These are tranquillo-sedative drugs which fall into the category of benzodiazepines and have gained tremendous popularity. Since these drugs are known to counteract anxiety and tension, they have been indiscriminately used by both the patients and the physicians. In addition to their calming effect, these drugs cause muscle relaxation. The sleep produced by these agents is very refreshing. Of these, diazepam is the most popular. Lorazepam is far more effective when given by injection.



Diazepam was introduced to the world market by a Swiss pharmaceutical company, Hoffman-la-Roche. The drug caught the attention of doctors and patients very quickly and its sales increased dramatically, so much so that Hoffman-la-Roche soon became the largest pharmaceutical company in the world.

Alprazolam has fewer side-effects than others. Oxazepam has a short duration of action and may have to be given 4 to 6 times daily, as against others which can be given 2 to 3 times only.

Dosage: The usual oral dose of diazepam is 2 to 10 mg and that of oxazepam, 30 to 120 mg. Generally half to 2/3 dose is given at night and 1/3 to 1/2 in day time although it is not necessary in view of longer duration of effect.

Adverse Effects: The adverse effects of these drugs are few. These include drowsiness, and a drunken or a light-headed feeling. These are most likely to occur during the first two days of the treatment and usually disappear when the drug is continued. In some cases a reduction in doses may be necessary. Other adverse effects are ataxia or difficulty in walking, vertigo, increased appetite, weight gain, and a confused mental state, specially in patients suffering from impairment of blood supply to the brain. In these cases also, a reduction in the dose is helpful. Some women fail to ovulate while on regular treatment. In rare cases there may be hypotension (low blood pressure) and visual disturbances.

Precautions

These drugs should not be taken continuously by patients with liver or kidney disease.

Use of alcohol or anti-allergic drugs should be avoided while taking these drugs as the sedative effect is enhanced.

Drugs like monoamine oxidase inhibitors or phenothiazines may also enhance the action of these drugs, and their concurrent use should be avoided.

These agents may cause episodes of rage, excitement, hostility, and severe depersonalization reaction if administered to a patient suffering from schizophrenia.

These drugs should be used cautiously in infants and elderly.

Prolonged use of these drugs may cause addiction. They should not be withdrawn abruptly.

These drugs are not effective in smokers and therefore, cigarette smoking should be avoided by the users.

Propranolol (a drug used in heart disease) reduces symptoms of anxiety in a dose of 10 to 20 mg thrice a day. It is a valuable drug in stress induced anxiety such as examination fear, stage phobia and public appearance. It can be given along with alprazolam or diazepam.