Managing Anxiolytic & Hypnotic Adverse Events
Seventeen point-of-care chapters on what to do when a benzodiazepine, Z-drug, orexin antagonist or other anxiolytic or hypnotic causes the problem — recognition, differential, and a decision for each adverse effect, built for the clinician who has eight minutes and a patient waiting.
All 17 chapters are now live for Academy members.
What this course is for
Anxiolytics and hypnotics are prescribed in almost every clinical setting, and their harms are easy to miss because sedation is the effect everyone expects. A benzodiazepine taken with an opioid can stop a patient’s breathing. Stopping a benzodiazepine abruptly after regular use can cause seizures. A Z-drug can cause complex sleep behaviors such as sleep-driving, and a patient who feels fully awake the next morning can still be impaired at the wheel.
Every chapter is built around the decision that follows. Is it the drug, the illness or something else, and what do I do now: continue, lower the dose, taper, switch, stop for good, or send the patient to the emergency department? Getting that call wrong in either direction is how a manageable adverse effect becomes an emergency, or how a drug that needed a slow taper gets stopped overnight.
Bedside panel first
Each chapter opens with a two-minute panel: do now, do not, the questions to ask and a red / amber / green triage, then a lookup by situation. The detailed chapter follows below.
Numbers with denominators
Every figure names its study population. Where evidence is weak or contested, the chapter says so, and a threshold that could not be verified is not printed.
Built to use, not to read
Patient and family scripts and copy-paste EMR notes in every chapter, so the work of the visit is already drafted.
The benzodiazepine overdose triage, exactly as it appears in the chapter
Call 911 now if any of
- Not breathing normally: slow, shallow, gasping or noisy breathing
- Cannot be woken, or falls straight back to sleep
- Any opioid, alcohol or pill not from a pharmacy, with drowsiness
- Intentional ingestion
- A seizure, or a cyclic antidepressant among the tablets taken
Poison center now and same-day medical assessment if any of
- Drowsier than usual but rousable, breathing normally
- Amount or timing unknown
- Heart or lung disease
- No one available to stay with the patient
Outpatient, with a safety net
Fully alert patient who took one or two extra prescribed doses by mistake, with nothing else: follow poison center advice, someone stays with the patient, no driving, and clear advice to call 911 for any change in breathing or alertness.
Prescriber-side triage. The chapter’s own synthesis of the 2023 AHA poisoning guideline, FDA labeling and its other sources, not a validated instrument. US Poison Help line: 1-800-222-1222.
Every chapter opens with a bedside panel like this one — what to do now, what not to do, the questions to ask and the triage — before the detailed chapter begins.
📅 Released November 6, 2026
All six sections and all 17 chapters, including the quick-reference grid, are live now.
Academy members can read every chapter today, at no additional cost, along with every other course in the Academy.
The 17 chapters
Overdose when an opioid is also on board, withdrawal that can cause seizures and delirium, and the paradoxical reaction that can be mistaken for the illness.
- 1Benzodiazepine Overdose and Opioid Co-Exposure: Respiratory Depression, Naloxone and Flumazenil Risks
- 2Benzodiazepine Withdrawal: Seizures, Delirium and When to Admit
- 3Paradoxical Agitation and Disinhibition on Benzodiazepines
Telling physical dependence from misuse and use disorder, and tapering at a pace the patient can sustain.
- 4Dependence, Misuse or Use Disorder: Telling Them Apart
- 5Tapering Long-Term Benzodiazepines: Rate, Substitution and Protracted Withdrawal
What the dementia evidence does and does not show, and when falls, fractures and delirium mean it is time to taper.
- 6Benzodiazepines and Dementia Risk: What the Evidence Shows and What to Tell Patients
- 7Benzodiazepines in Older Adults: Falls, Fractures, Delirium and When to Taper
Complex sleep behaviors that mean stopping for good, the long-term Z-drug decision, and the sleep paralysis, hallucinations and cataplexy-like events seen with the orexin antagonists.
- 8Complex Sleep Behaviors on Zolpidem, Eszopiclone and Zaleplon: When to Stop for Good
- 9Long-Term Z-Drug Use: Continue, Taper or Switch to a DORA?
- 10Orexin Antagonists: Sleep Paralysis, Hallucinations, Cataplexy-Like Events and Worsening Depression
Gabapentinoids, propranolol, hydroxyzine and buspirone: the alternatives to benzodiazepines, and the serious harms that come with each.
- 11Gabapentinoids for Anxiety: Respiratory Depression, Misuse and Withdrawal
- 12Propranolol for Anxiety: Overdose Toxicity, Contraindications and Stopping Safely
- 13Hydroxyzine for Anxiety: QT Prolongation, Anticholinergic Burden and Sedation
- 14Buspirone: Serotonin Syndrome, MAOI Contraindication and CYP3A4 Interactions
The “gentler” hypnotics, off-label sedatives for sleep, and next-day impairment and driving across every agent, with a one-page grid.
- 15Low-Dose Doxepin, Ramelteon and Melatonin: Adverse Effects of the “Gentler” Hypnotics
- 16Off-Label Sedatives for Sleep: Sedating Antihistamines, Low-Dose Antipsychotics and Mirtazapine
- 17Next-Day Impairment and Driving Across Anxiolytics and Hypnotics, with a Quick-Reference Grid
Covered elsewhere in the Academy
Trazodone, and the insomnia and sedation caused by antidepressants, are covered in Managing Antidepressant Adverse Events. Antipsychotic class effects are in Managing Antipsychotic Adverse Events; this course covers low-dose antipsychotics only as off-label sleep aids. Pregnancy and breastfeeding are covered in the Perinatal Psychopharmacology Series, and general QTc management in Psychopharmacology with Cardiac Impairment.
Read every chapter with Academy membership
One membership covers this series and the entire Academy library — psychopharmacology lessons, case discussions and clinical pearls, with new content added monthly.
Monthly
Flexible access without a long-term commitment.
Billed monthly. Cancel anytime.
Select MonthlyYearly
Our most popular plan. Save over 67% versus monthly.
Just $12.50 a month.
Select YearlyStudent & Resident
Discounted access for verified students and residents.
Verification of trainee status required.
Apply
Responses