Benzodiazepine Overdose

Benzodiazepines, sometimes more commonly referred to as tranquilizers, are central nervous system (CNS) depressants that can be prescribed to lessen anxiety, prevent seizures, decrease muscle spasms, induce sleep, and encourage sedation.  The effect of these drugs varies depending on the dose and the speed of action.  For example, at low doses, benzodiazepines produce a sedative (calming) effect.  At moderate doses, they can decrease anxiety, called an “anxiolytic” effect in the medical community.  High doses, by contrast, have a hypnotic or sleep-inducing result. Short-acting benzodiazepine medications include ProSom, Restoril, Halcion, and Dalmane.  Longer-acting benzodiazepines include Ativan, Xanax, Klonopin, Centrax, Doral, Tranxene, Serax, and Librium.  According to the Drug Enforcement Administration, diazepam (Valium) and alprazolam (Xanax) are the two most popular benzodiazepines purchased and sold illegally. Another benzodiazepine, Rohypnol, is not legal in the U.S. due to its association with sexual assault/date rape.

For What Reasons Might a Person Overdose on Benzodiazepines?

An overdose of benzodiazepine medications, especially in combination with other substances, can be fatal.  Therefore, benzodiazepines may be used with other drugs in intentional overdoses (i.e., suicide attempts). In general, benzodiazepine abuse is particularly common among people who are addicted to cocaine or heroin.  An accidental overdose may occur if someone who is mixing substances is unaware of the extent to which each drug is affecting them and takes more to enhance the high.  Benzodiazepine overdoses may occur among individuals with chronic insomnia or severe anxiety who are desperate for a solution to their problems and assume that a higher dose will be more effective without considering the potential for dangerous consequences.

What Are Signs of a Benzodiazepine Overdose?

A person who has overdosed on one of these drugs may have poor balance, difficulty walking, slurred speech, and trouble with memory and concentration. Depending on the amount taken and the amount of time that has passed since the overdose, the person may experience depressed (slow, shallow) breathing, coma, cardiac arrest, cold skin/hypothermia, and hypotension.

Helping Someone Who Has Overdosed on Benzodiazepines

Because of the dangers associated with benzodiazepine overdoses, it is crucial to get a person who has taken a large dose of benzodiazepines medical attention quickly. Know what drug and how much was taken before calling for help; also, try to determine if alcohol or other drugs were used as well. Cover the person with blankets to keep them warm while waiting for help to arrive. If another person is present, additional advice for your specific situation can be obtained from the National Poison Control Center by calling 1-800-222-1222.

How Benzodiazepine Overdoses Are Treated in an Emergency Department

If other substances were also ingested, a doctor may use activated charcoal, stomach pumping, or bowel irrigation.  If the patient shows signs of severe respiratory depression, intubation and artificial ventilation could be necessary.  A benzodiazepine antagonist such as flumazenil may be prescribed as an antidote; however, this depends on a number of factors including how long the patient has taken benzodiazepines, whether an ingested drug will decrease the seizure threshold, or if the patient has a seizure disorder, tachycardia, or another medical condition.