Using Two Benzodiazepines For Anxiety

In our latest question and answer, our pharmacist discusses the use of two benzodiazepines at the same time.

Dec 13, 2017

Will asked

Hi, I have been diagnosed with several things and I’ve asked a few questions on here but mostly this question revolves around my Generalized Anxiety Disorder & Panic Disorder w/Agoraphobia. I have severe anxiety and quite a few panic attacks a week despite being on 1mg Klonopin 3 times a day. My question is: Are there any instances were psychiatrists will have a patient on a Long acting benzodiazepine like Valium or Klonopin kind of like for maintenance and also on a quick acting benzodiazepine like Ativan or Xanax to take if there is a severe panic attack that breaks up here and there. Thanks.


Although the use of two benzodiazepines has been used in practice, it is exceedingly rare and not recommended per treatment guidelines for anxiety.

On the surface, it may make sense to use multiple benzodiazepines with different characteristics, one short acting and one long acting for example. However, most studies find that using two benzodiazepines don't confer any additional benefit versus using one alone and the risk of side effects is greatly increased. In addition, fast acting benzodiazepines are generally not recommended to be prescribed on an as-needed basis for anxiety disorders. This is because irregular, inconsistent use of short acting benzodiazepines, while providing intermittent relief, have shown to exacerbate symptoms afterwards. This mostly due to fluctuating blood levels of the drug.

Most treatment guidelines list non-benzodiazepine drugs as first line treatment of anxiety disorders such as SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin-norepinephrine reuptake inhibitor) drugs.  In guidelines that do recommend benzodiazepines purely for adjunctive/augmentation therapy, they specifically state to NOT use short acting benzodiazepines due to the higher risk of adverse effects.

The key takeaway is that benzodiazepine use for anxiety disorders is almost universally recommended for use only in crisis situations.

Now, there certainly could be rare situations in which two different benzodiazepines may be the best option for a specific scenario. If you have a question about your therapy, please check with your doctor regarding the medications prescribed to you.

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