairment, accumulation can occur, increasing the risk of daytime sedation, cognitive impairment and falls.

Safety and risks are important considerations. Tolerance and dependence can develop with prolonged use, and withdrawal can be challenging, sometimes requiring gradual tapering. Side effects include drowsiness, impaired memory and coordination, and, when combined with other central nervous system depressants such as alcohol, an increased risk of serious respiratory depression. They are generally avoided in pregnancy and are contraindicated in some conditions such as severe respiratory insufficiency, sleep apnea and certain forms of glaucoma.

Examples commonly prescribed include diazepam, lorazepam, temazepam, alprazolam, clonazepam, oxazepam and chlordiazepoxide, with midazolam used for procedural sedation. Regulation varies by country, but clinicians emphasize using the lowest effective dose for the shortest possible duration.