Elderly people are more susceptible to side effects and should usually start at half the dose prescribed for younger people. Of great concern are studies showing automobile accidents and a high risk for hip fractures from falls in older people who take benzodiazepines. They are associated with birth defects, and should not be used by pregnant women or nursing mothers. The primary problem with these drugs is their loss of effectiveness over time with continued use at the same dosage. As a result, patients may require increasing doses to prevent anxiety.
Dependence is a common danger, which can occur after as short a time as three months.
People who discontinue benzodiazepines after taking them for long periods may experience rebound symptoms, sleep disturbance and anxiety, which can develop within hours or days after stopping the medication. Some patients experience withdrawal symptoms, including stomach distress, sweating, and insomnia, that can last from one to three weeks. As with benzodiazepines, opiates such as codeine, oxycodone, methadone, or propoxyphene have been prescribed for severe cases. Tramadol is an agent with fewer adverse effects and less potential for addiction than opiates. In one small study, the drug was very effective for RLS with few or no side effects.