Benzodiazepines and Similar Drugs Misuse Abuse and Dependence
Benzodiazepines and Similar Drugs: Misuse, Abuse, and Dependence Randy Brown, MD University of Wisconsin, Madison Alcohol Medical Scholars Program Copyright Alcohol Medical Scholars Program 1
Key Points • Daily use of benzodiazepines (BZs) = risky • Certain situations ↑ risk – Prescribing practices/med characteristics – Patient characteristics • Taper BZs slowly if daily use ~2+ weeks Copyright Alcohol Medical Scholars Program 2
What Are Benzodiazepines (BZs) ? Sedative-hypnotic Flurazepam (Dalmane) Temazepam (Restoril) Anxiolytic Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Triazolam (Halcion) Diazepam (Valium) Related meds = Non-BZ BZ receptor agonists (BZRAs) • Zolpidem (Ambien) Copyright Alcohol Medical Scholars Program 3
Adverse Effects • Motor impairment (reaction time) • Cognitive impairment (sedation, amnesia) • Increased risk – Age > 65 BZRAs ≤ BZs – Alcohol – Using >1 BZ – Highly lipid soluble BZ (e. g. diazepam) Copyright Alcohol Medical Scholars Program 4
“Misuse” & Use Disorders • Misuse – Long-term – Non-medical • Abuse = dysfunction in 1+ areas • Dependence = 3+ of 7 criteria repetitively • Physical dependence (2 criteria) • Compulsive use/loss of control (5 criteria) Copyright Alcohol Medical Scholars Program 5
Misuse: Medication Factors • Dose/duration – ↑ dose – 2+ weeks daily use • Short half-life – Triazolam ~6 hrs vs. chlordiazepoxide ~20 hrs • Highly lipid soluble BZ (e. g. diazepam) Copyright Alcohol Medical Scholars Program 6
Misuse: Patient Factors • Substance dependence history – BZs, alcohol + • Psychiatric history – Anxiety, depression + • Social & demographic factors – Age, gender, unemployment, poor social support + Copyright Alcohol Medical Scholars Program 7
Tapering BZs 1) 2 -4 doses daily 2) Taper 25% every 3 days 3) Slower in last half Provide support • behavioral therapy • engage close family Copyright Alcohol Medical Scholars Program 8
Summary • Long-term use (> 2 weeks) ↑ risk for: – Side effects – Misuse, abuse, & dependence • Prescribing practices & patient characteristics ↑ risk • If taken for > 2 weeks, taper slowly Copyright Alcohol Medical Scholars Program 9
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