1 benzodiazepines and similar drugs: misuse, abuse, and dependence randy brown, md university of...
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Benzodiazepines and Similar Drugs:
Misuse, Abuse, and Dependence
Randy Brown, MD
University of Wisconsin, Madison
Alcohol Medical Scholars Program
Copyright Alcohol Medical Scholars Program
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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
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What Are Benzodiazepines (BZs) ?
Sedative-hypnotic
Flurazepam (Dalmane)
Temazepam (Restoril)
Triazolam (Halcion)
Anxiolytic
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Diazepam (Valium)
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Related meds = Non-BZ BZ receptor agonists (BZRAs)
•Zolpidem (Ambien)
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Adverse Effects
• Motor impairment (reaction time)• Cognitive impairment (sedation, amnesia)• Increased risk
– Age > 65– Alcohol– Using >1 BZ– Highly lipid soluble BZ (e.g. diazepam)
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BZRAs BZRAs ≤≤ BZs BZs
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“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)
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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)
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Misuse: Patient Factors
• Substance dependence history
– BZs, alcohol +
• Psychiatric history
– Anxiety, depression +
• Social & demographic factors
– Age, gender, unemployment, poor social support +
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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
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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