Benzodiazepine dependence (Rivotril, Xanax) and Night Calm: why stopping suddenly is risky

Can sedatives and sleeping pills cause dependence?

Yes. Benzodiazepine dependence, and dependence on sleeping pills, can happen even when you started on a doctor's prescription. Benzodiazepines such as clonazepam (Rivotril), alprazolam (Xanax) and diazepam can cause physical dependence after days to weeks of regular use, according to a 2020 safety warning from the U.S. Food and Drug Administration (FDA). It is not only benzodiazepines: the UK's NHS says addiction is possible with the sleeping pill zopiclone, and the U.S. National Library of Medicine notes that stopping eszopiclone suddenly can cause withdrawal symptoms. Eszopiclone is the active ingredient in Night Calm, a tablet well known in Egypt.

That is why, when these medicines are used for sleep or anxiety, the NHS recommends using them for a short time only, often no longer than four weeks. Longer use may sometimes be appropriate for certain conditions, such as some seizure disorders, and that decision belongs to your doctor. Becoming dependent does not mean you are weak or did something wrong; it is simply how the brain adapts to the medicine. The good news is that stopping safely is possible, as long as it is planned and medically supervised.

The names of these tablets vary from country to country. In Egypt you may hear "Rivotril", "Apetryl" or "Roche"; in Saudi Arabia "Abu Saliba"; in Algeria "al-Hamra"; and in Morocco and Algeria "qarqoubi". What matters is not the street name but the active ingredient printed on the box. If you are not sure what it is, ask your doctor or pharmacist.

How does the body get used to sedatives, even on prescription?

Dependence usually builds in quiet steps that people don't notice at first:

1. The start: a tablet helps you sleep or calms an anxiety attack, and the relief feels huge.
2. Tolerance: the brain adapts to the medicine, so its effect on sleep weakens. The NHS notes that the body can get used to zopiclone so that it no longer works as well.
3. Physical dependence: when a dose is late or smaller, anxiety and insomnia come back stronger than before. You may think your original problem has got worse, when these are actually withdrawal symptoms.
4. The closed circle: you go back to the tablet to calm down, and the dependence continues.

Not all physical dependence is addiction. The joint clinical guideline on benzodiazepine tapering, led by the American Society of Addiction Medicine and published in 2025, separates physical dependence, an expected response to regular use, from a substance use disorder, which means losing control and carrying on despite harm. So physical dependence on its own does not decide whether you should stop: according to the guideline, tapering is generally advised when the risks of continuing outweigh the benefits, a decision you make with your doctor. In either case, once stopping is decided, it needs a safe plan with your doctor, never a sudden stop.

The problem is widespread: the FDA estimates that about 5.4 million people in the United States aged 12 and over misused benzodiazepines in 2018.

Signs of sedative and sleeping pill addiction

The U.S. National Institute on Drug Abuse (NIDA) describes prescription drug misuse as taking a medicine in a way or amount other than prescribed, taking someone else's prescription, or taking it to get high. Signs worth paying attention to include:

• Needing more: the tablet that used to be enough no longer makes you sleep or calm down, so you raise it yourself or take it early.
• Panic without the tablet: you feel intense worry when the box is running low, or you won't leave home without it.
• Getting extra supplies: you go to more than one doctor or pharmacy, buy tablets without a prescription, or take from a family member's medicine.
• You cannot sleep a single night without the tablet, even though you started it for a short time.
• Daytime drowsiness, slow thinking and forgetfulness, or slipping at work or in your studies.
• Hiding how much you take from your family or doctor.
• Combining it with alcohol or other medicines to make it stronger.

One or two signs are not a diagnosis; only a doctor can make that. But they are a signal that it is time to talk openly with a professional, without shame. Before the appointment, you can try a simple self-check to see whether your use has crossed the line.

Why is stopping sedatives suddenly dangerous?

Once the brain is used to a sedative, it resets itself around it. If the medicine stops suddenly or is cut too quickly, the brain is left over-excited. That is why the FDA warns that abrupt stopping or rapid reduction can cause withdrawal reactions, including seizures that can be life-threatening. Benzodiazepine withdrawal symptoms listed by MedlinePlus (U.S. National Library of Medicine) and the 2025 guideline include:

• Severe anxiety, tension and irritability, and insomnia returning strongly
• Shaking, muscle twitching and sweating
• Nausea, and stomach or muscle cramps
• Memory problems and mood changes
• In severe cases: seizures or delirium (serious confusion and disturbed awareness)

In some people, certain symptoms can last for weeks, and sometimes months, after stopping, according to the FDA. MedlinePlus also notes that stopping eszopiclone suddenly can cause withdrawal symptoms and, rarely, seizures.

The danger of mixing sedatives with alcohol, tramadol or opioid painkillers

Sedatives, alcohol and opioid painkillers such as tramadol all slow down the nervous system. Taken together, their effects add up and breathing can slow to a dangerous level. NIDA reports that about 14% of opioid-related overdose deaths in the United States in 2021 also involved benzodiazepines. The NHS advises not drinking alcohol at all with zopiclone or diazepam.

Treating the insomnia or anxiety behind the tablet

Many people fear stopping because they remember what their nights were like before the tablet. That is why the 2025 guideline recommends that a tapering plan comes with psychological therapy such as cognitive behavioral therapy, and with treatment of related conditions such as anxiety and depression.

Cognitive behavioral therapy for insomnia (CBT-I) is the first-line, drug-free treatment for chronic insomnia, according to the Sleep Foundation. It usually takes six to eight sessions and includes: challenging worrying thoughts about sleep, linking the bed with sleep only, setting the time you spend in bed, relaxation exercises and a daily sleep diary. Read more about treating chronic insomnia and about cognitive behavioral therapy.

When should you get help?

• If you have taken a sedative or sleeping pill every day for more than a few weeks and want to stop.
• If you tried to stop and got shaking, severe anxiety or unbearable insomnia.
• If you have started raising the amount yourself or getting tablets without a prescription.
• If you combine the sedative with alcohol, tramadol or other drugs.
• If you have had seizures before, or have another mental or physical illness.
• If you are a family member noticing these signs in someone you love: you can come alone first to understand the steps.

What does medically supervised stopping of sedatives look like?

Treatment starts with an appointment with a psychiatrist, who reviews the medicine, how long you have taken it and any other substances, then builds an individual reduction plan with you and keeps reviewing it. The 2025 guideline says most people can taper as outpatients and that tapering may take months, sometimes longer, while a medically supervised inpatient stay is preferred when severe or complicated withdrawal is expected, or when there are risks or other conditions that are hard to manage outside hospital.

At Oxygen, doctor appointments in our outpatient clinics and therapy sessions are available to men and women aged 15 and over (under 18 with a guardian's consent). When an inpatient stay is needed, our detox unit offers inpatient care for males with round-the-clock medical monitoring, followed by psychological follow-up that includes family counseling and relapse prevention. For the bigger picture, read our guide to withdrawal symptoms. You can also call the hotline of Egypt's Fund for Drug Control and Treatment of Addiction on 16023, 24/7, which offers confidential treatment through partner centers. Remember that many people have stopped sedatives safely and got their sleep and calm back; the first step is asking for help.