Anxiolytics & hypnotics
also: benzodiazepine · diazepam · zopiclone · propranolol anxiety · flumazenil
Overview
Short-term anxiety/insomnia drugs — benzodiazepines and Z-drugs (dependence-prone, short-term only), plus the non-sedating options. (SSRIs are first-line for chronic anxiety — see Antidepressants.)
Mechanism
Benzodiazepines and Z-drugs (zopiclone/zolpidem) are positive allosteric modulators of the GABA-A receptor → enhance Cl⁻ influx → CNS depression (anxiolytic, sedative, anticonvulsant, muscle relaxant). Propranolol blunts the physical (adrenergic) symptoms of anxiety. Flumazenil is the benzodiazepine antagonist.
Indications
- Short-term severe anxiety / insomnia
- Alcohol withdrawal (chlordiazepoxide — cross-ref Dependence)
- Status epilepticus / seizures (cross-ref)
- Somatic anxiety symptoms (propranolol)
The agents
Dependence within 2–4 weeks; taper to stop (switch to diazepam); flumazenil reverses overdose.
Similar dependence; falls in elderly.
Performance/somatic anxiety (tremor, palpitations); non-sedating, non-addictive.
Non-dependence-forming anxiolytic.
Adverse effects
Short-term use only; taper slowly.
Dangerous with opioids/alcohol.
Cautions & contraindications
Dependence — short-term only.
Respiratory depression.
Interactions
- Additive CNS/respiratory depression (opioids, alcohol, gabapentinoids)
Monitoring & kinetics
Review duration; plan a stop date; taper
Oral; short courses. Flumazenil for reversal (caution — seizures).
Source: NICE — Generalised anxiety / hypnotics · BNF — Anxiolytics & hypnotics