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Long-acting benzodiazepines with long-acting active metabolites, such as diazepam and chlordiazepoxide, are often prescribed for benzodiazepine or alcohol withdrawal as well as for anxiety if constant dose levels are required throughout the day.
“Half-life” is a measure of how long it takes until half of the drug becomes inactivated. Since several of the benzos are metabolized into other benzos, to understand the full impact of a benzo, you must include its active (benzo-like) metabolites, as this table does.
Some are long-acting and last several days. Most long-acting benzodiazepines aren’t as strong. The strength and duration of action of benzodiazepines are important in what conditions they treat.
All benzodiazepines work in a similar way but there are differences in the way individual benzodiazepines act on different GABA-A receptor sub-types. In addition, some benzodiazepines are more potent than others or work for a longer length of time.
Visual disturbances may include diplopia (“double vision”), cyclic eyelid movement, loss of balance, and difficulty focusing the eyes on objects. Long-term use of benzodiazepines can lead to cognitive impairment.
Some benzodiazepines act on your brain and body for longer than others. The half-life of each drug is a helpful way to understand how long a drug’s effects may last. Short-acting benzodiazepines have a shorter half-life. This means that the drugs are processed and leave your body more quickly.
Long-acting BZDs are also used to taper, and eventually discontinue, short-acting, chronic BZD usage. Like alcohol, abrupt withdrawal of the sedative action of BZDs on GABA causes hyperstimulation of the autonomic nervous system with similar associated symptoms and signs.
Some benzodiazepines (diazepam, chlordiazepoxide) have active metabolites that remain in the system for an extended period (long-acting), and this can be problematic for patients, especially older patients.
Although beneficial for the acute relief of anxiety, long-term use of benzodiazepines is not recommended due to the risk of dependence. Although tolerance to the anxiolytic effects is uncommon, avoid use in patients with a history of substance use disorder.
There is increasing evidence that a substantial proportion of long-term users can discontinue benzodiazepines via interventions that require minimal investment of the physician’s time. As long as benzodiazepines are tapered gradually, their discontinuation is safe and comfortable, and many patients can achieve benzodiazepine abstinence.