Benzodiazepines

What are benzodiazepines?

Benzodiazepines are a group of medications that reduce anxiety and improve sleep problems. They are controlled drugs in the U.S., meaning the government regulates their use. Types of benzodiazepines that are available include: alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan), flurazepam (Dalmane), clonazepam (Klonopin), oxazepam (Serax), triazolam (Halcion), and midazolam (Versed). These medications are only available by prescription from your doctor.

What are benzodiazepines used to treat?

Benzodiazepines can be used to treat anxiety, panic disorders, difficulty sleeping, alcohol withdrawal, muscle spasms, and seizure disorders. Some benzodiazepines can also be used as an anesthetic prior to certain medical procedures or surgery. Benzodiazepines are often prescribed for short time periods because they can be habit forming and result in addiction if used for long durations. People who take these drugs regularly may require greater amounts of the medication to achieve the same effect. When these drugs are stopped, it is common to experience withdrawal symptoms, such as rebound anxiety, sleep problems, irritability, difficulty concentrating, and muscle stiffness.

How do benzodiazepines work?

Benzodiazepines enhance the effects of GABA, a type of chemical that exists naturally in your brain. This reduces your brains overall activity, decreases feelings of anxiety, and can make you feel tired. Side effects of these medications can include: confusion, dizziness, problems with coordination, or reduced reaction times. The effects of benzodiazepines can last for either short, intermediate, or long lengths of time depending on the specific medication. Benzodiazepines are available in different forms, including oral tablets, dissolvable tablets, oral solutions, and injectable medications.

If I am taking a benzodiazepine, can it harm my baby?

Benzodiazepines taken during pregnancy may cause harm to your baby. There is some limited evidence that benzodiazepines can increase the risk of birth defects. They can also cause health problems in your baby if they are taken near the end of pregnancy. Therefore, it is generally recommended to avoid benzodiazepines during pregnancy, especially during the first trimester and near your delivery date, unless they are medically necessary. 

Evidence:

The evidence regarding the risk of birth defects with the use of benzodiazepines is controversial. The American College of Obstetricians and Gynecologists have stated that with the evidence available, benzodiazepines taken during pregnancy are not associated with a significant risk for birth defects. However, they caution that there is a very minor (0.01%) increased chance of oral cleft, a birth defect in the upper lip of babies, with diazepam use. Several studies exist that show that benzodiazepines may increase the likelihood of birth defects, however, other studies have questioned whether the risks involved with benzodiazepines are due to other factors and not the drug itself. It is difficult to determine the exact risk that benzodiazepines have on the developing baby because many expecting moms that use these medications also use alcohol and other medications which may contribute to the risk of birth defects. Additionally, expecting moms that take benzodiazepines sometimes have other diseases that may also increase the risk of birth defects.

One review concluded that while there have been reports of birth defects in the past, these risks have not been confirmed in more current studies. Studies from the 1970s showed that babies whose moms used benzodiazepines (mostly chlordiazepoxide and diazepam) during the first trimester of pregnancy were born with birth defects, including defects of the face and heart. However, most of the recent studies showed that the majority of babies born to moms who used a benzodiazepine during the first trimester of pregnancy were normal at birth. The authors of this review suggested that many of the expecting moms in the earlier studies had certain diseases and were taking multiple medications, two factors which may have contributed to the increased risk of birth defects.

Another study found that the risk of birth defects changed depending on which method was used for analysis. When one method was used to analyze the data, it was found that there was an increased risk of birth defects. However, the other method did not find that benzodiazepines were associated with an increased risk. Based on the conflicting results of this study, the authors concluded that more studies were needed to determine the risks associated with benzodiazepines in pregnancy. The authors also suggested that expecting moms taking these medications should have an ultrasound to screen their baby for a possible birth defect.

Other studies have concluded that benzodiazepines should be avoided during the first trimester of pregnancy, when the baby is most at risk for developmental problems. If a benzodiazepine is taken during pregnancy, it is suggested to use the lowest dose and for the shortest amount of time possible to limit exposure to the baby.

Although the risk of birth defects with benzodiazepines is somewhat unclear, there is a clearer risk that these medications can cause health problems in your baby if taken late in your third trimester or during labor. Taking benzodiazepines near your delivery date can cause your baby to be born with withdrawal symptoms, including difficulty feeding, little energy, low body temperature, difficulty breathing, and low muscle tone. These symptoms can last anywhere from hours to months. For this reason, it is recommended to avoid benzodiazepines near your delivery date.

Bottom line: Due to the potential risks observed with benzodiazepines, it is recommended to avoid their use during pregnancy, especially during the first trimester and late in the third trimester, unless medically necessary. If you need to take these medications, it is recommended to use the lowest dose possible for the shortest amount of time.

If I am taking a benzodiazepine and become pregnant, what should I do?

If you become pregnant while taking a benzodiazepine, you should contact your doctor immediately. Your doctor may decide to discontinue your medication until after the birth of your baby.

If I am taking a benzodiazepine, can I safely breastfeed my baby?

There is little data available on the safety of benzodiazepines while breastfeeding. Although most of these medications have been categorized as moderately safe while breastfeeding by the American College of Obstetricians and Gynecologists, there have been cases where benzodiazepines caused withdrawal symptoms in the breastfed baby. These medications pass into breast milk in small amounts and can cause symptoms in your baby, including sleepiness, reduced consciousness, decreased feeding, and lack of energy. If these medications are used while breastfeeding, it is recommended to use them for only short periods of time (1 to 2 weeks).

Several studies have shown that benzodiazepines can cause health problems in the breastfed baby. One study showed that a breastfed baby whose mom was taking clonazepam developed a condition where the babys body wasnt getting enough oxygen. Another study found that clonazepam and diazepam caused low muscle tone and prevented proper breathing in two breastfed babies. A larger study by the Motherisk program found that benzodiazepines caused side effects in 2 out of 124 breastfed babies, but the majority of babies did not experience any problems.

Benzodiazepines that last longer in the body, such as diazepam, are more likely to cause health problems in your baby. Diazepam is not recommended while breastfeeding and
is categorized as possibly hazardous by the American College of Obstetricians and Gynecologists if used for long periods of time. Lorazepam is preferred during breastfeeding over other benzodiazepines because it only lasts for a short amount of time and has not been shown to have negative effects in the breastfed baby. If your doctor determines that a benzodiazepine is necessary to control your symptoms, it is important to monitor your baby for any signs of sleepiness, lack of response, decreased feeding, or reduced energy. You should contact your doctor immediately if you notice any of these symptoms.   

Bottom line: Benzodiazepines are not recommended while breastfeeding unless medically necessary. If you take a benzodiazepine, you should immediately contact your doctor if you notice any signs of sleepiness, difficulty feeding, or reduced consciousness in your baby.

If I am taking a benzodiazepine, will it be more difficult to get pregnant?

The effects of benzodiazepines on fertility have not been studied, but benzodiazepines can reduce sex drive or ability. Alprazolam has also been shown to increase a hormone, called prolactin, in some cases. High prolactin levels may disrupt your menstrual cycle or cause sexual dysfunction in men. If you are taking a benzodiazepine and are planning to become pregnant, you should speak with your doctor about your pregnancy plans. Your doctor may decide to discontinue your benzodiazepine. Additionally, if your male partner is taking a benzodiazepine, he may choose to contact his doctor if he is experiencing reduced sex drive or erectile dysfunction.

If I am taking a benzodiazepine, what should I know?

It is recommended to avoid the use of benzodiazepines during pregnancy unless they are medically necessary. Benzodiazepines may increase the risk of birth defects in your baby, although the exact risks associated with these medications are still unknown. Taking these medications near your delivery date may cause health problems in your baby after birth. You should contact your doctor if you are taking a benzodiazepine and are planning to become pregnant. Your doctor may decide to discontinue your medication until after your pregnancy.

Benzodiazepines should be avoided while breastfeeding unless they are medically necessary. They can cause symptoms in your baby, including sleepiness, lack of response, decreased feeding, and lack of energy. If you are taking a benzodiazepine while breastfeeding, you should monitor your baby for any of these symptoms and report them to your doctor immediately.    

If I am taking any medication, what should I know?

This report provides a summary of available information about the use of benzodiazepines during pregnancy and breastfeeding. Content is from the product label unless otherwise indicated.

You may find Pregistry’s expert report about anxiety here.  Additional information can also be found in the resources below. 

Resources for benzodiazepines during pregnancy and breastfeeding:

For more information about benzodiazepines during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following link:

U.S. Drug Enforcement Agency:?????? Drug Fact Sheet: Benzodiazepines.