Since there are some similarities between benzodiazepines and alcohol, you may be concerned that taking these drugs can affect the liver. While alcohol is well-known to cause liver damage, benzodiazepines do not cause liver problems to the same extent.
Some types of benzodiazepines may lead to liver damage, however. Some are processed by the liver so hepatic impairment can impact how they are processed.
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.
These drugs work on gamma-aminobutyric acid (GABA), a neurotransmitter that helps to manage communication between neurons. When the average brain has enough GABA, the person feels normal. With less GABA available, the person may feel anxious, have trouble falling asleep, or experience seizures, in extreme cases.
Too much GABA and the person will feel fatigued, sleepy, dizzy, or like they are drunk. This is because alcohol is another drug that impacts GABA bioavailability in the brain. Both alcohol and benzodiazepines bind to GABA receptors, allowing more of the natural neurotransmitter to remain in the brain and slow down neuron firing.
Despite their similarities, benzodiazepines and alcohol affect the liver differently.
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.
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:
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.
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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.
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.
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:
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.
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(October 30, 2018). Benzodiazepines. LiverTox at the National Institutes of Health (NIH). from https://livertox.nih.gov/BenzodiazepineDrugs.htm
(November 13, 2013). All Benzodiazepines are Metabolized by the Liver. Academic Life in Emergency Medicine (ALiEM). from https://www.aliem.com/2013/11/all-benzodiazepines-are-metabolized-by-the-liver/
(February 28, 2018). Does High-Dose Benzodiazepine Abuse Really Produce Liver Toxicity? Results from a Series of 201 Benzodiazepine Monoabusers. Expert Opinion on Drug Safety. from https://www.tandfonline.com/doi/abs/10.1080/14740338.2018.1457646?journalCode=ieds20
Gamma-Glutamyl Transferase (GGT). Lab Tests Online. from https://labtestsonline.org/tests/gamma-glutamyl-transferase-ggt
(July 10, 2017). Alcoholic Liver Disease. MedlinePlus. from https://medlineplus.gov/ency/article/000281.htm