Talk:Benzodiazepine: Difference between revisions

different benzo's do not have different effects!

1. Benzodiazepines should not be distinguished as to their primary effects (e.g. "sedatives" vs. "hypnotics" vs. "anxiolytics" etc.). The only valid distinction between benzodiazepines is by elimination half-life (long, medium, and short-acting).

"Most medications used to treat anxiety also treat insomnia, often in the same dose. The myth of two separate treatments has largely been due to patterns of individual consumption and to the advertising patterns of pharmaceutical firms which want the public to think of a medication as a treatment for a specific condition and not as one of many that are broad in their effects. Thus, flurazepam (Dalmane) became a hypnotic while diazepam (Valium) became a tranquilizer, although they could easily have been reversed without sacrificing effectiveness."

2. Benzodiazepines should not be called muscle relaxants, because they have no specific effect on skeletal muscles. Their "muscle relaxant" effects are due entirely to their sedative/hypnotic action on the central nervous system - i.e. by relieving axiety and promoting sleep, they relieve stress and thereby relieve chronic muscle contraction. This should be corrected also in related articles (e.g. Librium).

Wwallacee 02:02, 4 February 2007 (UTC)

I beg to differ. Elimination half-life is NOT the only difference, at least not with me. Alprazolam puts me to sleep, while clonazepam (at the same/equivalent dosage) does not. In fact, it doesn't sedate me at all -- it just makes me feel less anxious. That's why I take clonazepam by day, and alprazolam by night. RobertAustin 12:52, 15 February 2007 (UTC)

No offence, but what absolute crap. I've had diazepam, alprazolam, oxazepam, temazepam, and nitrazepam, and i'm telling you now, they are not just different in terms of their half-life. They may all have the various effects on the body, but with one drug, one or more effect(s) will be FAR more obvious than the rest. Each of these drugs had a different effect on me, as they would for most others. Timeshift 13:04, 15 February 2007 (UTC)

H E L P !

Would someone please work a bit on this article?

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mm

Why is the page in French..?

Hey there is a problem ! bezodiazepines are anxiolytics and myorelaxants as well. BTW let's avoid brand names so leave out Rohypnol.

172.209.111.18 15:06, 12 December 2006 (UTC)well.... if you are a Pharmacologist, then yes, you would leave out brand names. But the public use wikipedia too, and they might want to search for the brand name of the anxiolytic they or someone they know might use.

They are mentioned under anxiolytic. And I think Rohypnol deserves a mention, as the 'date-rape' drug.

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Why is the image named 'bennies'? 'bennie' is a slang for Benzedrine, which is a form of amphetamine, and for any kinds of amphetamines in general. It has no connection to benzodiazepines.

"Bennies" is also mentioned in the main article as being slang for benzodiazepines. I can google a number of sites that back this up, but "bennies" was indeed the slang term for benzedrine and other amphetamines during the 50s and 60s. This is backed up in literature (Kerouac, Burroughs, et al), and googling. I'm not sure if benzodiazepines were also refered to as "bennies" during this same time period (as is claimed in the article), but it certainly does seem to be confusing as these drugs have opposite effects more or less.

172.209.111.18 15:06, 12 December 2006 (UTC) So? Slang has never been terribly intellectual or educated.

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Hey. Bromazepam (Lexotan) is described (at the end of the article) as a Schedule I drug, not available on the US. This is not true, Bromazepam is Schedule IV, the same as Diazepam (Valium) or Alprazolam (Xanax).

http://www.usdoj.gov/dea/pubs/scheduling.html

-- If you have the links to back it up then by all means change it.

-Foolishben

Withdrawal of flunitrazepam from market

Flunitrazepam (rohypnol) is listed as withdrawn from the market. Here in the Netherlands however it is still available. Where is it withdrawn? In the USA? --WS 19:32, 9 July 2005 (UTC)

Probably US. Some Americans forget there are other English-speaking countries, or any countries for that matter :-) JFW | T@lk 22:49, 9 July 2005 (UTC)

Changed it into 'withdrawn in some countries' as I am not completely sure where, probably in the USA, but certainly not everywhere. --WS 12:01, 10 July 2005 (UTC)

According to the flunitrazepam page: Flunitrazepam has never been approved for medical use in the United States. So has it actually been withdrawn anywhere? --WS 14:08, 11 July 2005 (UTC)

Flunitrazepam is still available in australia, it is schedule 8 (same class as morphine) but the type that dissolved easily in drinks was withdrawn in march 2001. I have tested the new product, which is meant to make a drink taste salty, turn blue, and take longer to disolve, but all this only happened after almost 12 hours - so it could potentially be used as a date rape drug still.

Flunitrazepam is Schedule IV in the US, not Schedule I as was stated. Made edit.

The Flunitrazepam article says it is schedule III... which is it? --WS 10:02, 31 December 2005 (UTC)

I was mistaken it is a different classification. --WS 10:06, 31 December 2005 (UTC)

An American friend of mine is prescribed this drug for her narcolepsy, so the "withdrawal from the market" may not be total. She has her medication delivered by courier because it's not available in pharmacies, though. 86.140.49.134 12:28, 13 December 2006 (UTC)Trialia

Benzodiazepine fallout

I have a theory that ADHD or ADD may be caused by prenatal exposure to benzodiazipines. I've been looking for data but haven't found any. Mental health problems in children (and later as adults) could also be caused by being raised by a Benzo addict.

Despite clear stern warnings that Benzodiazipines should only be used for around 2 weeks maximum, many doctors wrote prescriptions on a permanent basis to patients. Addiction and withdrawal caused symptoms similar to the symptoms the drug is used to treat causing a viscious cycle of addiction.

Until you have collected a substantial amount of supporting data, the proper word is hypothesis, not "theory" Sinus 11:46, 9 October 2005 (UTC)

Do you have any observations to back up this hypothesis, and are you claiming that all cases of AD(H)D are caused by prenatal exposure to benzodiazepines? It's a very ...interesting... idea. I've a whole compendium of anxiety/depression/focus issues, and I've been taking a combination of 1 mg clonazepam and 18 mg methylphenidate fo just over a month now, and it's the first time in a long while I've actually felt functional. --squishycat71.202.124.98 03:25, 5 February 2007 (UTC)

Hi. I currently suffer from severe GAD. I was prescribed .5mg alprazolam about two months as of this writting. I am 15 and not addicted. I take .5-1mg daily as needed. However I don't take them everyday. I sometimes go up to a week without taking any, and I'll take a break if I take them too much. It is true that benzodiazepines shouldn't be prescibed for more than two weeks. However with me I just found no other effective long term solution to manage my symptoms. I have tried many different treatments, but to no avail.

I also suffer from what might be considered a sublimated anxiety disorder, social anxiety, avoidance, or social phobia (I try not to discuss DSM classifications with my psychiatrist, as I feel they're a little monolithic, but technically I avoid most physical expressions of anxiety yet still feel overwhelmingly 'internally' uncomfortable in certain situations). Clonazepam .75mg (delivered as three halves of .5mg tablets) in combination with bupropion (mainly helping me hold down any urges to avoid social situations so I can smoke!) has worked well for me over the past year, generally *increasing* my motivation to work or interact by suppressing my tendency to think forward to negative outcomes. Paradoxically, an SSRI (escitalopram) increases my sense of unsettledness at rest, making me feel like I can't sit still, though I continue on a small (5mg) dose to take the edge off any major downswings in mood -- such as being chewed out by people who might benefit from some sort of therapy to control their quickness to anger. ;) .... Probably a bit confessional, but I hope that gives some sense of where a benzo can fit into a treatment regime. What I wanted to mention is that, from discussion and perusal of the literature, many doctors are concerned about the risk of *seizure* upon withdrawal rather than the (predictable) psychological rebound effects -- anxiety is one thing, but they'd rather not test your susceptibility to that withdrawal symptom while you're alone or driving. This, I think, is a major reason for long-term prescription, since a monitored cessation is expensive and inconvenient to the patient as long as the treatment is still working, even if breaks could lessen the chance of truly severe withdrawal effects. (Every withdrawal event exposes the prescriber to liability, so they prefer to take a single risk at the end, when a patient's more likely to consent to a brief hospital stay for monitoring.)

half lives and onset of effect

"chlordiazepoxide (Librium®) - 5-25 hours "

I'm pretty sure this is wrong, but I'm just a med student. It should have a half life of over 100 hours. I know the onset of it's effect is fast, which might be what caused the confusion.

According to page 399 of First Aid for the Wards, the half life is over 100 hours.

I'll leave editing the article to fix this problem up to a doctor or pharmacist.

The 5-25hr halflife is correct, but (clinically more important) the active metabolites have a much longer halflife (>100hr). --193.172.33.211 14:42, 2 May 2006 (UTC)

Addictiveness

Needs more information on the addictiveness of them, the way it's currently phrased it makes it seem like it's no big deal. Nathan J. Yoder 19:25, 5 November 2005 (UTC)

I agree, but a good general source for this is essential. Have you got anything of that sort? JFW | T@lk 22:46, 5 November 2005 (UTC)

I am currently looking for good sources, they are hard to find with all the tertiary (and very unreliable!) information on the internet. I guess I'll have to search through journals. I have heard nurses say that benzos have worse withdrawal than opiates (which may imply more addictiveness), but since they are not doctors I'm not sure how true that is. I will try to look for more information on that, and see if I can tie information on addictiveness between all the different articles on addictive substances. Do you know if there is a special name for the kind of studies that compare different classes of drugs like that? Nathan J. Yoder 06:27, 6 November 2005 (UTC)

A recent edit changed the text from "potentially addictive" to "highly addictive". The addiction article is quite thorough on the definition of addiction and dependence. Given that the Benzodiazepine article covers all benzodiazepines, can we really say they are all "highly addictive", whatever that means. Do you become an addict after one pill or shot? Surely it depends on which drug you take, how much you take and for how long? --Colin Harkness 18:07, 6 February 2006 (UTC)

Yeah well, LSD is a DEA Schedule I drug, and it is not considered to be really "addictive." We all know that the DEA scheduling of a certain drug is a very poor (if any) means of judging addictive potential. --Seven of Nine 05:06, 10 May 2006 (UTC)

The addictive potential of Benzo's is indesputable. I have personally gone through this, and believe me, it is not pretty. I spent some time in the Priory hospital in the UK for Cocaine related problems, and these are minisclule in comparison to the problems created by these nasty little pills. I only took Librium and Valium for 3 weeks, and it very nearly destroyed my life. I did take several times the prescribed limit, (I had 3 months worth of pills, taken in 3 weeks), but still, when I stopped, (after my wife left me), I was unable to sleep for about a month. Check out http://www.benzo.org.uk for a list of further personal stories of lives destroyed by this evil drug.

I second that. I personally had a hellish experience myself withdrawing off of lorazepam. --Seven of Nine 23:21, 10 June 2006 (UTC)

I have gone through withdrawal from severe opiate (heroin) and flunitrazapam addictions. By severe i mean years of continous (illegal) use. Heroin withdrawal is worse, but never lasts more than 2-3 weeks. Flunitrazepam withdrawal took 8 weeks.

Not an "evil drug"; a magical drug when taken for anxiety. But one must titrate off/down! Three weeks of .5mg alprazolam [xanax] every six hrs. can be reduced first to .5 every 12 hrs., then .5 every 24 hrs., every 48 hrs., then to .25 every 48 hrs., & finally only "as needed." About a week at each stage. Moderate initial discomfort, but nothing too difficult nor enduring. (Of course, this presumes the cause[s] of the anxiety has been successfully treated [e.g., by an SSRI] or eliminated.)

Do NOT take this last post as tapering advice. The half life of alprazolam is WAY TOO SHORT to effectively taper by repeatedly doubling the time between taking doses of the same magnitude. The http://www.benzo.org.uk site posted by the earlier user is a very useful source of additional information including more info on why this sort of xanax taper would be impractical. The poster is correct, however, that benzodiazepines can be "magical" for crippling anxiety. —The preceding unsigned comment was added by 64.20.163.2 (talk) 14:19, 2 February 2007 (UTC).

Benzo's are not addictive in the same way as heroin. But this do not make them less addictive. They're more like alcohol. While on University, I drank a lot of alcohol every single day for a couple of years and I never become addicted. With my personal experience I could say that alcohol is not addictive. And this cannot be more far from truth. Alcohol is highly addictive and so are Benzo's. [unsigned]

Some people having problems with benzo addiction doesn't make them *more* addictive, either. Most people who are legitimately prescribed benzodiazepines do not become addicted and do not gain tolerance. Problems with withdrawal is not the same as addiction--many drugs can lead to uncomfortable (and even dangerous) withdrawal but are not considered addictive. As far as length and severity of possible withdrawal, I think that would be more appropriate on each individual drug's page as they vary quite substantially. --Sdfromage 20:28, 30 November 2006 (UTC)

Why is this even an issue? benzodiazepines are all 'addictive', and yes there is a nice 'addiction' page here; yet this article is about the properties of the chemicals and their uses. There does not seem to be a good Addiction Medicine reference throughout the article, but the content here is almost less than one page from the PDR. Is the word 'limbic' even used? These are medications utilized for the treatment of many disorders. Do you look for Fosamax before you look for Osteoporosis? The biochemical interactions of the pharmaceutical products and the human body result in a state whereby the continued administration of the drug, an alternate class of drugs, or gradual withdrawal from the medication are the only relevant outcomes. Instead of having a usable article this one is getting hung up in personal experiences that would be better placed in their appropriate areas. if you have DSM-IVtm 300.xx or whatever then find that page, cite any manual indicating the usage of the agents on this page for treatment of that disorder, then add the disorder to this page in an appropriate manner or to the specific linked pages when the drug is primarily utilized for the treatment of that disorder over other benzodiazepines. I am not demeaning any individual for their psychiatric diagnosis or withdrawal experiences, but I am of the opinion that this page is an informative hub as a pharmaceutical reference and can function cleanly as such while the concerns addressed above can be incorporated into the whole body of work through Wikipedia in a manner that does not detract from the focus of this page. Recreational use and abuse of these drugs do not deserve large sections in this article, unless they have some level of cultural relevance or a specific usage of one compound is outside the norm for these drugs. For example, date rape and 'roofys' (sp?) would fall under criticisms or another detractive heading. Instead of making this a mess of disorders, FDA/DEA/addiction comments, and other extraneous information we should keep the general section concise and remove the dispute and neutrality issues. What use is this article if it's flagged as such?

Dependance plus tolerance is totally different than addiction and all should understand this. An addict generally seeks drugs for illicit purposes, or to create euphoria. An addict takes drugs for no medical benefit regardless to their health and welfare. They generally take the drug long enough, and of enough quantity to produce tolerance, and physical or psychological dependance. This in turn leads to drug-seeking behavior, doctor shopping, etc.

Physical dependance and tolerance will develop in those who need the drug for genuine medical conditions such as leading a normal life even for long term use. However, in this case, the one taking the medicine does not crave the medicine, nor want to use it for its euphoric effects. It is used only for the the patient to conduct a normal productive life. Even though the patient is tolerant, and physically dependant, they are NOT an addict! One can be placed on a steroid like Prednisone for medical purposes and become both physically dependant and tolerant to the drug. Are they then an addict here? It's the same scenario which has been proven by several research groups. Before one says anything about addiction, this should always be understood.--Craxd

I disagree with premise that an individual who is physically dependent upon a substance is not an addict. Clarifying what you mean by tolerance within the context of benzodiazepine use would be helpful in understanding your point of view. Many people who abuse medications tolerate the side effects extremely well, many desire the side effects and thus increase their dosage to consistently surpass tolerance; there are also many drugs which are abused without causing physical dependence, thus tolerance is often irrelevant or unclear when discussing dependance. What all should understand is the difference between ABUSE and ADDICTION. Drug seeking behavior and doctor shopping, even increasing dosage beyond normally accepted therapeutic levels has occurred in numerous patients suffering from previously unknown, undiagnosed, or misdiagnosed, disorders, in these cases the clinician's failure to recognize that an individuals symptoms are consistent with a disorder or to further investigate complaints from the individual can be seen as a stimulus to legitimate self-medication. The often cited criteria for addiction are problematic to say the least, they are insufficient for the purposes of distinguishing between abuse and appropriate use. When considered in the psychiatric realm; where many addictive drugs with psychotropic properties are prescribed the purpose can be to purposely create a euphoric effect in a patient without the goal of that individual leading a 'normal life' ADL/Extended ADL.

Pain management is another realm where the physician encounters difficulty distinguishing between abuse and appropriate use when applying the addiction potential toolset (drug-seeking behavior etc). Furthermore, whether or not a moral compass or the legalities of a locale apply is irrelevant. Why state 'illicit' purposes? One may as well say drug dealers, gun runners, rapists, embezzlers, generally participate in their activities for illicit purposes. The fact that a medication may be illegal and determined to be morally reprehensible by a particular audience is merely a correlation.Those engaged in drug abuse do not, as a rule, do so to 'break the law'. In point of fact, the legality of drug use is completely irrelevant to the functions of addiction. Claiming that an addict takes drugs without regard for their health and welfare is also debatable, what you have presented is a laundry list of common criteria for assessment of addiction that has always been problematic within the realm of addiction medicine.

Were your first paragraph rephrased to use abuse with the goal of euphoria or even 'mood altering', or 'escape from reality', I would credit you more for the mostly concise, logical, and relatively well explained second paragraph that is accurate with the exception of terminology. I am not merely placing a semantic debate on the proverbial table with regards to tolerance and addiction, I am presenting the idea that abuse be utilized where appropriate in order to separate one broad category of drug users from an inherent property of the pharmaceuticals in question 'addiction'. As I stated before, "The biochemical interactions of the pharmaceutical products and the human body result in a state whereby the continued administration of the drug, an alternate class of drugs, or gradual withdrawal from the medication are the only relevant outcomes." Remove the second outcome and that is addiction. Granted, the closest relevant article is 'Substance Abuse'.

Although the Substance Abuse article has an addictive component, it is far more palatable than the Addiction or Drug Abuse articles with regards to neutrality. It seems obvious to me that this article will fail as a hub through too much information or neutrality. I propose that terminology likely to create bias or 'unbalance' the article be prefaced as a sourced specific point of view and linked within Wikipedia or dropped. —The preceding unsigned comment was added by 63.195.181.245 (talk) 11:13, 30 January 2007 (UTC).

Members section

The members section could use a little reorganization into the categories it lists (i.e. short-, medium- and long-acting), with the appropriate members under their respective sections. Fuzzform 19:51, 12 February 2006 (UTC)

Half-Lives and Drug Testing

Do the listed half-lives relate to the period that the drug is detectable in a UA (urinalysis), or is it more related to the amount of time the effects of the drug will last? I think i once read that it's usually metabolites a drug that are actually detected in these tests, but I'm not sure. Any insight would be appreciated.

A biological half-life of a substance is its pharmacokinetic/toxicokinetic characteristic. It is simply said a period of time, in which 50% of the administered dose of the substance is eliminated (either metabolised or excreted). In many drugs with active metabolites, half-lives of these must be taken into account, and so, e.g. clorazepate, while itself beeing a very weak benzodiazepine agonist with very short half-life (about 20-30minutes p.o.), breaks down to nordazepam (1-desmethyldiazepam), which is a fairly potent BZD agonist with very long half-life (50-80 hours), so the active principle of clorazepate drugs is the main active metabolite nordazepam.

Half-lives greatly influences detectability in biological samples (urine, blood), but with modern sensitive methods, traces of BZDs and their metabolites can be detected for many half-lives of the given substance after single administration of the drug and longer if taken regullary for longer time.--Spiperon 18:48, 15 October 2006 (UTC)

Clonazepam and Alprazolam and a few other serious questions - Please Help!

Which of these 2 is stronger? I have a prescription for both for an anxiety disorder (social (not nearly as much anymore) and general anxiety) and I find Xanax is a lot more sedating but gives me headaches and is a strong anxiolytic, except Paxam (Clonazepam), I barely feel a thing from it. It says longer-acting agents have a persisting sedative effect and with Clonazepam, but I barely feel sedated? Weird, someone should change that. Also, in Australia, can General Practioners prescribe Rohypnol aka. Hypnodorm aka. Flunitrazepam the devil drug? It seems relatively useful in treating anxiety. It's also Scheduelle 8 drug in Oz, which is the same category as Dexamphetamine and only psychiatrist can prescribe that, so can GP's prescribe it? One other thing, my eyes are fucking up on me, like I'm seeing shit that ain't there like flashes and blue dots and just weird little zippy things, is this due to any benzodiazepene? (I've been on Ativan, Lexotan for short periods and Xanax for long period and just started Clonazepam while withdrawing from Xanax). Also, what is the most potent Benzo all round? I know Halcion, Xanax and Clonazepam are the most potent (.25 MG to 10 MG Valium) but which is the strongest all round (meaning strong as in strong anxiolytic, sedative, longer lasting etc.)? (I was thinking Rohypnol or Xanax?!?!) So please help me.....Also, I happen to smoke, does this affect the metabolism of any Benzos?

I am on and off with my use of Lorazepam for GAD, Panic Disorder, and others. Before I began treatment at all with a benzodiazepine I saw things that aren't there, like trailers and dots and such. I don't think it's due to medication. I think it's symptomatic. Mild hallucinations almost. After administration of Lorazpem, these symptoms are sometimes dulled and sometimes more pronounced. As for smoking...what are you smoking?69.132.62.234 07:04, 29 October 2006 (UTC)CaL

Alprazolam is more potent than clonazepam on a mg/kg basis but it's half life is shorter and she be dosed more frequently than clonazepam who's duration of action is greater than 24 hours (about 30hours or so). Your question however, is different on the merits of anxiolytic, sedative, half life etc. Without going into pharmacology too much, each benzodiazepene binds differently to subunits to a receptor, GABA. Benzos work by stimulating GABA which is an INHIBITORY neurotransmiter in the brain. Xanax (alprazolam) binds and exerts a greater effect on one of GABA's subunits that causes sedation and is a very potent but short lived anxiolytic. Klonopin (clonzepam) is longer-acting, less potent (contrary to the text) but more suitable as an anti-seizure drug due to its effects and confirmational binding to the GABA receptor that is different than xanax. In short, each drug while classified as being in the same "family" of drugs are not exactly chemically identical and are more like "cousins" in their image and actions, therapeutically. I'm unsure of the prescribing and scheduling of drugs in Austrailia but in the US all benzos are schedule 4 and can be prescribed by any MD or DO, resident or intern or nurse practioner if it is "within their scope of normal practice."

The OP might want to see the visual snow article regarding the visual disturbances. Of course, that just gives it a name without specific causation (since there can be so many poorly-related causes), but it does present some avenues to consider. I don't think it's a stretch to suggest that every real-world information-processing system, including the eye and the brain, is going to have some sort of intrinsic noise, and an anxious or agitated person is more likely to notice and worry about it, wherever it comes from -- while a stress reaction can influence everything from the brain's interpretation of the visual signal right on through to basic physical matters like blood pressure and cell metabolism, possibly exacerbating an underlying cause or inducing it outright (signal noise + overexcitability -> amplification of noise or error, whether psychologically or anatomically, right?). That said, I might just be a lucky git, since getting my astigmatism diagnosed and corrected happened to 'cure' my personal case of snow; less blur led to less noise and apparently less weird artifacts of my brain's attempt to compensate. Of course, with my glasses off, prescription failing, or under stress, symptoms return. I'd suggest any snow sufferer without other symptoms (like full blown hallucinations or migraines) should start by getting a really thorough ophthalmologic exam, and remember that even the best eye doctors won't always get their diagnosis perfect every time. Hopefully the new technologies that directly scan and map the cornea will make it easier to objectively detect simple optical defects (without waiting for you to say things are blurry or curved, especially if you're experiencing the aberration as 'snow' instead) or rule them out as the problem. :P --69.177.176.115 00:54, 3 December 2006 (UTC)

Withdrawal methods and support groups

I would like to create some links to some of the Internet's best known support groups for helping individuals get off of these drugs.

I am also considering creating a separate wikipedia page discussing known proven withdrawal taper methods that work. The two that I know of are Ashton's Valium cross-over taper method and water titration.

Would it be considered out of line or against wikipedias rules to create external links to the top support groups?

Would anyone object to placing an external link on the benzodiazepine page to support groups and if not why?

Would anyone object to placing a link on the benzodiazepine page that would link to an internal wikipedia page that would discuss known proven taper methods?

Would it be appropriate to create a short section in the benzodiazepine page that discusses known tapering methods? — Preceding unsigned comment added by Benzobuddy (talk • contribs)

First, I am quite active against external links on pages. I try to remove as many as possible, and am still busy with a process to make more go. It may seem a bit harsh, and if that is the case, I am sorry.

Why I reverted these specific links, they do not provide specific information about the chemical itself, the relation is (at least) one step further, or one has to browse through the linked site to find the information.

What I would suggest is (if the subject is large enough), add a short paragraph about 'how to get off the drug', and (as you already suggest), write a main page about the subject, in the paragraph on the benzodiazepine-page you can add the {{main}} to point to the main page for the subject. In the full page about the subject the link to support groups would not necessarily be wrong (keeping a neutral point of view, of course).

An example of a page that uses this approach is inorganic chemistry. That page discusses in short paragraphs different subfields of the subject (which itself is immensily broad), and many of the subfields are linked via the {{main}} template.

Happy editing (hope to see you around, many 'chemical' pages can use the eye of an expert). And if you want me to help you with some tips and tricks to setup the new page, drop me a line on my talk page when you have made a start (and give me the name of the new page). --Dirk Beetstra ^{T C} 20:49, 31 August 2006 (UTC)

Mess

This article, which could be a really reliable resource if we tried hard enough, presently looks like a dump. It doesn't cite many reliable primary sources, instead linking excessively to a UK benzodiazepine interest website (which is not verified by experts).

When I added the history of Leo Sternbach and librium I was quietly hoping someone would work in some more detail on the remainder of the material. I won't be doing this alone, but let me know if my help is needed. JFW | T@lk 20:41, 14 September 2006 (UTC)

some minor edits

I added following "uses" of diazepam: (apart anxiolytic) hypnotic (in higher dosis taken to empty stomach, it is in fact one of the most prescribed BZDs for insomnia), anticonvulsant (one of first-line options for status epilepticus, along with lorazepam and clonazepam IV), muscle relaxant (given in doses 5-10mg t.i.d.-q.i.d., f.e. by posttraumatic spasticity). Keep in mind that diazepam is the BZD with the broadest spectrum of uses of all. I also changed the use of midazolam from "anxiolytic" (a nonsense, it is used almost exclusively in anesthesiology) to "hypnotic".--Spiperon 00:01, 15 October 2006 (UTC)

Given the shift in prescriptions being consistent with patient information I think it might be beneficial to state dosage in as 't.i.d' and '1 tablet daily' formats. —The preceding unsigned comment was added by 63.195.181.245 (talk) 11:25, 30 January 2007 (UTC).

Comments

I agree with JFW, the page is a mess, and it apparently has been a mess for several months now. Here are my comments on the state of the page, as of November 11, 2006.

• References - Citing the website "www.benzo.org.uk" is unacceptable, because the website is not a reputable source, nor does it reference any other sources. For all we know, all of the data could have been thought up by the website's creator. Although it isn't false data, it is still a very poor source. I recommend using DrugBank, PubChem, or other well-known, reputable sources for referencing.
• General information chart - We need to find a reliable source for the information contained in the disputed section, and its usage must be agreed upon by the majority of this page's editors. The information in the chart is correct, but as I have said above, the source is dubious at best.

Fuzzform 23:06, 10 November 2006 (UTC)

Since the 'general information chart' is closer to the 'dose equivalency charts' I'd suggest using any of the charts citing:

1 Micromedex 2003 2 Nelson J, Chouinard G. Guidelines for the clinical use of benzodiazepines: pharmacokinetics, dependency, rebound and withdrawal. Canadian Society for Clinical Pharmacology. CanJ Clin Pharmacol. 1999 Summer;6(2):69-83. 3 Rickels K, DeMartinis N, Rynn M, Mandos L. Pharmacologic strategies for discontinuing benzodiazepine treatment. J Clin Psychopharmacol. 1999 Dec;19(6 Suppl 2):12S-16S. 4 Teboul E, Chouinard G. A guide to benzodiazepine selection. Part II: Clinical aspects. Can J Psychiatry. 1991 Feb;36(1):62-73. 5 Teboul E, Chouinard G. A guide to benzodiazepine selection. Part I: Pharmacological aspects. Can J Psychiatry. 1990 Nov;35(8):700-10.

Obviously there are some older studies and the half life of some medications, notably diazepam, will be listed at +/- 100% on charts citing the same sources; but the table is useful. It should however be renamed Dosage Equivalency Table or something to that effect, as that is what the chart generally depicts.

Half-Life of Ketazolam

Currently this is shown as 2 hours. Surely that can't be correct, can it? See e.g. this [1] pubmed abstract, which says, "half-lives of up to 100 h (flurazepam, ketazolam)." Sdsds 07:36, 4 January 2007 (UTC)

Should DMCM be on the list?

DMCM is a very obscure compound, and it is almost the only thing on the whole list in the "Members" section that isn't a full benzodiazepine agonist (clobazam is a partial agonist). Probably the only BZ antagonist that is worth mentioning is flumazenil, and I am not even sure that the page should list non-agonists (as there is no way to say the equivalent dose, and it is confusing). DMCM should probably be removed, at least. Fluoborate 11:46, 4 January 2007 (UTC)

Is DMCM another name for R015-4513? Or are they different inverse agonists? If so, maybe the article would benefit from a separate table for these? Sdsds 21:58, 4 January 2007 (UTC)

DMCM is a beta-carboline derivative, and Ro 15-4513 is a benzodiazepine derivative, so their chemical structures are quite different. In my personal opinion, Ro 15-4513 is the most interesting BZ partial inverse agonist, because of the specific antagonism it exhibits against the effects of ethanol. Ro 15-4513 has been used in a lot of interesting studies on many topics, but I have never seen a particularly interesting study on DMCM.

A separate table for atypical benzodiazepine receptor ligands might be nice, it could include zolpidem, (es)zopiclone, zaleplon, flumazenil, clobazam, Ro 15-4513, and DBI (diazepam binding inhibitor, an endogenous protein). Fluoborate 06:41, 5 January 2007 (UTC)

OK, I started a new table with a few entries. I hope the terminology is correct. Should we instead be calling them "GABA(A) receptor benzodiazepine binding site ligands?" And why is there no mention of GABA(A) in this article? Sdsds 07:38, 5 January 2007 (UTC)

negative allosteric modulator?

Is it correct to describe benzodiazepines as "negative allosteric modulators" of GABA(A) receptors? Sdsds 20:43, 14 January 2007 (UTC)