Antianxiety medications, also known as “anxiolytics,” work to mitigate feelings of anxiety and psychological stress by depressing the CNS (central nervous system). There are a number of drug types that act as anxiolytics including: barbiturates, benzodiazepines, carbamates, sympatholytics, and others (Medline Plus: U.S. National Library of Medicine “Mental Health Medications, October 2016). Benzodiazepines, such as Xanax and Valium, are the most commonly prescribed drug class for anxiety conditions, including panic disorder, generalized anxiety disorder, and insomnia (Medline Plus: U.S. National Library of Medicine: “Anxiety Disorders: Types, Diagnosis and Treatments,” 2015). This article will focus on benzodiazepines, which are tested in the Rxight® panel.
Serious Side Effects of Benzodiazepines
According to the FDA Drug Safety Communication (August 2016), “FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warningas reported by the FDA,” benzodiazepines have received a “Black Box Warning” due to adverse reactions when combined with opioid medications. Life-threatening adverse reactions from the combination of opioids and benzodiazepines include:
Addiction to Benzodiazepines
Benzodiazepines carry a risk of serious addiction and withdrawal according to the Drug Enforcement Agency: “Fact Sheet on Benzodiazepines.” The reactions include:
Common Side Effects of Benzodiazepines
The most frequently reported adverse reactions include, according to FDA Drug Safety Communication “FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning, August 2016):
Less Common Side Effects
Benzodiazepines generally bring about calmness. However, there is the rare, paradoxical effect exhibited in some patients including hostility, violent behavior and rage. Additionally, hallucinations and convulsions from rapid withdrawal can occur as well, according to an FDA Drug Safety Communication (August 2016).
Understand Your Risks with the Rxight® Genetic Test
Rxight® DNA testing is designed to help determine if you are at risk for side effects from over 200 clinically relevant medications (including most antianxiety drugs). This type of genetic testing is known as “pharmacogenetic testing.” A panel of genes is sequenced at our labs based on a simple, non-invasive cheek swab for a sample of your DNA. You will receive a detailed one-on-one review of the results. With Rxight® genetic testing, you and your prescriber will know if you are likely to experience side effects or therapeutic inefficacy – ideally before the start of treatment – so that your prescriber can determine the optimal dose, or if necessary find an alternative medication.
How Does Pharmacogenetic Testing Work?
Antianxiety medication can cause a large number of side effects in a portion of patients, while other patients will tolerate the medication well and not experience adverse reactions. This interpatient variability is in part accounted for by differences in the genes that code for the enzymes and brain chemicals that interact with antianxiety medication.
Most antianxiety drugs are metabolized in the liver by a specific chemical. Genetic variation in these chemicals have been shown to increase the probability of developing side effects, or conversely the probability of patients not benefiting from the medication at standard doses.
Contributors to this Article:
Michael Sapko, MD, PhD; Deborah Kallick, PhD, Medicinal Chemistry