Benzodiazepines

Generic and Trade Names:

Alprazolam	Xanax
Chlordiazepoxide		Librium
Clonazepam	Klonopin
Clorazepate dipotassium	Tranxene
Diazepam		Valium
Flurazepam		Dalmane
Lorazepam		Ativan
Oxazepam			Serax
Temazepam		Restoril

Description:

Benzodiazepines are a group of tranquilizer drugs which are classified as anti-anxiety agents. They primarily affect the lower brain areas to produce emotional calmness and relaxation without causing depression or significant sedation (see also under sedative and insomnia).

Nutritional Considerations:

Grapefruit juice may interact with some benzodiazepines by increasing their duration of effect, the clinical significance of this is unknown. (Ozdemir 1998)(Pronsky 1999)

Avoid alcohol. (Pronsky 1999)

Avoid over 400mg/day of caffeine: coffee, tea. (Pronsky 1999)

Herbal Considerations:

German Chamomile may increase the sedative effects of benzodiazepines. (Brinker 1998)

Tobacco speeds the elimination of benzodiazepines. (Brinker 1998)

The combination of kava and alprazolam can be very dangerous, and patients should not use these in combination. (Brinker 1998)

Newall and Brinker have a list of herbs with sedative action which could potentiate the action of benzodiazepines.

Herb        
                                
Calamus (Sweet Flag)                
Calendula
California poppy
Catnip
Celery Seed        
Chamomile,
Couchgrass        
Elecampane
Ginseng        
Hops        
Jamaica Dogwood        
Kava
Lemon balm
Nettle                                
Passion Flower        
Sage        
Skullcap                                
Shepherd's Purse                
St. John's Wort        
Valerian        
Wild Carrot Seed        
Wild Lettuce
Withania
Yerba mansa        

References

Almeida JC; Grimsley EW: Coma from the health food store: interaction between kava and alprazolam. [letter] Ann Intern Med, 1996 Dec, 125:11, 940-1.

AMA Department of Drugs: AMA Drug Evaluations, 6th ed. American Medical Association, Chicago, IL, 1986.

Brinker, Francis N.D. Herb Contraindications and Drug Interactions. Eclectic Medical Publications. 1998.

Davies LP, Drew CA, Duffield P, et al. Kava pyrones and resin: Studies on GABAA, GABAB and benzodiazepine binding sites in rodent brain. Pharm Toxicol 1992;71:120-26.

Dorian P, Sellers EM, Kaplan HL et al: Triazolam and ethanol interaction: kinetic and dynamic consequences. Clin Pharmacol Ther 1985; 37:558-562.

Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.

Guthrie SK & Lane EA: Reinterpretation of the pharmacokinetic mechanism of oral benzodiazepine ethanol interaction. Alcoholism 1986; 10:686-690.

Holm E, Staedt U, Heep J, et al. Studies on the profile of the neurophysiological effects of D,L-kavain: Cerebral sites of action and sleep-wakefulness rhythm in animals. Arzneim Forsch 1991;41:673-83.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996

Ozdemir M, Aktan Y, Boydag BS. Interaction between grapefruit juice and diazepam in humans. Eur J Drug Metab Pharmacokinet 1998; 23:55-9

Pinto, J.T. & Rivlin, R.S. : Drugs that promote renal excretion of riboflavin. Drug Nutrient Interactions, 1987, 5: 143-151.

Product Information: Torecan(R), thiethylperazine. Boehringer Ingelheim, Ridgefield, CT, 1996.

Product Information: Xanax(R), alprazolam. Upjohn Company, Kalamazoo, MI, 1996.

Pronsky, Z Food Medication Interactions, 11th edition, 1999.

Smith RB & Schoemfeld MJ: Effect of food on the bioavailability of Xanax(R) (alprazolam) following a single oral 1.0 mg dose. Upjohn Company, Kalamazoo, MI, 1981.

Viola, H et al., Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptor-ligand with anxiolytic effects. Planta Medica, 1996, 61:213-216.