Paradoxical reactions to benzodiazepines: literature review and treatment options

Pharmacotherapy. 2004 Sep;24(9):1177-85. doi: 10.1592/phco.24.13.1177.38089.


Benzodiazepines frequently are administered to patients to induce sedation. Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients. The exact mechanism of paradoxical reactions remains unclear. Most cases are idiosyncratic; however, some evidence suggests that these reactions may occur secondary to a genetic link, history of alcohol abuse, or psychological disturbances. This review evaluates the numerous cases of paradoxical reactions to benzodiazepines in adult and pediatric patients that have been reported in the biomedical literature. It also explores the advantages and disadvantages of the various available treatment options.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Anxiety Agents* / adverse effects
  • Anti-Anxiety Agents* / pharmacology
  • Benzodiazepines* / adverse effects
  • Benzodiazepines* / pharmacology
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Mental Disorders / chemically induced*
  • Middle Aged
  • Randomized Controlled Trials as Topic


  • Anti-Anxiety Agents
  • Benzodiazepines