The Use of Carbamazepine to Treat Benzodiazepine Withdrawal in a Geriatric Population
Division of Geriatric Psychiatry, St. Louis University School of Medicine, MO.Journal of Geriatric Psychiatry and Neurology (Impact Factor: 2.24). 04/1991; 4(2):106-9. DOI: 10.1177/089198879100400209
Rapid withdrawal of short to intermediate half-life benzodiazepines may be hazardous, particularly in the elderly. The use of carbamazepine to facilitate withdrawal has been reported in younger patients. We describe four elderly patients (average age, 72.5 years) who had each experienced at least one unsuccessful attempt at alprazolam withdrawal and who were subsequently successfully withdrawn via the use of carbamazepine over a period ranging from 2 to 6 days. These geriatric patients experienced no major withdrawal symptoms, but mild symptoms were common. There was no correlation between dose or duration of alprazolam use and extent of withdrawal symptoms. We recommend use of this treatment regimen in a hospital setting only, where close monitoring can occur.
- [Show abstract] [Hide abstract]
ABSTRACT: Summary Objective Aim of the present review is to provide a view of the possible use of mood stabi- lizers (lithium and antiepileptic agents which proved useful in the management of bipolar disorders) in substance-related disorders. Methods Evidence from the literature was reviewed regarding different therapeutic objec- tives between different substance-related pictures: intoxication, withdrawal, prob- lematic use and abuse, comorbid mood instability and impulsiveness. From this viewpoint, single antiepileptic drugs are not judged on the basis of raw results, but sample characteristics as for diagnosis and observation terms are accounted for as major variables. For instance, the improvement in withdrawal symptoms is a short-term parameter which does not predict long-term efficacy upon relapsing behaviour. On the other hand, the usefulness upon substance abuse in bipolar disorder as a substrate may not correspond to effects in addictive pictures. Results Withdrawal pictures often include a disposition to epileptic seizures. Nevertheless, when agonist drugs are available antiepileptic drugs should be regarded as second choice and not combined with agonist drugs as a routine. In particular, methadone and carbamazepine should not be combined since it induces methadone metabo- lism, while overdosing is possible with other associations. For abuse-related mood symptoms and impulsiveness, mood stabilisers are preferable to antidepressants since they allow the risk of (hypo)manic switching to be bypassed. Some antiepileptic drugs were shown to be useful in reducing the frequency of recurrent use, and prolong the time to first relapse. Most studies are not suitable to evaluate the effectiveness of the drugs employed for chronic relapsing behaviours, such as those of addictions: in fact, in a short-term perspective it is unclear whether use is only just in- terrupted or decreases gradually to extinction. Some others evaluate abusers and addicts together, or automatically select abusers with milder levels of craving. Therefore, reliable data concerning the effectiveness
Article: Managing benzodiazepine withdrawal[Show abstract] [Hide abstract]
ABSTRACT: The long-term use of Benzodiazepines (BZs) is currently a source of growing concern, owing to increasing doubts about their efficacy, and evidence of important adverse effects, including physical dependence and neuropsychologi- cal impairment. The long-term use of BZs in patients with anxiety and mood disorders calls for special concern; in these patients, in fact, interepisodic chronicity and residual symptoms often appear to be related to inappropriate long-term use of BZs. The problem of dependence on benzodiazepines has been aggravated by iatrogenic physiological dependence on these medications and by polysubstance-abusing patients using them in addition to other agents, in particu- lar opioids or cocaine. A safe, rapid, and effective way to detoxify patients from benzodiazepines is of prime importance in facilitating further treatment of their psychiatric or substance use disorder. Correct withdrawal strategies should combine gradual dosage reduction, psychological support and adjuvant medica- tions in selected patients. The tapering schedule should be individually titrated and adjusted according to the patient's reactions; substitution with a long-acting BZ is often useful. Psychological support should include information about BZ withdrawal, general encouragement and the correction of misconceptions about discontinuing medicines; it should be available both during tapering and after withdrawal. Some antiepileptics and sedative antidepressants may be useful to mitigate withdrawal phenomena. Adequate dosages of antidepressants should be used to treat the re-emergence of an underlying mood or anxiety disorder. Success rates of withdrawal are high (54-92%); the follow-up studies, however, indicate that long-term discontinuation of BZ is a slow process, taking many weeks or months - in some cases years - with a protracted clinical course after drug cessation.
Article: Misuse of Prescription Drugs[Show abstract] [Hide abstract]
ABSTRACT: The elderly person is at risk of drug misuse and related problems because of frequent use of prescription drugs, biologic factors, and social circumstances associated with aging. Confusion, falls, and aggravation of untoward emotional states are examples of the adverse consequences. Diagnosis of drug dependency states is difficult because of the overlap of general medical disorders and mental disorders and a lack of suitable diagnostic criteria for the aged. Two case examples of drug misuse are given, and the management of drug misuse and the treatment of drug dependence on an inpatient and outpatient basis are discussed. Future research directions are suggested.The International journal of the addictions 01/1995; 30(13-14):1871-901. DOI:10.3109/10826089509071059
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.