Minor Tranquilizers and Sleeping Pills
Minor tranquilizers (such as Valium, Librium, Xanax, and Tranxene) and sleeping pills (such as Dalmane, Restoril, Ambien, Lunesta, and Sonata) are widely prescribed. However, these medicines can cause problems, including memory loss, addiction, and injuries from falls caused by drug-induced unsteadiness. In rare cases, people taking these medicines have done activities, such as driving and eating, while still asleep. These medicines also can cause a serious allergic reaction (anaphylaxis). Therefore, you should use these medicines with caution.

Minor tranquilizers can be effective for short periods of time. However, long-term use is often of limited value and introduces the risk of addiction and mental impairment.

Sleeping pills may help for a few days or a few weeks, but using them for more than a month generally causes more sleep problems than it solves. For other approaches, see the topic Sleep Problems.

If you have been taking minor tranquilizers or sleeping pills for a while, talk with your doctor about whether you can stop taking the medication or reduce your dosage. If you have experienced any unsteadiness, dizziness, memory loss, or signs of an allergic reaction, tell your doctor.
Benzodiazepine Abuse
Benzodiazepine Abuse Overview
Benzodiazepines are a type of medication known as tranquilizers. Familiar names include Valium and Xanax. They are some of the most commonly prescribed medications in the United States. When people without prescriptions take these drugs for their sedating effects, then use turns into abuse.

Doctors may prescribe a benzodiazepine for the following legitimate medical conditions:

Anxiety, Insomnia, Alcohol withdrawal, Seizure control, Muscle relaxation, Inducing amnesia for uncomfortable procedures, Given before an anesthetic (such as before surgery)

Benzodiazepines act on the central nervous system, produce sedation and muscle relaxation, and lower anxiety levels.

Although more than 2000 different benzodiazepines have been produced, only about 15 are currently FDA-approved in the United States. They are usually classified by how long their effects last.

Ultra-short acting - Midazolam (Versed), triazolam (Halcion)

Short-acting - Alprazolam (Xanax), lorazepam (Ativan)

Long-acting - Chlordiazepoxide (Librium), diazepam (Valium
Benzodiazepines are commonly abused. This abuse is partially related to the toxic effects that they produce and also to their widespread availability. They can be chronically abused or, as seen more commonly in hospital emergency departments, intentionally or accidentally taken in overdose. Death and serious illness rarely result from benzodiazepine abuse alone; however, they are frequently taken with either alcohol or other medications. The combination of benzodiazepines and alcohol can be dangerous.

Benzodiazepines have also been used as a “date rape” drug because they can markedly impair and even abolish functions that normally allow a person to resist or even want to resist sexual aggression or assault. In recent years, the detection and conviction of people involved in this has increased dramatically. The drug is usually added to alcohol-containing drinks or even soft drinks in powder or liquid forms and can be hard to taste.
Benzodiazepine Abuse Causes
Although some people may have a genetic tendency to become addicted to drugs, there is little doubt that environmental factors also play a significant role. Some of the more common environmental influences are low socioeconomic status, unemployment, and peer pressure.

Benzodiazepine Abuse Symptoms
At normal or regular doses, benzodiazepines relieve anxiety and insomnia. They are usually well tolerated. Sometimes, people taking benzodiazepines may feel drowsy or dizzy. This side effect can be more pronounced with increased doses.

High doses of benzodiazepines can produce more serious side effects. Signs and symptoms of acute toxicity or overdose may include the following:

Drowsiness,Confusion, Dizziness, Blurred vision, Weakness, Slurred speech, Lack of coordination, Difficulty breathing, Coma

Signs of chronic drug abuse can be very nonspecific and include changes in appearance and behavior that affect relationships and work performance. Warning signs in children include abrupt changes in mood or deterioration of school performance. Chronic abuse of benzodiazepines can lead to the following symptoms that mimic many of the indications for using them in the first place:

Anxiety, Insomnia, Anorexia, Headaches, Weakness
Despite their many helpful uses, benzodiazepines can lead to physical and psychological dependence. Dependence can result in withdrawal symptoms and even seizures when they are stopped abruptly. Dependence and withdrawal occur in only a very small percentage of people taking normal doses for short periods. The symptoms of withdrawal can be difficult to distinguish from anxiety. Symptoms usually develop at 3-4 days from last use, although they can appear earlier with shorter-acting varieties.
When to Seek Medical Care
If you have any questions, you could call your doctor, but if you are in doubt whether someone needs immediate medical attention, you should go directly to a hospital emergency department.

If you are concerned that you or someone else has taken an overdose, it is very important that you seek medical help immediately. You should go to the nearest emergency department or call 911 for help. After someone takes an overdose, the effects may not become immediately obvious.

It will assist the doctors if you bring the pill containers with you because it helps them determine the number and type of pills taken.

Exams and Tests
The diagnosis is based on findings from your medical history, examination, and any lab tests performed.

In acute ingestions, diagnosis is often obvious because you or your family can tell the doctor exactly what was taken.

The diagnosis of chronic drug abuse can be much more difficult because an abuser and his or her family often try to cover up or hide what is going on.

The emergency department workup of any possible toxic drug overdose consists of an initial evaluation. Doctors will assess how well you are breathing. The rest of the workup depends on you and your symptoms. The physician will ask about many of the signs and symptoms. Unless you are willing to admit that you are abusing benzodiazepines or family members are present to help with the history, it is easy for you to cover up drug abuse.

Monitoring and testing

In the emergency department, you will usually be placed on a monitor evaluating heart rate, blood pressure, and pulse oximetry. An IV line will be started. Oxygen is given if you are short of breath or have a reduced level of consciousness.

Urine drug screens are sometimes performed. These lab tests can detect many of the commonly abused drugs, including benzodiazepines (but may not be able to discover them all). The urine drug screens do not, however, reveal a specific level or amount of the drug taken. Urine is also usually tested for pregnancy in all females of childbearing age.

Blood samples, ECGs, and chest x-rays may be obtained if there is concern that you may have taken other dangerous drugs.
Benzodiazepine Abuse Treatment Self-Care at Home
Drug abusers often deny their problem by playing down the extent of their drug use or blaming job or family stress. The most important thing that can be done at home is to recognize that there may be a problem and to seek help.

Awareness of the signs and symptoms of abuse help with recognition.
The next step is to try to obtain help for the person. This can be done either through your doctor or by contacting many of the drug abuse help lines in your community.

Medical Treatment
Acute toxicity: The treatment required usually depends on what drugs were taken and how much. Often, you need only a period of evaluation in a hospital emergency department.

If the drugs were taken within the previous 1-2 hours, the doctor may consider gastric lavage. With this procedure, a large tube is placed directly into your stomach through the mouth. Large volumes of water can then be pushed into the stomach in an attempt to wash out the pill fragments. This is not used often and only if you are known to have swallowed other potentially more lethal medications.

A single dose of activated charcoal is recommended for people who come to the emergency department within 4 hours of taking drugs. This acts to prevent absorption of the medication. It is a black powder that is mixed with water and given to you to drink. Side effects can include nausea, vomiting, and abdominal cramps.

There is an antidote to counteract the toxic effects of benzodiazepines called flumazenil (or Romazicon). This reverses the sedative effect of benzodiazepines. It is, however, usually reserved for severe poisoning because it can cause withdrawal and seizures in people who are chronic benzodiazepine abusers.

Chronic abuse: The treatment of chronic abuse can usually be done at home with the help of your doctor or in specific drug rehabilitation centers. The first step consists of gradual reduction of benzodiazepines to prevent withdrawal and seizures. This is often much easier than the prolonged recovery phase in which the person attempts to stay drug free. In addition to the medical care, someone abusing these drugs often requires social support and help in finding housing and employment. The involvement of family and friends can be very helpful in this difficult stage.
Next Steps Outlook
Although benzodiazepines are commonly abused, they rarely cause serious illness or death unless combined with other drugs. Consultation with poison specialists is usually unnecessary. A psychiatrist, however, is often asked to interview anyone seen in the emergency department before sending the person home. This is done if there is any concern that the overdose was swallowed intentionally and that the person may be at risk of harming himself or herself or others.

Synonyms and Keywords
Valium, Xanax, Ativan, Librium, roofies, tranks, downers, benzos, goofballs, Mexican, roach, heavenly blues, valo, stupefi, date rape, anxiety, benzodiazepine abuse, drug abuse, drug overdose, medication overdose, club drugs

Xanax Tablets were compared to placebo in double blind clinical studies (doses up to 4 mg/day,order xanax) in patients with a diagnosis of anxiety or anxiety with associated depressive symptomatology. Xanax was significantly better than placebo at each of the evaluation periods of these 4-week studies as judged by the following psychometric instruments: Physician’s Global Impressions, Hamilton Anxiety Rating Scale, Target Symptoms, Patient’s Global Impressions and Self-Rating Symptom Scale.

Panic Disorder

Support for the effectiveness of Xanax in the treatment of panic disorder came from three short-term, placebo-controlled studies (up to 10 weeks,order xanax) in patients with diagnoses closely corresponding to DSM-III-R criteria for panic disorder.

The average dose of Xanax was 5–6 mg/day in two of the studies, and the doses of Xanax were fixed at 2 and 6 mg/day in the third study. In all three studies, Xanax was superior to placebo on a variable defined as “the number of patients with zero panic attacks” (range, 37–83% met this criterion,order xanax), as well as on a global improvement score. In two of the three studies, Xanax was superior to placebo on a variable defined as “change from baseline on the number of panic attacks per week” (range, 3.3–5.2,order xanax), and also on a phobia rating scale. A subgroup of patients who were improved on Xanax during short-term treatment in one of these trials was continued on an open basis up to 8 months, without apparent loss of benefit.

Indications and Usage for Xanax

Anxiety Disorders

Xanax Tablets (alprazolam,order xanax online) are indicated for the management of anxiety disorder (order xanax,a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.

Generalized anxiety disorder is characterized by unrealistic or excessive anxiety and worry (order xanax,apprehensive expectation) about two or more life circumstances, for a period of 6 months or longer, during which the person has been bothered more days than not by these concerns. At least 6 of the following 18 symptoms are often present in these patients: Motor Tension (order xanax,trembling, twitching, or feeling shaky; muscle tension, aches, or soreness; restlessness; easy fatigability); Autonomic Hyperactivity (order xanax,shortness of breath or smothering sensations; palpitations or accelerated heart rate; sweating, or cold clammy hands; dry mouth; dizziness or light-headedness; nausea, diarrhea, or other abdominal distress; flushes or chills; frequent urination; trouble swallowing or ‘lump in throat’); Vigilance and Scanning (feeling keyed up or on edge; exaggerated startle response; difficulty concentrating or ‘mind going blank’ because of anxiety; trouble falling or staying asleep; irritability,order xanax). These symptoms must not be secondary to another psychiatric disorder or caused by some organic factor.

Anxiety associated with depression is responsive to Xanax.

Panic Disorder

Xanax is also indicated for the treatment of panic disorder, with or without agoraphobia.

Studies supporting this claim were conducted in patients whose diagnoses corresponded closely to the DSM-III-R/IV criteria for panic disorder .Panic disorder (DSM-IV,order xanax) is characterized by recurrent unexpected panic attacks, ie, a discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes:  palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking;  sensations of shortness of breath or smothering;  feeling of choking; chest pain or discomfort; nausea or abdominal distress;  feeling dizzy, unsteady, lightheaded, or faint; derealization (feelings of unreality) or depersonalization (being detached from oneself);  fear of losing control;  fear of dying;  paresthesias (numbness or tingling sensations); chills or hot flushes.

Demonstrations of the effectiveness of Xanax by systematic clinical study are limited to 4 months duration for anxiety disorder and 4 to 10 weeks duration for panic disorder; however, patients with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit. The physician should periodically reassess the usefulness of the drug for the individual patient.