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Benzodiazepines are commonly prescribed CNS depressants used primarily for sedative, hypnotic, muscle relaxant and anticonvulsant purposes. Potential side effects of benzodiazepines are mainly extensions of therapeutic effects (e.g., over-sedation with excessive dosage). Benzodiazepines may suppress brainstem-regulated functions such as respiration, but this is accompanied by suppression of arousal to the level of stupor or unconsciousness. To our knowledge, there has been no prior report of benzodiazepine-induced pharyngeal dysphagia with preservation of normal consciousness. Case 1: A 59-year-old woman presented with a 2 year history of dysphagia mainly for solids. Her medications included a benzodiazepine, alprazolam (Xanax), at high dosage. Two cineradiographic studies revealed moderate diffuse pharyngeal paresis with aspiration. Extensive neurologic investigation was negative. Alprazolam was withdrawn, and she regained the ability to eat solid food such as hamburger. Benzodiazepines (clorazepate [Tranxene], then oxazepam [Serax]) were restarted at relatively lower dosage, and her dysphagia recurred. A third cine showed pharyngeal dysfunction similar to, but milder than, the first two. Benzodiazepines were again withdrawn, her dysphagia resolved, and a fourth cine demonstrated normal pharyngeal function. Case 2: A 74-year-old woman with a 3 year history of mild Parkinson's disease well controlled on carbidopa-levodopa (Sinemet) had no history of dysphagia prior to treatment with alprazolam, at which time she developed pharyngeal dysphagia. Her neurologic status was otherwise unchanged. A cine revealed moderate diffuse pharyngeal paresis with aspiration. Alprazolam was discontinued, and her dysphagia resolved. A second cine performed off alprazolam 2 weeks after the first study showed near-normal pharyngeal function. Conclusions: Benzodiazepines may selectively induce pharyngeal dysphagia, probably as a result of suppression of brainstem swallowing regulation. These drugs should ' be used with caution in patients with pharyngeal dysphagia.
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