Available online 9 August 2012

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Clinical review

Blood drug concentrations of benzodiazepines correlate poorly with actual driving impairment

  • Joris C. Verstera, Corresponding author contact information, E-mail the corresponding author,
  • Thomas Rothb
  • a Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
  • b Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
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The use of benzodiazepine receptor agonists can significantly impair driving performance. The aim of this review was to determine if there is a relation between blood concentrations of these drugs and the degree of driving impairment.


A literature search was conducted to identify driving studies that examined the effects of benzodiazepine receptor agonists. Studies were included if the on-the-road driving test was employed, using the standard deviation of lateral position (SDLP), i.e., the weaving of the car, as primary outcome measure.


A total of 24 studies were identified that employed the on-the-road driving test to examine driving performance after administration of benzodiazepine receptor agonists. Eleven of these studies (45.8%) measured blood drug concentrations after the on-the-road driving test was performed. Technical reports of some of these studies provided individual data on blood drug concentrations and ΔSDLP (the ΔSDLP difference between drug and placebo). While group differences in concentrations were found as evidenced by significant effects of dose and time of driving since time of drug ingestion, no significant relationship between individual blood drug concentrations and ΔSDLP was found in any of the studies.


While group mean average ΔSDLP and blood drug concentration sometimes correlate, individual differences in blood drug concentrations of benzodiazepine receptor agonists correlate poorly with driving impairment. From the currently available data, it must be concluded that there are no significant relationships between individual blood drug concentration and ΔSDLP. Future driving studies should assess blood drug levels as a standard procedure, to enable further research into the relationship between blood drug concentration and performance impairment.