Benzodiazepines (drug interactions)
Benzodiazepines are a class of central nervous system depressants commonly prescribed for various conditions, including anxiety, insomnia, muscle spasms, and alcohol withdrawal. However, they can interact harmfully with certain substances, necessitating caution in their use. Grapefruit juice, for instance, can inhibit the metabolism of benzodiazepines, leading to elevated drug levels in the bloodstream, which may result in serious side effects. Herbal supplements such as kava, hops, and valerian can also intensify the sedative effects of benzodiazepines, potentially leading to excessive sedation and impairment.
Conversely, melatonin, a natural hormone that regulates sleep, may assist individuals looking to taper off benzodiazepines, although its use should be guided by a healthcare professional, especially during withdrawal. Pregnenolone, another supplement, has been shown to reduce the effectiveness of benzodiazepines, which is important for users to consider. While kava may help alleviate withdrawal symptoms when supervised medically, it should not be combined with benzodiazepines without professional advice due to the risk of increased sedation. Overall, understanding these interactions is crucial for anyone using benzodiazepines to ensure safe and effective treatment.
Benzodiazepines (drug interactions)
DEFINITION: Central nervous system depressant medications used as muscle relaxants, sedatives, and anticonvulsants in treating insomnia, anxiety, epilepsy, muscle spasms, alcohol withdrawal, and some symptoms experienced by individuals with cancer
INTERACTIONS: Grapefruit juice, hops, kava, melatonin, passionflower, pregnenolone, valerian
DRUGS IN THIS FAMILY: Alprazolam (Xanax), chlordiazepoxide hydrochloride (Libritabs, Librium, Limbitrol, Lipoxide, Mitran, Reposans-10, Sereen), clonazepam (Klonopin), clorazepate dipotassium (Gen-XENE, Tranxene-T, T-Tab), diazepam (Diastat, Valium, Valrelease, Vazepam), estazolam (ProSom), flurazepam hydrochloride (Dalmane, Durapam), halazepam (Paxipam), lorazepam (Ativan), oxazepam (Serax), quazepam (Doral), temazepam (Razepam, Restoril, Temaz), triazolam (Halcion), midazolam (Versed, Nayzilam, Seizalam)
Grapefruit Juice
Effect: Possible Harmful Interaction
Grapefruit juice slows the body’s normal breakdown of several drugs, including some benzodiazepines, allowing them to build up to potentially dangerous levels in the blood. Research indicates that this effect can last for three days or more following the last glass of juice. Because of this risk, if one takes benzodiazepines, the safest approach is to avoid grapefruit juice altogether.
Hops, Kava, Passionflower, Valerian
Effect: Possible Harmful Interaction
The herb kava (Piper methysticum) has a sedative effect and is used for anxiety and insomnia. Combining kava with drugs in the benzodiazepine family, which possess similar effects, could result in “add-on” or excessive physical depression, sedation, and impairment. In one case report of a fifty-four-year-old man hospitalized for lethargy and disorientation, these side effects were attributed to his having taken the combination of kava and alprazolam for three days.
Experimental studies suggest that kava, similarly to benzodiazepines, exerts its sedative effects at binding sites in the brain called GABA receptors.
Other herbs with a sedative effect that might cause problems when combined with benzodiazepines include ashwagandha (Withania somnifera), calendula (Calendula officinalis), catnip (Nepeta cataria), hops (Humulus lupulus), lady’s slipper (Cypripedium), lemon balm (Melissa officinalis), purple passionflower (Passiflora incarnata), sassafras (Sassafras officinale), skullcap (Scutellaria lateriflora), valerian (Valeriana officinalis), and yerba mansa (Anemopsis californica). Because of the potentially serious consequences, one should avoid combining these herbs with benzodiazepines or other drugs that also have sedative or depressant effects unless advised by one’s physician.
Melatonin
Effect: Supplementation Possibly Helpful
Melatonin is a natural hormone that regulates sleep. Many people who take conventional sleeping pills (most of which are in the benzodiazepine family) find it difficult to quit. The reason is that when one tries to stop the medication, one may experience severe insomnia or interrupted sleep. A double-blind, placebo-controlled study of thirty-four people who regularly used such medications found that melatonin at a dose of 2 milligrams (mg) nightly (in a controlled-release formulation) could help them discontinue the use of the drugs. However, further research found conflicting results.
Other research found a reciprocal relationship between benzodiazepines and melatonin, in which long-term benzodiazepine use causes a disruption in the normal secretion of melatonin. Adding a melatonin supplement may help restabilize this, but only with the advice of a medical professional.
Warning: It can be dangerous to stop using benzodiazepines if one has taken them for a while. Consult a physician before trying melatonin to help handle benzodiazepine withdrawal or before trying to stop benzodiazepine medication under any conditions.
Pregnenolone
Effect: Supplementation May Decrease Effectiveness
The adrenal gland naturally produces the hormone pregnenolone, but when taken as a supplement, it is intended to improve cognitive function, stress, and depression. It is widely sold as a kind of “fountain of youth.” However, the only direct evidence that pregnenolone supplements have any effect relates to a potential interaction between the hormone and benzodiazepine drugs. In a carefully designed clinical trial, regular use of pregnenolone was found to greatly decrease the sedative effects of diazepam (Valium). The reasons for this interaction are not known. However, people who rely upon benzodiazepine drugs may find them less effective if pregnenolone is added into the mix.
Kava
Effect: Possibly Helpful for Medication Cessation
Although they are highly effective for anxiety, benzodiazepine drugs can cause unpleasant and dangerous withdrawal symptoms when they are discontinued.
A six-week, double-blind, placebo-controlled trial of forty people who had been taking benzodiazepines found that the use of kava significantly reduced withdrawal symptoms and helped maintain control of anxiety. This trial involved close medical supervision and a very gradual tapering of benzodiazepine dosages. Persons should not discontinue anti-anxiety medications except on the advice of a physician, as withdrawal symptoms can be life-threatening.
However, when taken with benzodiazepines, Kava can prevent the breakdown of the drug, causing increased sedative effects for a longer period. Kava should only be taken with benzodiazepines at the direction of a medical professional.
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