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Benzodiazepines Tablets and Capsules

Benzodiazepines Fact Card

  • Drug Class:
    CNS Depressant, Sedative, Hypnotic, Anxiolytic, Preanesthetic, Anticonvulsant, Antispasmodic
  • DEA Class:
    Schedule 4
  • Availability in US:
    Prescription Forms
  • Synonyms:
    Benzos, Depressants, Sedatives, Sleeping Pills, Anxiety Pills, Tranquilizers
  • Generic Names:
    Adinazolam, Alprazolam, Bromazepam, Camazepam, Chlordiazepoxide, Climazolam, Clobazam, Clonazepam, Clorazepate, Cloxazolam, Delorazepam, Diazepam, Estazolam, Fludiazepam, Flunitrazepam, Flurazepam, Halazepam, Haloxazolam, Ketazolam, Loprazolam, Lorazepam, Lormetazepam, Medazepam, Midazolam, Nimetazepam, Nitrazepam, Nordiazepam, Oxazepam, Oxazolam, Pinazepam, Prazepam, Quazepam, Temazepam, Tetrazepam, Triazolam
  • Brand Names:
    Alprazolam Intensol (Alprazolam), Ativan (Lorazepam), Diastat (Diazepam), Diazepam Intensol (Diazepam), Gen-Xene (Clorazepate), Halcion (Triazolam), Klonopin (Clonazepam), Librax (Chlordiazepoxide), Librium (Chlordiazepoxide), Lorazepam Intensol (Lorazepam), Onfi (Clobazam), Restoril (Temazepam), Rohypnol (Flunitrazepam), Seizalam (Midazolam), Tranxene (Clorazepate), Valium (Diazepam), Xanax (Alprazolam)
  • Street Names:
    Benzos, Nerve Pills, Tranks, Bars (Xanax), Footballs (Xanax), Xannies (Xanax), Vals (Valium), Klonnies (Klonopin), Pins (Klonopin), Lorries (Lorazepam), Date Rape Drug (Rohypnol), Ruphies (Rohypnol)

What are benzodiazepines?

Benzodiazepines are a class of CNS depressant drugs, highly sought after by medical patients and recreational users — most notably alprazolam, lorazepam, diazepam, clonazepam, chlordiazepoxide, and flunitrazepam. Many other benzodiazepines have been synthesized or marketed over the past century. However, the large majority of them are either no longer manufactured or not available in the US.

Benzodiazepines are prescribed for a number of medical purposes: as sedatives, as anxiolytics for treating anxiety and panic disorders, as hypnotics for treating insomnia, as anticonvulsants, as antispasmodics, as preanesthetics to reduce anxiety prior to surgery, and to assist with severe alcohol withdrawal symptoms — most notably under the brand names Xanax, Ativan, Diazepam, Klonopin, Librium, Rohypnol, and many generic labels. Benzodiazepines are highly addictive and are abused for their euphoric effects and their ability to induce sleep.

Diazepam Tablets
Diazepam Tablets

Benzodiazepines Types

Benzodiazepines are produced commercially, available only by prescription and for use by licensed medical facilities. They are found in the form of oral tablets and capsules, in a variety of shapes and colors — most notably Xanax bars (rectangular, bar-shaped tablets) and Xanax footballs (oval, football-shaped tablets). Benzodiazepines are also found in the form of oral solutions and syrups, injectable forms, and rectal gels. Street benzodiazepines are licitly manufactured benzodiazepines that are either diverted prescriptions or the subjects of another form of diversion.

Chlordiazepoxide Capsules
Chlordiazepoxide Capsules

Onset and Duration of Action

Benzodiazepines are commonly divided into groups based on the onset and duration of their action. [1]

  • Short-acting benzodiazepines: Alprazolam, Midazolam, Oxazepam, Triazolam

  • Medium-acting benzodiazepines: Estazolam, Lorazepam, Temazepam

  • Long-acting benzodiazepines: Chlordiazepoxide, Clobazam, Clonazepam, Clorazepate, Diazepam, Flurazepam

Short-acting benzodiazepines are generally more attractive to recreational users because they provide quicker results. In addition, short-acting benzodiazepines are believed to cause more issues with drug tolerance, dependence, and severity and length of withdrawal symptoms when use of the drug is discontinued. [1]

What are the effects of benzodiazepines?

Benzodiazepines produce varying levels of relaxation, euphoria, drowsiness, and/or unconsciousness, depending on the specific drug and dose. In general, lower doses or less potent benzodiazepines may produce euphoric or sedative effects — while higher doses or more potent benzodiazepines may produce hypnotic, sleep-inducing effects. When high doses are consumed, the threat of death by overdose is a concern, especially when benzodiazepines are combined with alcohol or other drugs[2]

Benzodiazepine Abuse and Addiction

The euphoric and sedative properties of benzodiazepines make them an attractive choice for recreational users. Such users typically procure the drug, directly or indirectly, from individuals possessing legitimate prescriptions. The hypnotic properties of benzodiazepines make them attractive to those seeking help with sleeping. Benzodiazepines are often abused in combination with CNS stimulant drugs, such as cocaine, amphetamine, or methamphetamine, either to help neutralize the effects of the stimulant drug or to expedite sleep. [3] Abusers of opioids such as oxycodone are likely to combine the opioid with a benzodiazepine in attempt to enhance the effects of the opioid. When potent CNS drugs are combined in such fashions, or when combined with alcohol, results can be unpredictable and at worst fatal. [2]

Benzodiazepines are highly addictive and prone to a high degree of physical dependence. For the benzodiazepines addicted attempting abstinence, withdrawal symptoms can be debilitating and long lasting, often requiring professional assistance.

Urine Testing for Benzodiazepines

Benzodiazepines urine tests target oxazepam, with possible cross-reactivity for a lengthy list of different benzodiazepines and metabolites, including alprazolam and lorazepam glucuronide. Alprazolam is prominent as unchanged parent drug in the urine of those ingesting alprazolam[4] Lorazepam glucuronide is prominent as a metabolite in the urine of those ingesting lorazepam[5]

Benzodiazepines Drug Test
Benzodiazepines Drug Test

In a study published in the Journal of Analytical Toxicology, patients receiving alprazolam (Xanax) submitted urine samples for screening. At 48 hours, approximately 20% of alprazolam doses were recovered in the urine as unchanged alprazolam[4]

In a review published in the Journal of Clinical Psychiatry, it was reported that 70–75% of a lorazepam dose is recovered in the urine as lorazepam glucuronide. [5]

Most benzodiazepines are extensively metabolized and excreted primarily as a conjugated form of the drug, with trace amounts of free, unchanged parent drug appearing in the urine. [6]

Related Pages

References

Links for references open in a new tab or window.

  1. "Benzodiazepines: Overview and Use". Drugs.com. Retrieved Dec 2, 2018, from: https://www.drugs.com/article/benzodiazepines.html
  2. Jones JD, Mogali S, Comer SD. (2012, Sep 1). "Polydrug Abuse: A Review of Opioid and Benzodiazepine Combination Use". Drug and Alcohol Dependence, 125(1–2): 8–18. PMCID:PMC3454351, [PDF file]
  3. Weaver MF. (2015, Sep 3). "Prescription Sedative Misuse and Abuse". Yale Journal of Biology and Medicine, 88(3): 247–256. PMCID:PMC4553644, [PDF file]
  4. Fraser AD, Bryan W, Isner AF. (1991, Jan/Feb). "Urinary Screening for Alprazolam and Its Major Metabolites by the Abbott ADx and TDx Analyzers with Confirmation by GC/MS". Journal of Analytical Toxicology, 15(1): 25–29. PMID:2046338
  5. Kyriakopoulos AA, Greenblatt DJ, Shader RI. (1978, Oct). "Clinical Pharmacokinetics of Lorazepam: A Review". Journal of Clinical Psychiatry, 39(10 Pt 2): 16–23. PMID:30762
  6. Karch SB (Ed). (2008). "Pharmacokinetics and Pharmacodynamics of Abused Drugs" (pp 36–38). Boca Raton, FL: CRC Press. Retrieved from: https://www.crcpress.com/Pharmacokinetics-and-Pharmacodynamics-of-Abused-Drugs/Karch-MD-FFFLM/p/book/9781420054583

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