How does the toxicity of Alcohol compare to that of Benzodiazepines?I understand that ethanol is toxic to the human body, in particular the liver. But benzodiazepines and alcohol have cross-tolerance, which is why benzodiazepines are prescribed to treat dangerous withdrawal. But are benzos toxic in any way themselves?
Just curious. Of course, an over-dose of benzos might be considered 'toxic'; the same with alcohol, but do these molecules themselves pose any danger to the lives of cells in the human body?
Answer by Soul Prophet
Not as far as I'm aware. Benzos are pretty safe, relatively speaking. In fact, several times the therapeutic dose still won't cause any long-term damage. Certainly not recommended, but it speaks to the (again, relative) extremely low toxicity.
I also found more information if you need it.
http://www.benzo.org.uk/ashtox.htm
Answer by Joe
Alcohol IS very toxic, indeed.
Benzodiazepines - which largely replace barbiturates as tranquilizers are RELATIVELY safe.
The "therapeutic index" is very high - meaning that it takes many times the therapeutic dose to cause toxic/lethal effects. Barbiturates - on the other hand - had a very low therapeutic index - just a couple of extra pills could kill.
Therapeutic index = LD50 / ED50 (dosage amount that causes lethality in 50% of subjects divided by the dosage amount that causes therapeutic effect in subjects - animals, of course).
And - NO - ethanol is directly toxic to cells but benzos are not.
Answer by Mathieu
If we rank potential hepatotoxicity on a scale of 1 to 10 (10 having a large risk and 1 being no risk) then alcohol would be 10 and most benzodiazepines, aside from lorazepam or oxazepam, would be a 2-3 (that is being liberal) but oxazepam and lorazepam would be a 1.
Benzo's are some of the safest drugs on earth interns of anything really. A massive overdose is almost never lethal. Alprazolam (Xanax) for example is one of the more dangerous benzodiazepines but it would require several thousand milligram to kill most people.
The LD50 (median lethal dose) for Librium (chlordiazepoxide) is 800 mg/kg and for Serax (oxazepam) the LD50 is greater than 5000 mg/kg.
There are only a very small number of people to ever die from a benzodiazepine. In The US about 70 people die yearly from "sedative/hypnotics" I don't know the break down of specific drugs but still most are likely barbiturates. HOWEVER when benzo's are mixed with alcohol, barbiturates, or opioids in particular then the danger is much higher. The risk, for example, of death by ABUSING methadone is moderate however when a bunch of benzo's are used it become very dangerous. In France most methadone addicts die from methadone and a benzodiazepine, particularly temazepam (which ranks with alprazolam in terms of danger).
Many people take benzo's for months or year or for life and basically none have toxic effets. Also any theoretical toxic effects of long term use at therapeutic doses are not really dose dependent (except potential neurotoxicity from chronic high dose benzo abuse (ie 1 gram of diazepam/day)). For example the dose range of clonazepam is typically a minimum of 0.25 mg/day and a maximum of 20 mg/day (that is the therapeutic range) and a person on 20 mg/day does not really have much more risk of any toxic effects compared to the person taking 0.25 mg. With alcohol 1 drink a day should not cause problems however 80 drinks will cause massive damage.
Lorazepam and oxazepam are not at all metabolized by the liver so there is zero risk of hepatotoxicity.
Typically for alcohol withdrawal Valium (diazepam), Librium, Serax, or Ativan are used. If an alcoholic has alcoholic liver disease (which includes alcoholic hepatitis and cirrosis) or even if they have significantly elevated liver enzymes they are given either lorazepam or oxazepam.
For the most part there needs to already be significant damage for a benzodiazepine to have any effect.
Over all alcohol out of all the drugs of abuse (heroin, cocaine, methamphetamine....) is the hardest on the body and cause the most direct physical changes and toxicity. Alcohol is also neurotoxic.
Benzo's are certainly cross tolerant with alcohol as are barbiturates, chloral hydrate, "Z" drugs (zolpidem, zaleplon, zopiclone, meprobamate, ethchlorvynol, glutethimide, methaqualone, and other GABAnergic drugs.
But benzodiazepines and just about all other oral drugs are not toxic. Even barbiturates which can literally cause all activity in the brain to cease (and people can come back from that) is not really toxic in a similar way like alcohol.
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