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Benzodiazepine Information Coalition

Benzodiazepines and COVID-19

Table of Contents
  • Increased Risk of hospitalization
  • Delirium
  • Paxlovid

As the COVID-19 pandemic continues, anxiety levels across the world have increased. Benzodiazepines, like alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan) prescriptions have risen 34%, with anti-anxiety medications becoming easier to access through telemedicine. Benzodiazepines have played a dangerous role in COVID-19, both through the many risks of prescribing and the increased risk of respiratory complications and delirium. Benzodiazepines also interfere with the Covid treatment Paxlovid.

Increased Risk of hospitalization

A 2022 study found that benzodiazepine use increased the risk of hospitalization in covid-positive patients but did not increase the risk of test positivity, severe outcomes, or mortality.

Benzodiazepines are potentially dangerous for those with pre-existing respiratory illnesses such as asthma and chronic obstructive pulmonary disease (COPD). Long-term benzodiazepine use increases pneumonia risk. 

Delirium

Delirium, a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment, is also a serious concern. The start of delirium is usually rapid, within a few hours or days.A significant percentage of individuals who are hospitalized for management of acute illness related to COVID-19 experience delirium and other severe neurologic symptoms. The Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center has started using the mnemonic device of F-COVID to help clinicians think about the causes of delirium during the pandemic and what will put a patient at higher risk of developing delirium in the ICU:

Family (and lack of visitation)
Clotting problems

Oxygenation issues
Virus itself
Immobilization
Drugs (eg, benzodiazepines)

According to E. Wesley Ely, MD, MPH, a professor of medicine and critical care at Vanderbilt University Medical Center in Nashville, Tennessee delirium has increased through COVID-19. In a 2020 Infectious Special Edition interview he shared about a New England Journal of Medicine case series that came out in April. In it, 50 of 58 patients (86%) with COVID-19 received a benzodiazepine (midazolam). Dr. Ely noted that:

We’ve been working for 20 years, and we’ve reduced delirium down from 70% in ventilated patients to around 40%, but COVID-19 has got it back up to 80%. So in three months, we’re erased 20 years of progress.

He went on to share another alarming statistic:

We stopped using benzodiazepines years ago because of how deliriogenic they are. To see 86% of people on a ventilator getting a benzodiazepine is like going back to how we practiced in 1995.

Paxlovid

Paxlovid, an FDA-approved treatment for Covid-19, has been shown to reduce the severity and shorten the duration of infection. A 2022 paper from the University of Waterloo School of Pharmacy warns not administer due to a risk of severe toxicity in patients taking clonazepam (Klonopin), diazepam (Valium), flurazepam, or midazolam. Another paper states dosages may need to be adjusted.

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Scroll to top
  • About Benzodiazepines
    • Benzo Basics
      • Ashton Manual
      • A Brief History Of Benzodiazepines
      • Class Actions, Lawsuits and Reporting Harm 
      • FDA 2020 Benzodiazepine Boxed Warning
      • Medications and Supplements of Concern
      • Sleeping Pills: What You Need to Know
      • Xanax Study Outcomes
    • Prescribing
      • Addiction vs Physical Dependence
      • Genetic Testing
      • Informed Consent
      • Low Dose Benzodiazepines
      • Mechanism of Action
      • Prescribing Statistics
      • Steps to Reduce Benzodiazepine Overprescribing
      • Therapeutic Actions
    • Prescribing Risks
      • Akathisia
      • Fluoroquinolones
      • Functional Brain Changes
      • Interdose Withdrawal
      • Paradoxical Reactions
      • Physical Dependence
      • Risks of Remaining on Benzodiazepines
      • Red Flags
      • Short-Term Risks
      • Side Effects
      • Suicide
      • Tolerance
    • Deprescribing
      • Ashton Manual
      • Detox, Cold Turkey, Abrupt Cessation
      • Dosages Prevent Safe Withdrawal
      • Estimates of Withdrawal
      • The Maudsley Deprescribing Guidelines
      • How To Find Tapering Help
      • Phenobarbital
      • Tapering Strategies and Solutions
    • Desprescribing Risks
      • Akathisia
      • Benzodiazepine Withdrawal Syndrome (BWS)
      • Forced Switching or Stopping
      • Functional Brain Changes
      • Kindling
      • Protracted Withdrawal Syndrome (PWS)
      • Suicide
      • Withdrawal & Post Withdrawal Symptoms
    • Special Populations
      • Benzodiazepines and PTSD
      • Celebrities
      • Benzodiazepines and COVID-19
      • Older Adults
      • Women
      • Incarcerated Population
      • Substance Use Disorders
  • About Us
    • Our Mission
    • Board Members and Advisors
    • Press Room
    • Receive Our Newsletter
    • FAQs
    • Volunteer
  • Our Impact
    • Media Outreach
    • Press Room
    • Programs
    • Research and Publications
    • Past Speaking and Events
    • Upcoming Events
  • Resources
    • Find Support
    • Benzodiazepine Cooperative Providers
    • Information
  • Contact Us
  • Blog
  • Donate
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