Benzodiazepines and cancer
Benzodiazepines are a class of medications commonly used for their anxiolytic, sedative, and muscle-relaxing properties, with notable examples including Alprazolam (Xanax), Diazepam (Valium), and Lorazepam (Ativan). These drugs primarily target the GABA-A receptors in the brain and are often utilized to alleviate anxiety, treat insomnia, and support cancer patients undergoing various treatments. In the context of cancer care, benzodiazepines can help manage treatment-related anxiety, nausea, and restlessness, with different types chosen based on their onset speed, duration of effect, and the specific needs of the patient.
Recent research has suggested that certain benzodiazepines may influence cancer progression; for instance, while Lorazepam was associated with shorter progression-free survival in pancreatic cancer patients, Alprazolam appeared to correlate with longer periods without disease progression. However, the findings warrant further investigation. Despite their benefits, benzodiazepines have potential side effects, including drowsiness, cognitive impairments, and risk of dependence. It is crucial for healthcare providers to monitor patients closely to manage dosage and mitigate withdrawal symptoms effectively. Given their complex role in cancer treatment, benzodiazepines require careful consideration and individualized treatment approaches.
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Subject Terms
Benzodiazepines and cancer
ATC CODE: N05BA
ALSO KNOWN AS: Alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan)
DEFINITION: Benzodiazepines are a class of drugs with antianxiety, sedative, and muscle-relaxing properties.
Cancers treated:Adjuvant therapy for many types of cancer
Delivery routes: Orally by capsule or tablet, intramuscularly by injection
How these drugs work: Benzodiazepines are a class of medications that act primarily on the gamma aminobutyric acid-α (GABA-A) receptors in the brain. Medications within the class vary according to their rapidness of onset, potency, frequency of dosing, length of effect, and half-life. They are typically used in the general medical population to alleviate anxiety or treat insomnia. Benzodiazepines are put to similar uses with cancer patients, as well as directed toward disease-specific conditions.
When choosing among benzodiazepines, physicians consider the unique properties of specific medications (such as speed of onset, duration of effect, and side effects), as well as patient characteristics (age, vigor, pain tolerance, coping skills) and the types of cancer and treatments involved. Short-acting medications with rapid onset are often employed to treat acute anxiety, panic, and phobic responses to therapy. Longer-acting medications may be selected to assist patients engaging in painful or aversive cancer treatments (such as chemotherapy) to promote relaxation, reduce anticipatory anxiety, suppress recall of treatment, and alleviate nausea and restlessness (akisthisia). Long-acting benzodiazepines may also be employed to treat generalized anxiety and grief reactions stemming from cancer. Highly sedating benzodiazepines are often used to treat anxiety-related insomnia. In the mid-2020s, research emerged indicating some benzodiazepines may allow for longer progression-free periods in a patient's cancer. In pancreatic cancer patients, lorazepam appeared to lead to shorter progression-free survival periods, while alprazolam allowed for longer periods without disease progression. More study, however, was needed.
Side effects: Several side effects are associated with benzodiazepines. Long-term use can lead to drowsiness and deficits in memory, concentration, and motor coordination. Though safe for most in recommended dosages, benzodiazepines can potentially cause respiratory depression, and patients should be monitored closely as they initiate treatment. All benzodiazepines, especially those with rapid onsets and short durations of action, have the potential to cause dependence and, in rare cases in the cancer patient population, abuse. Consequently, physicians must closely supervise patients’ use of these medications. Abrupt discontinuation of benzodiazepines may cause withdrawal symptoms that, while severe, are usually managed with appropriate medical intervention. These symptoms include “rebound” anxiety, confusion, agitation, seizures, and, rarely, death.
Bibliography
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