BENZODIAZEPINES

Substance Information Sheet

Benzodiazepines

Benzodiazepines, often called "benzos," are a class of psychoactive substances that function as central nervous system depressants. They enhance the efficiency and effects of the primary inhibitory neurotransmitter, gamma-aminobutyric acid (GABA), by binding to and acting on its receptors.

Common effects include reducing anxiety, inducing sedation and sleepiness, relaxing muscles, reducing inhibitions, and causing amnesia. Medically, short-acting benzodiazepines are usually prescribed for insomnia or acute panic attacks, while longer-acting versions are used to treat anxiety disorders.

Abruptly stopping benzodiazepine use can trigger seizures, which can be life-threatening, particularly for individuals who have used them heavily over an extended period. Instead of sudden cessation, gradually reducing the daily dose over time (known as tapering) is recommended to minimize withdrawal risks.

Class Membership

Psychoactive class - Depressant

Chemical class - Benzodiazepines

Benzo Drug Interactions

Mixing Benzodiazepines with other drugs

MDMA

The effects of both drugs are likely to be reduced.

Amphetamines

Stimulants mask the sedative effects of depressants, which people use to assess their intoxication level. When the stimulant wears off, the depressant’s effects can become intense, leading to significant disinhibition, motor control loss, and blackout states. This combination also increases the risk of dehydration. If combining these substances, carefully limit the amount taken per hour and stick to a dosing schedule with a predetermined maximum threshold. This combination places stress on the heart due to the opposing mechanism of action.

Amphetamines

Antihistamines

Avoid benzos if you are taking allergy medicines. benzos and allergy medicines. Both are depressants and slow down your central nervous system. This can produce heightened side effects such as drowsiness, sedation and poor concentration. In extreme cases, loss of consciousness may occur.

Alcohol

When combined, these substances intensify muscle relaxation, amnesia, sedation, and respiratory depression. Higher doses can result in sudden, unexpected unconsciousness and dangerously slowed breathing. Users risk suffocating on their vomit if they pass out. If nausea or vomiting occurs before losing consciousness, it’s important to sleep in the recovery position or have a friend assist.

MAOIs

Using these drugs together can cause an effect stronger than desired though they aren't likely to cause a serious adverse reaction if used carefully. Additional research should always be done before mixing drugs.

Ketamine

Combining depressants with dissociatives unpredictably intensifies amnesia, sedation, motor control loss, and delusions. This combination may also result in sudden unconsciousness and severe respiratory depression. If nausea or vomiting happens before passing out, users should try to sleep in the recovery position or get assistance.

Opioids

GHB / GBL

Benzos and GHB are an unsafe combination. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position

Modafinil

We strongly recommend you avoid taking these drugs together, reactions are highly unpredictable and can be fatal. You will likely come to some degree of harm even if you take strong precautions.

Cocaine

Be careful when taking benzos and cocaine together. Each drug can mask the effects of the other, making it easier to overdose, especially if one wears off before the other. If you use cocaine often, the effects of the benzos may be amplified so start low and go slow

Birth Control Pill

The hormones in the contraceptive pill may slow down your liver’s ability to metabolise benzos, meaning the effects of benzos may come on more strongly. The effectiveness of the contraceptive pill does not decrease when combined with benzos. However, if the contraceptive pill you are taking is causing you any side effects, benzos may make these worse.

Benzodiazepine Harm Reduction Information

RISKS

Depression

Benzos are primarily used for anxiety, which usually co-occurs with depression. However, benzos do not have antidepressant effects with the possible exception of alprazolam. On the contrary, benzos might exacerbate depression and cause suicidal behaviour and ideation as they depress the central nervous system.

Dependence

The occasional use of benzos has a relatively low risk of harm. However, when used longer than 3-4 weeks, dependence is likely to develop and stopping the drug suddenly causes withdrawal symptoms. Therefore, it is best not to take benzos for more than 1-2 weeks.

Unlike many other recreational drugs, craving is not a major problem while withdrawing from benzos. It is the physical and psychological symptoms which makes it difficult. Symptoms may take up to 3 weeks to become apparent.

Withdrawal symptoms include anxiety-related symptoms such as panic attacks, insomnia, irritability, aggression, palpitations, nausea, depression and muscle pain.

Other signs include:

Tremor
Hypersensitivity to senses
Abnormal body sensations like pins and needles, tinnitus, metallic taste etc.
Hallucinations, paranoia, delirium
Derealisation and depersonalisation

In severe cases, sudden discontinuation can lead to life-threatening seizures or death.

Therefore, benzos should never be stopped suddenly. Instead, the dose should be reduced gradually, ideally with a doctor’s supervision.

Gradual dose reduction does not eliminate the withdrawal symptoms. Anxiety management and psychological support is equally important.

Ethnic Considerations

Individuals of Asian heritage may have slower metabolism of benzos. It is advised to start with half the usual recommended starting dose.

Cocaine Users

Regular cocaine users have an enhanced sensitivity to benzos resulting with more intense effects . It is recommended to use lower doses than the common dose.

Avoid Injecting

Injecting crushed tablets causes severe complications such as tissue damage or death due to benzos’ high lipid-solubility. Injecting street benzodiazepine carries more danger as it is likely to contain other substances which may increase harm.

Vitamin C

Benzos affect memory creation and can cause short-term amnesia. Some evidence show that high doses of Vitamin C can reduce this.

Avoid other depressants for a few days following benzo use

Due to their unpredictable duration of effect, benzos (including short-acting ones) still carry a risk of overdose with depressant drugs the day after.