Benzodiazepines are listed in a class of drugs called central nervous system depressants, along with barbiturates and alcohol. Alcohol is known to cause several health issues when you drink too much, especially when it comes to the liver. If alcohol can cause liver damage and serious liver disease, can benzodiazepines like Xanax and Ativan do the same thing? Is Xanax bad for your liver?

Benzodiazepines do share some similarities with alcohol, and some prescription medications can be hard on your liver. But benzos do have some key differences that lower their liver toxicity and make them safe to use. However, what happens when you take benzodiazepines in high doses? Learn more about benzodiazepines and how they interact with the liver, including Ativan liver issues.

What are Benzodiazepines?

Benzodiazepines are the most commonly prescribed central nervous system (CNS) depressant in the United States. While this group of medications has many important uses, the main applications are in managing anxiety, panic disorders, and insomnia. Some benzodiazepines are used in treating seizure disorders like epilepsy, and others are used off-label to treat alcohol withdrawal symptoms. They may also be part of pre-surgery anesthesia.

Benzodiazepines work with a neurotransmitter in the brain called gamma-aminobutyric acid (GABA). This chemical messenger is the brain’s primary inhibitory neurotransmitter related to rest and relaxation. When it binds to its receptors, it slows down nervous system activity and communication. This facilitates relaxation, anxiety relief, and sleep. People with anxiety or sleep disorders may have a psychological or biological problem that makes it so that GABA’s normal activity isn’t enough to allow relaxation and sleep. 

Benzodiazepines bind to GABA receptors on a different part of the receptors than GABA. When GABA binds, the benzodiazepine gives it a boost. GABA opens a channel to negative charge that ultimately decreases nervous system activity. Benzodiazepines keep that channel open for longer, which increases the effectiveness of GABA. High doses of a benzodiazepine can cause some effects that are similar to alcohol, like drowsiness, dizziness, and memory issues. This is caused, in part, by the excessive effects of the drug on GABA as it slows down your nervous system.

How Do Benzodiazepines Affect The Liver?

One method of measuring liver function is serum enzyme elevations. When the liver is struggling to process chemicals or beginning to fail, this will be indicated by higher levels of specific enzymes in the blood.

Benzodiazepine treatment and even benzodiazepine abuse are rarely associated with elevated levels of liver enzymes. However, some benzodiazepines have been linked to rare instances of liver damage.

  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librax)
  • Clonazepam (Klonopin)
  • Clorazepate (Tranxene)
  • Diazepam (Valium)
  • Flurazepam (Dalmane)
  • Triazolam (Halcion)

Other benzodiazepines have not been reported in any instances of liver injury by themselves. However, most of them are metabolized by the liver in some way. Exceptions are:

  • Lorazepam
  • Oxazepam
  • Temazepam

These drugs work well for people who have liver damage or failure, so they have trouble metabolizing several drugs, including benzodiazepines. They may also be important as a method of treatment for people who abuse alcohol and need to manage withdrawal symptoms with medication but cannot metabolize other benzodiazepines safely. This includes Valium, which is the main benzodiazepine prescribed off-label for alcohol use disorder (AUD) treatment.

A medical study of high-dose benzodiazepine abuse did not reveal any liver damage. The study involved 201 people who abused benzodiazepines and no other drugs, who were admitted to addiction treatment. At admission, their liver enzymes were evaluated. About 20 patients, or 10 percent of participants, showed elevated levels of gamma-glutamyl-transferase (GGT), which tends to be elevated in the blood when a person’s liver or bile ducts are damaged.

However, this enzyme alone does not predict whether the liver is damaged or close to failure. It is, instead, one of several enzymes that must be measured. In the study, GGT was the only enzyme found to be elevated in the group that abused benzodiazepines, and no other signs of damage were recorded.

How Alcohol Damages The Liver

Alcoholic liver disease is associated with both binge drinking and excessive daily drinking. Your liver may be able to handle a glass of wine with dinner, but sending too much alcohol through your system on a regular basis can overwhelm your liver and lead to damage. Alcoholic liver disease comes in three phases: fatty liver, hepatitis, and cirrhosis. Around 90% of heavy drinkers are in the first phase of liver disease. But why is it more dangerous for your liver to drink alcohol than it is to take other depressants like benzodiazepines? 

In contrast to benzodiazepines, alcohol is well-known to cause extensive liver damage. Years of heavy drinking and binge drinking can cause alcoholic liver disease, which involves scar tissue developing on the liver. If left untreated, it can cause cirrhosis and eventual liver failure. Fatty liver and alcoholic hepatitis are also risks of abusing alcohol long term.

These conditions occur because the liver metabolizes almost everything people eat and drink, including alcohol, which is particularly toxic to that tissue. Alcohol can cause extensive damage while inducing sedation, relaxation, euphoria, and intoxication similar to benzodiazepines.

Alcohol causes fat to accumulate in the liver, which can lead to inflammation, scarring, and loss of function over time. The reason alcohol is damaging to the liver has to do with the way it’s broken down in the body. As a chemical is broken down, it can create metabolites, which are active chemicals that are created when a chemical is being processed. Alcohol can create some toxic metabolites. Alcohol is broken down into a chemical called acetaldehyde. Then that is broken down into acetate. During this process, fatty acid oxidation is lowered, and fatty acid synthesis is stimulated. In other words, the process of breaking down alcohol promotes the accumulation of fat in the liver. 

Harm to the Brain From Benzodiazepine Abuse

Benzodiazepines may not damage the liver as extensively as alcohol does, but these drugs still cause serious harm to people who abuse them. Brain damage is the most serious potential risk of abusing benzodiazepines. A study published in the British Medical Journal (BMJ) found a link between long-term, high-dose benzodiazepine abuse, especially in people over 65 years old, and a higher risk of dementia.

Taking These Drugs for Longer than Four Weeks, Or One Month Often Results in Physical Dependence. If You Try to Quit Taking Benzodiazepines Suddenly, You are at Risk of the Withdrawal Symptoms Below:

  • Anxiety
  • Depression
  • Restlessness
  • Muscle aches and twinges
  • Excessive sweating
  • Fever
  • Insomnia
  • Seizures

Because benzodiazepines manage the GABA neurotransmitter, the brain will soon adapt to their presence and stop managing GABA levels on its own. Abusing high doses of benzodiazepines for months or years can significantly increase your risk of seizures, which can be deadly.

Since these drugs have serious long-term health consequences, getting appropriate detox and rehabilitation is crucial. If you take benzodiazepines as prescribed, work with your doctor to taper off these drugs, even if you have not been taking them for a long time.

If you do not have a medical professional to work with already, addiction treatment will ensure you have medical supervision to safely detox and the behavioral therapy you need to avoid relapse.

Which Benzodiazepine is Safe in Liver Disease?

While benzodiazepines are safer than alcohol when it comes to liver toxicity, you should still be careful with these medications if you already have liver disease. However, benzodiazepines are sometimes used to treat people that are going through alcohol withdrawal syndrome, which can be life-threatening without treatment. 

Benzodiazepines can allow you to taper slowly, avoiding severe withdrawal symptoms. Since people that are seeking treatment for alcohol use problems may have liver disease, finding a benzodiazepine that’s safe for use in people with liver problems is important. According to research, lorazepam is among the safest benzodiazepines to be used in alcohol withdrawal treatment for people with liver disease. The drug is processed in the liver, but it’s broken down into inactive metabolites that should not do further damage to the liver.

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