More Rational Use of Benzodiazepines in the Outpatient Clinic
(Impact Factor: 0.9).
02/2007; 46(6):255-6. DOI: 10.2169/internalmedicine.46.0172
Available from: Fabio Lugoboni
- "The use of BZDs, albeit at therapeutic dosage, raises concerns about the capacity of some patients to maintain control of their drug use in the long term (Kurihara, 2007). Clonazepam, because of its pharmacological profile – a slow onset of action, half life of 18–50 h, lacking active metabolites (Estivill et al., 2003; Chouinard, 2004) – was beneficial in these patients during and after treatment as an anxiolytic and anticonvulsant. "
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ABSTRACT: The withdrawal syndrome from benzodiazepine (BZD) can be severe and in some cases may impede cessation of the use of the drug. We present here a case series of benzodiazepine detoxification by flumazenil infusion, stabilised with clonazepam. Patients were treated with flumazenil 1.35mg/day for a median of 7days. Self-reported physical withdrawal symptoms were recorded daily. In addition to flumazenil, antidepressants were given before treatment commenced and clonazepam was administered nightly with both being continued after discharge. Twenty-nine patients were treated. No patients dropped out from the treatment programme. Nine patients (31%) required a temporary reduction/cessation of the infusion. The linear trend in the reduction of the daily withdrawal scores in the overall study population was significant. The linear trends were also significant in the group of patients for whom a temporary reduction/suspension of the flumazenil was required. Six months after treatment, 15 patients (53%) were abstinent from clonazepam and other BZDs. For five (21%) the BZD dependence were reinstated. More than two-thirds of the subjects tolerated the procedure well and about half had a good long term response. Slow flumazenil infusion appears to merit consideration as a possible future treatment. Suggestions for future research are examined.
Available from: PubMed Central
- "Benzodiazepines are among the most commonly used classes of medication because of their multiple therapeutic actions as anxiolytics, sedative hypnotics, anticonvulsants, and muscle relaxants [1,2]. However, it has been reported that benzodiazepines are often prescribed in hospitals and for surgical patients in the absence of appropriate documentation of the indications for their use [3-7]. Benzodiazepine use during hospital stays is an important factor in the excessive long-term use of these drugs and can be harmful especially to the elderly, who have increased risks of falls and fractures [8,9] and cognitive and memory changes [10,11] that could dramatically decrease their quality of life. "
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ABSTRACT: The relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan. This study was done to assess the association between bed days and BDZ in a Japanese hospital.
21,489 adult patients (55.1% men, mean age 59.9 years old) hospitalized between April, 2005 and December, 2006 were enrolled in the study. Patient age, sex, ICD-10 diagnosis, prescription profile, and days of hospital stay were assessed in 13 non-psychiatric departments using a computer ordering system. Patients prescribed a benzodiazepine during hospitalization were defined as positive.
Of the total sample, 19.9% were allocated to the benzodiazepine (+) group. Female sex and older age were significant factors associated with benzodiazepine prescription. The median number of bed days was 13, and the likelihood of BDZ significantly increased with the number of bed days, even after controlling for the effects of age, gender, and ICD-10 diagnosis. For example, when the analysis was limited to patients with 50 bed days or longer, the percentage of BDZ (32.7%) was equivalent to that of a report from France.
Irrespective of department or disease, patients prescribed benzodiazepine during their hospital stay tended to have a higher number of bed days in the hospital. The difference in the prevalence of BDZ between this study and previous Western studies might be attributed to the relatively short length of hospital stay in this study. Because BDZs are often reported to be prescribed to hospitalized patients without appropriate documentation for the indications for use, it is important to monitor the rational for prescriptions of benzodiazepine carefully, for both clinical and economical reasons.
Available from: sciencedirect.com
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To determine the overall prevalence of the chronic use of benzodiazepines and similar drugs in primary care.
Observational, cross-sectional study.
Healthcare centres of the Reus-Altebrat Primary Care Service,Tarragona, Spain.
Patients older than 15 years, on prolonged treatment with benzodiazepines or similar drugs.
The variables studied were age, sex, type of healthcare centre (rural or urban), benzodiazepine, or similar drug administered and duration of treatment.
There were 6885 patients who were on prolonged benzodiazepine or similar drug treatment, of which 70.9% were female, 73.4% were 65 years or older, and 73% attended an urban centre. The overall prevalence was 6.9%, and was higher among women than men (9.7% and 4%, respectively), and increased with age up to 27.3% among patients of 75 years or more. The stratified results showed that chronic consumption was higher among women 75 years of age or older attached to urban healthcare centres, with a prevalence of 35.7%.
A high percentage of our population, which includes the most fragile patients, use benzodiazepines or a similar drug in a way that is not consistent with the recommendations of clinical practice guidelines.
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