Benzodiazepines Guidelines for the rational use of benzodiazepines. When and what to use by Ashton H Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, England. Rational use requires consideration of the large differences in potency and elimination rates between different benzodiazepines, as well as the requirements of individual patients. As hypnotics, benzodiazepines are mainly indicated for transient or short term insomnia, for which prescriptions should if possible be limited to a few days, occasional or intermittent use, or courses not exceeding 2 weeks. Temazepam, loprazolam and lormetazepam, which have a medium duration of action are suitable.
Diazepam is also effective in single or intermittent dosage.
Potent, short-acting benzodiazepines such as triazolam appear to carry greater risks of adverse effects. Indications for benzodiazepines include acute stress reactions, episodic anxiety, fluctuations in generalised anxiety, and as initial treatment for severe panic and agoraphobia. Alprazolam has been widely used, particularly in the US, but is not recommended in the UK, especially for long term use. The major clinical advantages of benzodiazepines are high efficacy, rapid onset of action and low toxicity. Adverse effects include psychomotor impairment, especially in the elderly, and occasionally paradoxical excitement.