Are benzodiazepines safe to take every day?

Benzodiazepines, often called "benzos", are sedative medications such as lorazepam (Ativan), alprazolam (Xanax), clonazepam (Rivotril) and diazepam (Valium). They work quickly and are safe and effective when taken as directed for a short time. Taken every day for weeks or months, however, they can lead to dependence, withdrawal and side effects such as drowsiness, memory problems and falls. Combining them with opioids or alcohol can be dangerous. Your genes also affect how your body handles several benzodiazepines.

What are benzodiazepines used for?

Benzodiazepines slow down activity in the brain by boosting the effect of GABA, a natural calming chemical. They are used for:

• short-term relief of severe anxiety and panic attacks;
• short-term treatment of insomnia;
• seizures, including emergency treatment of prolonged seizures;
• alcohol withdrawal;
• sedation before surgery or medical procedures.

Benzodiazepines do not treat depression. For long-term treatment of anxiety, antidepressants and cognitive behavioural therapy are usually preferred. Read more in What are the best medications for anxiety?

How long can you take benzodiazepines safely?

Benzodiazepines are generally meant for short-term use, usually no more than 2 to 4 weeks. With daily use beyond that, the body adapts: the medication may work less well, and stopping suddenly can cause withdrawal symptoms such as rebound anxiety, insomnia, tremor and, in severe cases, seizures. In 2020, the US Food and Drug Administration updated its boxed warning for all benzodiazepines about the risks of misuse, addiction, physical dependence and withdrawal.

Some people, such as those with certain seizure disorders, may need longer treatment under close medical supervision.

What are the different types of benzodiazepines?

Benzodiazepines differ in how quickly they work and how long they last in the body:

Short-acting	Intermediate-acting	Long-acting
midazolam	alprazolam (Xanax)	diazepam (Valium)
triazolam (Halcion)	lorazepam (Ativan)	clonazepam (Rivotril)
	oxazepam	chlordiazepoxide
	temazepam (Restoril)	clorazepate (Tranxene)
		clobazam (Frisium)

Short-acting drugs wear off quickly but are more likely to cause rebound symptoms between doses. Long-acting drugs build up in the body, especially in older adults, and can cause next-day drowsiness.

Which combinations are dangerous?

• Opioids, alcohol and other sedatives. Combining benzodiazepines with opioids (such as codeine, oxycodone or hydromorphone), alcohol, sleeping pills or sedating antihistamines can slow breathing and cause overdose and death. Tell your pharmacist about all your medications, especially if you are prescribed an opioid after surgery.
• Stimulants for ADHD. A stimulant can make you feel alert while you are still impaired by a benzodiazepine. Read more in Is it safe to take Adderall and Xanax together?
• Ketamine. In a study of people with depression, higher daily benzodiazepine doses were linked to a weaker response to ketamine. Read more in Ketamine: an option for treatment resistant depression?
• Medications that block CYP3A4, such as some antifungals, clarithromycin and some HIV medications, can sharply raise levels of alprazolam, midazolam and triazolam.

Seek emergency help if someone taking a benzodiazepine is unusually dizzy or sleepy, has slow or difficult breathing, or cannot be woken.

What are the side effects of benzodiazepines?

Common side effects include drowsiness, dizziness, poor coordination, slowed reactions and memory problems. Older adults are especially sensitive: benzodiazepines increase the risk of confusion, falls and hip fractures, and of car accidents. Read more in Which medications can cause falls in the elderly?

How can you stop taking benzodiazepines safely?

Do not stop suddenly after regular use. The Canadian deprescribing guideline recommends offering a slow taper to all adults 65 and older who take benzodiazepines, and to younger adults who have taken them for more than 4 weeks. Tapering slowly, with your prescriber's support, improves the chances of stopping successfully without serious harm. Cognitive behavioural therapy for insomnia can help people who used benzodiazepines for sleep.

How do genes affect benzodiazepines?

Most benzodiazepines are broken down in the liver, and some depend on enzymes whose activity is set by your genes:

• CYP2C19: diazepam and clobazam. Poor metabolizers clear these drugs more slowly, so levels can build up. The clobazam label recommends a lower starting dose for CYP2C19 poor metabolizers, and studies confirm much higher levels of clobazam's active metabolite in these people. Rapid and ultrarapid CYP2C19 metabolizers clear these drugs faster and may have a reduced response, although this has been less well studied.
• CYP3A4 and CYP3A5: alprazolam, midazolam, triazolam and also diazepam. Natural differences in these enzymes and, more importantly, drug interactions can change their levels.
• No CYP enzymes: lorazepam, oxazepam and temazepam are cleared by a different pathway (glucuronidation). They are less affected by genes, drug interactions and liver disease, which is why they are often preferred for older adults.

Can a pharmacogenetic test help?

Pillcheck reports CYP2C19, CYP3A4, CYP3A5 and other genes that affect benzodiazepines, antidepressants and many other medications, with 355 medications in total. A Pillcheck pharmacist reviews your results and all your medications, flags risky combinations and recommends safer options and doses to discuss with your prescriber.

Summary

• Benzodiazepines are safe and effective for short-term use, usually no more than 2 to 4 weeks.
• Daily long-term use can cause dependence, withdrawal, memory problems and falls, especially in older adults.
• Never combine benzodiazepines with opioids, alcohol or other sedatives without medical advice.
• Stop by tapering slowly with your prescriber, not suddenly.
• CYP2C19 affects diazepam and clobazam, CYP3A4 and CYP3A5 affect alprazolam and midazolam, and lorazepam, oxazepam and temazepam are less affected by genes.

Frequently asked questions

Is it safe to take a benzodiazepine every day?

Daily use for a few weeks is usually safe if prescribed. Longer daily use increases the risk of dependence, withdrawal and side effects, so the need for it should be reviewed regularly with your prescriber.

Which benzodiazepine is safest?

It depends on what it is used for, your age and your other medications. Lorazepam, oxazepam and temazepam are less affected by liver enzymes, genes and drug interactions, which makes them a common choice for older adults.

Can I drink alcohol while taking a benzodiazepine?

No. Alcohol increases sedation and can slow breathing to dangerous levels.

How do I stop taking benzodiazepines?

Talk to your prescriber about a gradual taper. Stopping suddenly after regular use can cause withdrawal symptoms, including seizures in severe cases.

Do genes affect how I respond to benzodiazepines?

Yes, for some of them. CYP2C19 affects diazepam and clobazam: poor metabolizers may need a lower dose, while rapid and ultrarapid metabolizers may have a reduced response. CYP3A4 and CYP3A5 affect alprazolam, midazolam and triazolam.

References

US Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Drug Safety Communication. September 23, 2020.

Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline. Can Fam Physician. 2018;64(5):339-351.

Andrashko V, Novak T, Brunovsky M, et al. The Antidepressant Effect of Ketamine Is Dampened by Concomitant Benzodiazepine Medication. Front Psychiatry. 2020;11:844.

Wan J, Yu Y, Liu X, et al. Clobazam in pediatric drug-resistant epilepsy: from pharmacology to clinical practice. Eur J Clin Pharmacol. 2026;82(9).

Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr. 2015;38(5):152-155.