Abstract
Nowadays, the misuse of benzodiazepines (BZDs) is a cause for a serious concern among pharmacologically inexperienced patients, whether treated or untreated, that could lead to significant complications, including tolerance, dependence, and addiction. We present a case report in which an Italian patient affected by anxiety disorder and treated with BZDs presented a severe case of dependence on BZDs. We treated him according to an agonist substitution approach, switching from the abused BZD to a slow-onset, long-acting, high potency agonist (clonazepam), and looking at the methadone treatment model as paradigm. We decided to use clonazepam for its pharmacokinetic properties. The advantage of choosing a slow-onset, long-lasting BZD for the treatment of our patient was that it led us to a remarkable improvement in the clinical situation, including the cessation of craving, absence of withdrawal symptoms, reduced anxiety, improvements in social functioning, and a better cognition level.
Highlights
Benzodiazepines (BZDs) are prescribed in the medical management of anxiety, insomnia, seizures, and muscle spasms, but, in some patients, it can lead to significant complications, including misuse, abuse, tolerance, dependence, and addiction [1,2,3,4]
We present a case report in which an Italian patient affected by anxiety disorder and treated with BZDs presented a severe case of dependence on BZDs
We treated him according to an agonist substitution approach, switching from the abused BZD to a slowonset, long-acting, high potency agonist, and looking at the methadone treatment model as paradigm
Summary
Benzodiazepines (BZDs) are prescribed in the medical management of anxiety, insomnia, seizures, and muscle spasms, but, in some patients, it can lead to significant complications, including misuse, abuse, tolerance, dependence, and addiction [1,2,3,4]. We present a case in which an Italian patient affected by anxiety disorder (he had received panic disorder and social phobia diagnoses according to DSMIV TR.) was treated with antidepressants (clomipramine) and benzodiazepines (lormetazepam) prescribed by a general practitioner This patient showed good compliance with the treatment, but, his anxiety did not recede and he autonomously started to increase benzodiazepine consumption, so developing a clinical condition of misuse abuse. We supposed that these changes were due to the pharmacokinetic properties of clonazepam, in the same way seen during substitution from heroin to methadone and/or buprenorphine
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