Common Side Effects of Anxiolytics, Sedatives, and Hypnotics

Disinhibition BZs can cause behavioral dysfunction, including irritability and personality changes. Children, adolescents, and elderly people may be more prone to this paradoxical side effect.

Cognitive Deficits High-potency BZs such as lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax) are associated with memory impairment. These BZs may exacerbate preexisting cognitive impairment.

Dependence The use of BZs as hypnotics for temporary insomnia should be for a maximum of 2 to 4 weeks only. Continued efficacy may last as long as 5 weeks, but there is no guarantee of efficacy afterward. For persistent insomnia, regular or intermittent use of BZs as hypnotics should be reevaluated every 2 to 4 months. In the case of zolpidem (Ambien) or zaleplon (Sonata), the duration of use should be 7 to 10 days with reevaluation if the use exceeds 2 to 3 weeks.

Withdrawal Symptoms Anxiety symptoms, delirium, seizures.

Overdose Ataxia, hypotonia, nystagmus, coma. BZ antagonist is flumazanil.

Respiratory Depression Use of BZs for sleep disturbance caused by sleep apnea can worsen the respiratory condition. Concomitant use with alcohol, TCAs, anticonvulsants, or clozapine (Clozaril) may increase sedative effects or cause respiratory depression.