Use Of Benzodiazepine Hypnotics Research Articles

Characteristics of patients who were able to switch from benzodiazepine hypnotics to lemborexant.

Objectives:There is little evidence of insomnia treatment, especially exit strategies for hypnotics. We examined on the characteristics of patients who were able to switch from benzodiazepine hypnotics to lemborexant.Methods:Insomnia was assessed using the Athens Insomnia Scale. Efficacy outcome assessment was the Clinical Global Impressions-Improvement scale.Results:Eighty patients switched from benzodiazepine hypnotic monotherapy to lemborexant and 57 patients who continued the use of benzodiazepine hypnotics. The switched group had a significantly lower benzodiazepine hypnotic diazepam equivalent and a significantly shorter dosing period than the continued group (p < 0.001 for all). The mean Athens Insomnia Scale total score of the switched group was a significant improved (5.8 ± 3.3 to 4.0 ± 3.3; p < 0.05). The mean Clinical Global Impressions-Improvement score of the switched group was 3.3 ± 0.7.Conclusion:Our findings suggest that when administering benzodiazepine hypnotics, shortening the administration period, as much as possible, allows a smooth switch to safe long-term maintenance therapy using lemborexant, without exacerbating insomnia.

Concomitant use of alcohol and benzodiazepine hypnotics in psychiatric outpatients

Concomitant use of benzodiazepines and alcohol appears prevalent in a clinical setting. The objectives of this study were as follows: (1) to investigate the prevalence of concomitant use of benzodiazepine hypnotics and alcohol in psychiatric outpatients, (2) to examine the clinical characteristics and factors associated with the concomitant use, and (3) to investigate the awareness of the psychiatrists-in-charge about the concomitant use. Outpatients with schizophrenia, depression, and insomnia who were receiving benzodiazepine hypnotics were asked to fill in a sleeping diary for seven consecutive days in which use of hypnotics and alcohol was also recorded. Clinical characteristics were assessed, and logistic analysis was performed to examine factors associated with the concomitant use. In addition, psychiatrists-in-charge were asked as to whether they thought their patients were concomitantly using them. The prevalence rate of the concomitant use was 39.8% (37/93). The CAGE score showed significant positive association with the concomitant use (odds ratio = 2.40, 95% confidence interval = 1.39-4.16, P = 0.002). Only in 32.4% of the concomitant users were suspected by their psychiatrists. The results suggest that concomitantly used benzodiazepine hypnotics and alcohol appears prevalent, and has been frequently overlooked by treating psychiatrists. The CAGE questionnaire may be helpful to screen such potentially hazardous users.

PS164. Concomitant Use of Benzodiazepine Hypnotics and Alcohol in Patients with Schizophrenia, Depression and Insomnia: A Preliminary Finding

PS164. Concomitant Use of Benzodiazepine Hypnotics and Alcohol in Patients with Schizophrenia, Depression and Insomnia: A Preliminary Finding

Trazodone as co-treatment for insomniac patients

Introduction Trazodone is an antidepressant belonging to the class of serotonin receptor antagonists and reuptake inhibitors. Trazodone is widely prescribed as a sleep aid, although it is indicated for depression, not insomnia. The aim of this study was to describe the usefulness of trazodone in the treatment of insomnia in our sleep unit. Materials and methods This retrospective cross-sectional study was conducted at a multidisciplinary sleep center (Hospital Universitario Araba) in Vitoria. Patients with insomnia treated with trazodone were analized. Average dose was 11.25±54.9mg (50–300mg). The quantify perceived insomnia severity were then assessed with the Insomnia Severity Index (ISI) questionnaire before and after taking trazodone. The use of benzodiazepine hypnotics, non- benzodiazepine hypnotics, antidepressants and other drugs were picked up on an average time of the intake for 6.1±4.4months. Results From December of 2011 to June of 2013, 166 patients were clinically diagnosed for insomnia, and 40 (24%) of them were started a treatment with trazodone or we added up more dose of it. 37.5% were men and mean age was 53.9±12.9. 33 (82.5%) had comorbid insomnia, and 50% associated with psyquiatric disorder. Compared to pre- treatment, trazodone improved scores on ISI ( p p =0.008). However, there was a increase in the number of non- benzodiazepine hypnotics taken. 13 patients (32.5%) discontinued the trazodone treatment because they did not perceive any benefit with treatment and/or they developed side effects. Conclusion In the group studied, the use of the trazodone could help to reduce the dose of benzodiazepine hypnotics taken. In some cases it could be possible to stop benzodiazepinas and to improve the sleep. One third of the patients discontinued the treatment of trazodone. More studies are necessary to demostrate the risk/benefit ratio for trazodone in insomnia. Acknowledgement All the people that made possible to develop this study.

An Approach to Reduce Benzodiazepine and Cyclopyrrolone Use in General Practice

The global use of benzodiazepines and cyclopyrrolones is generally high. The hypnotic and anxiolytic effects of these agents typically diminish after a period of weeks or months of continuous use. Patients may thus be caught in a trap where the usefulness of these substances is reduced and doses are consequentially escalated, and where a subsequent phased reduction in dose can be difficult. Although considerable resources have been expended on reducing the use of these agents, no unambiguous and effective method has been identified.In Denmark, it is estimated that there are approximately 100 000 benzodiazepine-dependent patients, constituting approximately 2% of the general population. The prescription of dependency-producing drugs (including benzodiazepine/cyclopyrrolone agents) in Denmark is regulated according to Danish directive CIR nr 12, introduced on 13 January 2003, which aimed for restrictions in the prescribing of benzodiazepine and cyclopyrrolone drugs while setting revised guidelines for the re-evaluation of these agents. However, by 2004, the use of these drugs had decreased by only 1.7%, far from the official objective of a 50% reduction. This article describes an effective strategy implemented in general practice in Denmark to reduce the use of benzodiazepine and cyclopyrrolone agents, while at the same time challenging practitioners' ingrained habits and prejudices in this field. An intervention involving new regulations for the prescription of benzodiazepines and cyclopyrrolones was introduced to ten Danish medical practices, comprising 13 medical practitioners and a patient base of approximately 18 500 patients. The new intervention was essentially in accordance with the official Danish regulations, such that a prescription for benzodiazepines and cyclopyrrolones could only be issued for 1 month at a time, and only following consultation. Telephone prescriptions were eliminated. Use was monitored using the Danish registration system, Ordiprax, which monitors sales of prescription medicine. All users of benzodiazepines and cyclopyrrolones within the ten practices, with the exception of seriously psychiatrically and physically ill patients, were included. Fifteen months after the inception of the intervention, the use of cyclopyrrolones was reduced by 50.3%. Use of benzodiazepine-hypnotics was reduced by 46.5% and use of benzodiazepine-anxiolytics was reduced by 41.7%. The reorganisation of prescription patterns proved to be significantly easier than practitioners had expected. During the first 3 months, only 4.3 additional consultations per week per 1000 patients were required. Subsequently, this number fell to 2.1 additional consultations. The usual collaborative partners, such as psychiatrists, homecare services, hospitals and substance abuse units, were essentially not deployed. No serious side effects developed in patients in whom drug use was reduced. The intervention was effective in reducing the use of benzodiazepine and cyclopyrrolone agents in general practices in a large municipality in Denmark. It is recommended that this intervention be introduced into the primary care sector, as it requires minimal effort on the part of the medical practitioner. The intervention is as simple as it is effective, and its implementation does not require any major level of supplementary training.

Alcohol consumption and regular benzodiazepine use in 55-year-old female Malmö residents: results of a health screening.

The main objective of the present study was to examine the relationship between regular benzodiazepine (BZD) use and drinking patterns in 55-year-old female residents of Malmö, Sweden. All women born in 1935 (a total of 1223 subjects) were invited to a health screening at the Preventive Medicine Section, Malmö General Hospital; 69% agreed to participate. The screening included an extensive health questionnaire, and the responses to 33 items assessing social background, including immigrant status, use of BZD and analgesics, alcohol consumption (the revised Malmö-MAST), smoking and morbidity were analysed. A psychiatric symptoms scale including five of these items was constructed, yielding a Cronbach's alpha of 0.57. Present use of BZD hypnotics and/or tranquillizers was acknowledged by 6% of the women. BZD use at any time in the past or present was endorsed by 23%. Endorsement of > or = 3 revised Malmö-MAST items, indicating problem drinking, occurred in 3% of the participants; 16% were teetotallers and about 25% were regular weekend drinkers. BZD use was significantly more likely to occur in women with the following characteristics: early retirement, pain symptoms, longstanding use of analgesics, multiple psychiatric symptoms. Drinking patterns in relation to BZD use indicated that regular weekend drinkers were significantly less likely to be current and/or previous BZD users than problem drinkers and teetotallers. Logistic regression analyses indicated that use of BZDs was mainly predicted by endorsement of multiple psychiatric symptoms.

Sleep quality and the use of benzodiazepine hypnotics in general practice.

The aim of the study was to determine the usage patterns of benzodiazepine hypnotics, the use of other ways of improving sleep and general sleep characteristics in patients prescribed these drugs on a regular basis and in a control group of age- and sex-matched patients not receiving hypnotics. Patients receiving regular benzodiazepine hypnotic prescriptions and a control group matched for age and sex were identified from a general practice computer. They were interviewed in their own homes about their habits relating to sleep, hypnotic use and attitudes to sleep and hypnotics. None of the recommended methods of improving sleep differed significantly in frequency between the two groups or had an effect on sleep parameters. Only daytime napping was found to be slightly more frequent in hypnotic users, but had no apparent effect on self-estimates of sleep duration or latency. The hypnotic users claimed a longer sleep latency and a shorter sleep duration than non-users. More patients who took hypnotics also perceived them to be beneficial and more convenient than other ways of promoting sleep. The recommendation of sleep-promoting methods such as caffeine and alcohol avoidance and regular exercise may not be helpful in patients attempting to avoid hypnotics, as many patients already claim to use such methods.

Risk of benzodiazepine dependence resulting from hospital admission

Benzodiazepines may result in dependence after relatively brief periods of prescription. This study reports the continued use of either temazepam or nitrazepam as a hypnotic 3-4 months after the provision of the drug as a discharge prescription following an acute hospital stay. Of 160 patients contacted by telephone (out of 275 given such a prescription on discharge), 68 (42.5%) were still taking the hypnotic when contacted and 23 (14%) of these had not previously used a hypnotic regularly prior to hospital admission. The risks of the use of benzodiazepine hypnotics, particularly in the elderly, are discussed and recommendations made to restrict in-patient hypnotic use to no more than 5 days at any one time. Patients should be counselled about the risks of the development of dependence and withdrawal insomnia. Discharge prescription of benzodiazepine hypnotics should not exceed three days duration and preferably be avoided altogether.

Failure to limit quantities of benzodiazepine hypnotic drugs for outpatients: Placing the elderly at risk

purpose: The long-term use of benzodiazepine hypnotics by the elderly is associated with serious side effects, and prescriptions of large quantities of these agents allow such use. Therefore, we determined the quantities of these agents prescribed to outpatients in our Veterans Administration teaching hospital, and the relationship of patient age to total number of doses prescribed per prescription. patients and methods: Pharmacy and patient records related to 655 consecutive prescriptions for triazolam (Halcion) and flurazepam (Dalmane) were reviewed. Only 266 (41%) of the prescriptions were for 30 or fewer doses, while 178 (27%) were written for 180 or more doses. results: Thirty-six percent of prescriptions for patients aged 65 years or older were for 180 or more doses, compared with 24% for those aged 45 to 64 years old, and 16% of the prescriptions for patients less than 45 years old (p <0.0001). In a multivariate analysis controlling for six other factors related to the total number of doses prescribed, patients aged 65 years or older were still more likely to receive a prescription for 180 or more doses (relative risk 1.9, 95% confidence interval 1.3, 2.8). conclusion: We conclude that inappropriately large quantities of benzodiazepine hypnotics were commonly prescribed, and that patients aged 65 years or older were at greatest risk for receiving such prescriptions.

The use of benzodiazepine hypnotics in the elderly.

An epidemiologic study was conducted to observe patient-reported use and effects of triazolam, flurazepam, and oxazepam taken at bedtime among 2260 outpatients age 65 years or older in Canada. The study used pharmacy-based enrollment, with participant follow-up through a 3-day diary and a telephone interview. The study also evaluated how the three benzodiazepine hypnotics were prescribed. Prescription information showed that 66% of the flurazepam prescriptions were for the highest strength, compared to 39% and 35% for triazolam and oxazepam, respectively. As patient age increased, the highest strength of each agent was prescribed less frequently. For all drugs, 53% of prescriptions were written for use as necessary (prn), and the proportion who received such prescriptions increased with age. Patient reports, however, revealed that 57% were using a hypnotic every day, and this regular use increased with advancing age. Regular daily use was more common among those who used triazolam and oxazepam (62%) than those who took flurazepam (42%).