Facts on benzodiazepines vs. barbiturates
- Benzodiazepines and barbiturates are central nervous system depressants that cause drowsiness and are used to treat insomnia and seizures.
- Benzodiazepines are also used to treat anxiety disorders, nervousness, panic disorders, muscle spasms, alcohol withdrawal, status epilepticus, premenstrual syndrome, and as sedation during surgery.
- Barbiturates are also used to treat headaches.
- Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril), and clonazepam (Klonopin).
- Common barbiturates include secobarbital (Seconal); butalbital, aspirin, and caffeine (Fiorinal); thiopental (Pentothal); and pentobarbital (Nembutal).
- Side effects of benzodiazepines and barbiturates that are similar include lightheadedness, drowsiness, nausea, and vomiting.
- Side effects of benzodiazepines that are different from barbiturates include confusion, memory problems, balance problems, changes in appetite, constipation, weight gain, dry mouth, decreased sex drive, and fatigue.
- Side effects of barbiturates that are different from benzodiazepines include dizziness, headache, and abdominal pain.
- Withdrawal symptoms may occur if you suddenly stop taking benzodiazepines or barbiturates. Withdrawal symptoms for benzodiazepines may include difficulty concentrating, sleep problems, irritability, anxiety, panic attacks, hand tremors, vomiting, palpitations, headache, muscle pain and stiffness, and perceptual changes.
- Withdrawal symptoms for barbiturates may include restlessness, agitation, anxiety, nausea, vomiting, insomnia, weakness, fast heart rate, tremors (shaking), hallucinations, or seizures.
What are benzodiazepines? What are barbiturates?
Benzodiazepines are central nervous system depressants that cause sedation (drowsiness) and are used to treat anxiety disorders, nervousness, panic disorders, muscle spasms, seizures, sleeplessness, alcohol withdrawal, status epilepticus, premenstrual syndrome, and as sedation during surgery. Benzodiazepines may work by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. Seizures, anxiety, and other conditions may be caused by excessive activity of nerves in the brain. GABA reduces the activity of nerves in the brain.
Barbiturates are central nervous depressants. They reduce the activity of nerves causing muscle relaxation. They can reduce heart rate, breathing, and blood pressure. Barbiturates affect the neurotransmitter gamma-aminobutyric acid (GABA) that nerves use to communicate with one another. Barbiturates are used to treat headaches, insomnia, and seizures.
What are the side effects of benzodiazepines and barbiturates?
Common side effects include:
- Memory impairment
- Improper body balance
- Increase or decrease in appetite
- Weight gain
- Dry mouth
- Reduced libido
Serious side effects include:
- Respiratory depression
- Dependence and abuse
- Withdrawal symptoms
- Slow heart rate
- Severe low blood pressure
- Akathisia (a movement disorder)
- Increased heart rate
Common side effects of barbiturates are:
What drugs interact with benzodiazepines and barbiturates?
Is it OK to drink alcohol or take similar drugs to benzodiazepines together (drug interactions)?
No. Combining alcohol with a benzodiazepine is very dangerous. People who drink alcohol while taking this medicine will feel the effects of alcohol faster. It's not safe to drink alcohol or take other drugs that have similar effects on the central nervous system (CNS) at the same time because these drugs or substances interact with oral benzodiazepines by causing additional depression of the brain and respiratory depression. Respiratory depression can lead to breathing that's inadequate for supplying oxygen to the body. This can cause death. Examples of these drugs and products that increase sedative side effects or the risk of respiratory depression from benzodiazepines include:
Pain medications called barbiturates that also cause respiratory depression, for example:
- morphine (MScontin)
- fentanyl (Duragesic)
- oxycodone (Oxycontin)
- hydrocodone (Zohydro ER)
- acetaminophen/hydrocodone (Vicodin, Norco, Lorcet)
Sedatives (for example, insomnia medicine) and other medicine that cause sedation, for example:
- zolpidem (Ambien, ZolpiMist)
- zaleplon (Sonata)
- eszopiclone (Lunesta
- many other drugs
Barbiturates should be used with caution with some medications because they accelerate the breakdown of these medications leading to decreased effectiveness. Examples of these medications that interact with barbiturates include:
- atazanavir (Reyataz),
- boceprevir (Victrelis),
- lurasidone (Latuda),
- ranolazine (Ranexa),
- telaprevir (Incivek),
- voriconazole, (Vfend), and
- ritonavir (Norvir).
Concomitant use of barbiturates and other central nervous system depressant medications should be used with caution because concomitant use can lead to excessive sedation, lethargy, and in severe cases coma and death. Examples of these medications that should be used with caution with other central nervous system depressant medications such as:
- alprazolam (Xanax),
- clonazepam (Klonopin),
- diazepam (Valium),
- zolpidem (Ambien), and
- zaleplon (Sonata).
Panic attacks are repeated attacks of fear that can last for several minutes.
Can I get addicted to benzodiazepines and barbiturates?
Benzodiazepines or benzos are habit forming and you can become addicted to them – even if you take them as your doctor or health care professional has prescribed. People who have a history of drug or alcohol abuse are more likely to develop an addiction to these drugs. If you use these drugs over a long period of time you can develop a tolerance for them. This means that you will need higher doses of the drug to treat your health condition or disease because you've become tolerant of the weaker formulations of the drug. These drugs may be very effective for the treatment of several conditions, for example, anxiety and insomnia; but be careful because you can become addicted to them.
The street names for benzodiazepine drugs are "Benzos" and "Downers." Drug addicts abuse these drugs to get "high." They can cause addiction similar to barbiturates (narcotic drugs like oxycodone, morphine, hydrocodone, and fentanyl), cannabinoids (marijuana), and the club drug GHB (gamma-hydroxybutyrate).
They are commonly abused by young adolescents and young adults who crush it up and snort it, or take the tablet to get high. If you abuse this medication you may have adverse effects with symptoms include:
- Disturbing or vivid dreams
Signs and symptoms that you might be addicted include:
- Problems sleeping
- Goose bumps
- Uncontrollable leg movements
- Bone and muscle pain
It is very difficult to recover from benzodiazepine addiction because these drugs change the chemistry of the brain. Contact a drug addiction treatment center if you or a loved one are suffering from a addiction. Quitting cold turkey is not likely to be successful and can be dangerous because of symptoms of withdrawal. Doctors and other health care professionals that treat addiction will formulate a taper schedule to slowly wean off the medication to reduce the severity of withdrawal symptoms during treatment.
Signs and symptoms of overdose include:
- Clammy skin
- Dilated pupils
- Rapid and weak pulse
- Shallow breathing
Barbiturates can slow breathing, reduce heart rate, and they can be habit forming.
What are the different types of benzodiazepines and barbiturates?
Examples of oral benzodiazepines are:
- alprazolam (Xanax, Xanax XR)
- clobazam (Onfi)
- clonazepam (Klonopin)
- clorazepate (Tranxene)
- chlordiazepoxide (Librium)
- diazepam (Valium, Diastat Acudial, Diastat)
- estazolam (Prosom is a discontinued brand in the US)
- lorazepam (Ativan)
- oxazepam (Serax is a discontinued brand in the US)
- temazepam (Restoril)
- triazolam (Halcion)
Formulations of benzodiazepines
All oral benzodiazepines are available in tablet forms.
- Alprazolam and clorazepate are available as extended-release tablets.
- Alprazolam, clobazam, diazepam, and lorazepam are available in oral liquid form.
- Alprazolam and clonazepam are available in orally dissolving tablets.
- Chlordiazepoxide, oxazepam, and temazepam are available in capsule form.
- Diazepam also is available as a rectal gel.
- Some benzodiazepines are available for injection.
Examples of barbiturates available in the US include:
- amobarbital (Amytal)
- butabarbital (Butisol)
- pentobarbital (Nembutal)
- secobarbital (Seconal)
- belladonna and phenobarbital (Donnatal)
- butalbital/acetaminophen/caffeine (Esgic, Fioricet)
- butalbital/aspirin/caffeine (Fiorinal Ascomp, Fortabs)
Formulations of barbiturates
- Amobarbital and pentobarbital are available as injections.
- Butabarbital, phenobarbital, belladonna and phenobarbital, butalbital/aspirin/caffeine, and butalbital/acetaminophen/caffeine are available as tablets.
- Butalbital/acetaminophen/caffeine, butalbital/aspirin/caffeine, and secobarbital are available as capsules.
- Butabarbital, phenobarbital, belladonna and phenobarbital, and butalbital/acetaminophen/caffeine are available as oral liquids.
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Are benzodiazepines and barbiturates safe to take while pregnant or breastfeeding?
- The FDA classifies benzodiazepines as pregnancy category D, which means that benzodiazepines can potentially cause fetal harm if administered to pregnant women. If benzodiazepines have to be used in pregnant women or if the patient may become pregnant while taking benzodiazepines, the patients must be informed of potential risks to the fetus.
- Benzodiazepines enter breast milk and can cause lethargy and weight loss in the newborn. Therefore, they should not be used in nursing mothers.
- FDA has listed amobarbital, phenobarbital, pentobarbital, secobarbital as Pregnancy Category D. This means they should not be used during pregnancy. FDA has listed belladonna and phenobarbital, butabarbital, butalbital/acetaminophen/caffeine, and butalbital/acetaminophen/caffeine as Pregnancy Category C. Pregnancy Category C classification means that there is no evidence of safe and effective use of barbiturates established for pregnant women.
- Therefore, risk to the infant cannot be ruled out. It is not known whether barbiturates enter breast milk; however, barbiturates should be avoided in nursing mothers to avoid harm to the infant.