Dependance: Benzodiadepines Flashcards
Define
Benzodiazepines (BDZ) – n.b. barbiturates are rarely used
- Uses: sedation, hypnotic, anxiolytic, anticonvulsant, muscle relaxant
- Should only be used for a short time (2-4 weeks)
Risks of Using Benzodiazepines
- Short-Term: drowsiness, reduced concentration
- Long-Term: cognitive impairment, anxiety and depression, sleep disruption, dependence
Symptom
similar to alcohol:
Calm and mild euphoria
Overdose = respiratory depression -> IV flumazenil
Slurred speech, ataxia, stupor S/S overdose: low GCS, low BP, mydriasis, hyporeflexia
Withdrawal – similar to alcohol:
- Insomnia
- Irritability
- Anxiety (the biggest SE)
- Tachypnoea
- Tachycardia
- Ataxia
- Tremor, Tinnitus, Sweating
- Hyperreflexia Seizures Mydriasis
- Palpitations Delusions Depression
- Derealisation Depersonalisation Anterograde amnesia
o Sudden withdrawal can lead to a delirium tremens-like picture
Management
Address underlying need for BDZ (i.e. anxiety, sleep, depression)
- Address long-term complications of use (cognitive impairment, anxiety, depression, insomnia)
- Check willingness to withdraw from use and whether it can be done successfully in primary care
- Withdrawal management – 2 methods of reduction:
Options for withdrawal:
- (1) Slow-dose reduction
- (2) Switch to equivalent dose of Diazepam, and slow-dose reduction; used in those…
- Difficult to physically taper down the dose
- On short-acting potent BDZs (i.e. lorazepam)
Advice:
- If done properly, there will be few, if any, withdrawal side effects
o Anxiety is most common side effect and is normal
o Treat with non-pharmacological management (e.g. relaxation breathing techniques)
- May take 3m to 1 year or longer (if necessary)
- Assess driving risk (DVLA regulations) and advise cannot drive on certain levels of BDZs
Withdrawal process = 1/8th daily dose reduction every 2 weeks – e.g. diazepam 40 mg per day:
- Reduce dose by 5 mg every 2 weeks until reaching 20 mg per day, then 8 weeks
- Reduce dose by 2 mg every 2 weeks until reaching 10 mg per day, then 10 weeks
- Reduce dose by 1 mg every 2 weeks until reaching 5 mg per day, then 10 weeks
- Reduce dose by 0.5 mg every 2 weeks until completely stopped 20 weeks
- Estimated total withdrawal time = 30–60 weeks
- Short-acting BDZs = lorazepam
- Long-acting BDZs = chlordiazepoxide, diazepam
