Unwanted Side Effects

Side effects are reactions to drugs that are not therapeutic or helpful, and they are therefore unwanted. The most common side effects from taking benzodiazepine are drowsiness and tiredness, and they are most marked within the first few hours after large doses. Other complaints of this type include dizziness, headache, blurred vision, and feelings of unsteadiness. The elderly are particularly sensitive to tranquilizers and may become unsteady on their feet or even mentally confused.

The feelings of drowsiness are, of course, what is wanted with a sleeping tablet. With the longer-acting benzodiazepines and with higher doses of medium-duration or with short-acting drugs, drowsiness can still be present the morning after taking a sleeping tablet; the drowsiness may even persist into the afternoon. The elderly are more likely to experience such residual, or ''hang-over,'' effects.

As well as these feelings of sedation, special testing in a psychology laboratory indicates that alertness, coordination, performance at skilled work, mental activities, and memory can all be impaired. Patients should be warned about this, and advised not to drive or operate machinery, at least initially until the effects of the benzodiazepine can be assessed and the dosage adjusted if necessary. If driving is essential—that is, to the patient's livelihood—small doses of the benzodiazepines should be taken at first and the amount built up gradually under medical supervision. Judgment and memory are often impaired early in treatment, so important decisions should be deferred.

As with many drugs affecting the brain, benzo-diazepines can interact with other drugs, especially ALCOHOL. People taking tranquilizers or hypnotics should not also drink alcoholic beverages. Other drugs whose effects may be enhanced include anti-histamines (such as for hay fever), painkillers, and antidepressants. Cigarette smoking may lessen the effect of some benzodiazepines.

Patients taking benzodiazepines may show so-called paradoxical responses—that is to say, the effects produced are the opposite of those intended. Feelings of anxiety may heighten rather than lessen, insomnia may intensify, or, more disturbing, patients may feel hostile and aggressive. They may engage in uncharacteristic criminal activities, sexual improprieties or offenses such as importuning or self-exposure, or show excessive emotional responses such as uncontrollable bouts of weeping or giggling. All these are signs of the release of inhibitions, and they are also characteristic of alcohol effects in some people. Although these paradoxical effects may not last long, it is better to stop the benzodiazepine.

Benzodiazepines can affect breathing in individuals who already have breathing problems, such as with bronchitis. Other side effects that may be occasionally encountered include excessive weight gain, rash, impairment of sexual functioning, and irregularities of menstruation. Benzodiazepines should be avoided during pregnancy whenever possible, as there may be a risk to the fetus. Given during childbirth, benzodiazepines pass into the unborn infant and may depress the baby's breathing after birth. They also pass into the mother's milk and may sedate the suckling baby too much. Many people have taken an overdose of a tranquilizer as a suicidal attempt or gesture. Fortunately, these drugs are usually quite safe and the person wakes up unharmed after a few hours' sleep.

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