Benzodiazepines in Epilepsy: A US Perspective on Clinical Use, Pharmacology, Abuse Methods, and Public Health Considerations.

Benzodiazepines (BZDs) are indicated for a range of therapeutic conditions and can improve patient outcomes when used appropriately. The role of BZDs in epilepsy management is essential in that they have long been first-line agents for acute seizure cessation, most notably including status epilepticus, with each BZD offering a unique pharmacokinetic profile. BZDs are commonly used to treat seizures because of their rapid onset, pronounced safety and tolerability profiles, and versatility of dosage forms and available routes of administration. Despite their clinical utility in a variety of therapeutic areas for a wide range of conditions, the potential for BZD misuse and abuse remains a topic of public health concern. Particularly in combination with other central nervous system depressants (e.g., opioids, gabapentin, and alcohol), misuse and abuse of BZDs are linked to serious and potentially fatal complications. As such, the US Food and Drug Administration has issued a boxed warning regarding concurrent use of BZDs and opioids, emphasizing the dangers of co-prescribing. Policies and prescribing safeguards are implemented to regulate and promote safe use of BZDs; however, such measures may unintentionally worsen patient care by limiting access for individuals that benefit from therapy for seizure control. The objective of this paper is to identify a practical balance between ensuring access to these essential medications for those who experience clinical benefit while also supporting safe prescribing of BZDs to minimize misuse and abuse. Findings from the present review support continued research, drug utilization policies, and patient education.