benzodiazepines

=Benzodiazepines=

How they work
//Benzodiazepines potentiate the inhibitory effects of gamma-aminobutyric acid (GABA) throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and antiepileptic effects.//

Questions to Ask
[|acid reflux] What medications? - medical conditions? //respiratory depression/disease, severe hepatic impairment, myasthenia gravis, renal impairment (reduce initial dose)// - allergies?

If used during pregnancy short acting drugs are preferable to long acting; plan to stop gradually before delivery; ADEC category C.

How to take

 * Short-acting:** alprazolam, temazepam, oxazepam, lorazepam, bromazepam, triazolam
 * Long-acting:** diazepam, clonazepam, flunitrazepam, nitrazepam, clobazam

Shorter acting agents (particularly those with rapid onset of action) are more likely to lead to acute withdrawal symptoms. Diazepam's rapid onset of action and long half-life mean it is associated with less withdrawal.

Long acting agents, eg diazepam, clonazepam, are preferred when using benzodiazepines as prophylaxis against withdrawal from alcohol, barbiturates or other benzodiazepines. They are considered inappropriate to treat insomnia in older people because they can lead to increased frequency of confusion, drowsiness, memory loss, unsteadiness, falls and incontinence

Side effects
drowsiness, oversedation, light-headedness, memory loss, hypersalivation, ataxia, slurred speech
 * Common:**

suddenly stopping treatment in dependent people may produce withdrawal symptoms, including: - anxiety, dysphoria, irritability, insomnia, nightmares, sweating, memory impairment, hallucinations, hypertension, tachycardia, psychosis, tremors and seizures
 * Withdrawal:**

Withdrawal symptoms from short half-life BZDs generally occur earlier than from those with long half-lives. Withdrawal symptoms commence within 1-2 days after reduction in dose of a short half-life BZD and between 1-5 days for a long half-life BZD. - the duration of withdrawal may persist for 6-8 weeks after cessation, with a peak in intensity in the second and third weeks.

Other advice?
- You may feel drowsy while taking this medication; drowsiness may persist the following day; avoid driving or operating heavy equipment until you know how you react. - Avoid alcohol and other medications that may cause drowsiness while taking this drug. - If you take this medicine regularly for more than 2–4 weeks your body may become used to it and in time, you may need a higher dose for it to continue to work. If you stop the medicine suddenly, you may have unpleasant effects (eg feeling anxious, difficulty sleeping). Discuss how to stop the medicine with your doctor first

//Withdrawal plan for patients using more than a typical dose for night-time sedation:// - Estimate the average daily intake of BZDs - Calculate an equivalent dose of diazepam* (which has a long half-life) and substitute diazepam for the BZD - Give diazepam in 3-4 divided doses per day at fixed times - Reduce dose by between 10-20% at weekly intervals. Reduction may need to be slower when the dose is down to 15mg daily - Regularly review and titrate dose to the severity of withdrawal symptoms. In general practice, a reducing regime will generally take 6-8 weeks, but may take 3-4 months or even a year. - Sometimes, even when the dose is reduced by only a small amount, withdrawal symptoms re-emerge. In this case, the dose may be held at a plateau for 1-2 weeks or even increased for a few days before the reduction regime is resumed.
 * substitution with diazepam may not be suitable for the elderly because of the risk of drug accumulation

Provide patients with specific information about the health benefits they may expect from ceasing the medication, eg feeling more alert in the morning. Reassure them that the medication is probably no longer helping them sleep and that any sleep disorder they may now experience is associated with withdrawal, not a recurrence of the original problem. The patient should not feel pressured but rather supported and encouraged.



CMI
Alpralozam: Bromazepam: Clobazam: Clonazepam: Diazepam: Flunitrazepam: Lorazepam: Midazolam: Nitrazepam: Oxazepam: Temazepam: Triazolam:

Resources
[|Reconnexion - Benzodiazepines]: categorises the different classes; has a frequently-asked questions section at the end [|NPS - Prescribing Benzodiazepines: ongoing dilemma for the GP]: [|NPS - Helping patients withdraw from benzodiazepines] //Pharmacology 301// [|Sedative - Hypnotics]
 * Lecture Notes:**

Some folks who use this drug fell like urinating often. Blood and protein levels in urine may conjointly rise. Some male patients might additionally feel pain in the testis. Increased levels of creatinine and glucose might also be noticed in blood tests. Alternative Prilosec side effects are coughing, skin irritation, hemostasis and high blood sugar levels. [|prilosec side effects]