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1.
Med Clin North Am ; 106(1): 113-129, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823725

RESUMO

Benzodiazepine and related sedative use has been increasing. There has been a growing number of unregulated novel psychoactive substances, including designer benzodiazepines. Benzodiazepines have neurobiological and pharmacologic properties that result in a high potential for misuse and physical dependence. Options for discontinuing long-term benzodiazepine use include an outpatient benzodiazepine taper or inpatient withdrawal management at a hospital or detoxification facility. The quality of evidence on medications for benzodiazepine discontinuation is overall low, whereas cognitive behavioral therapy has shown the most benefit in terms of behavioral treatments. Benzodiazepines may also have significant adverse effects, increasing the risk of overdose and death.


Assuntos
Benzodiazepinas/efeitos adversos , Redução da Medicação/métodos , Hipnóticos e Sedativos/efeitos adversos , Síndrome de Abstinência a Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Benzodiazepinas/farmacologia , Drogas Desenhadas , Feminino , Humanos , Hipnóticos e Sedativos/farmacologia , Inativação Metabólica/fisiologia , Masculino , Neurobiologia , Receptores de GABA-A/efeitos dos fármacos , Síndrome de Abstinência a Substâncias/terapia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/etnologia , Adulto Jovem
2.
J Opioid Manag ; 17(6): 445-453, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34904693

RESUMO

OBJECTIVE: The opioid epidemic is frequently discussed including the staggering numbers involved with coprescribing opioids and benzodiazepines associated with death. Community pharmacists, with the help of a system intervention, have a unique opportunity to help reduce the coprescribing of benzodiazepines and opioids and reduce the associated risk of death. DESIGN: A single center retrospective chart review was conducted after a system intervention was placed, as a quality improvement project, from November 2019 to May 2020. SETTING: Independent community pharmacy. PATIENTS/PARTICIPANTS: Data included demographics, dosing of each medication pre- and post-intervention, and naloxone status. Main outcome(s) measures: The primary outcome evaluated was reduction in dose/discontinuation of these prescriptions. The secondary outcome evaluated was the number of naloxone prescriptions ordered per protocol and picked up. RESULTS: The primary outcome did not show statistical difference; however, the secondary outcomes showed statistical significance. CONCLUSION: In conclusion, community pharmacists, with the help of evolving technologies, can reduce harm associated with the coprescribing of benzodiazepines and opioids.


Assuntos
Analgésicos Opioides , Farmácias , Analgésicos Opioides/efeitos adversos , Benzodiazepinas/efeitos adversos , Redução do Dano , Humanos , Assistência ao Paciente , Estudos Retrospectivos
3.
Am J Chin Med ; 49(8): 1949-1963, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34961418

RESUMO

Secondary metabolic disturbances in patients with schizophrenia or bipolar disorder may be attributed to olanzapine. It is important to prevent mild metabolic disorders progressing to metabolic syndrome. This study aims to investigate the effects of berberine on intestinal flora in patients with mild metabolic disorders induced by olanzapine. A total of 132 patients with schizophrenia, bipolar disorder, or schizoaffective psychosis that had been treated with olanzapine for at least 9 months were randomly assigned ([Formula: see text] = 66 each) to receive berberine or placebo tablets for 12 weeks. Metabolic assessments and intestinal flora were quantified at baseline and after 4, 8, and 12 weeks of treatment. Incidence rates of adverse reactions were recorded. FPG, FPI, HOMA-IR, HbA1, TG, BMI, and WC were significantly lower in patients who received berberine compared to placebo after 12 weeks of treatment ([Formula: see text]< 0.05). The abundance of firmicutes and coliform were significantly lower and the abundance of bacteroides significantly higher in patients who received berberine compared to placebo after 12 weeks of treatment ([Formula: see text]< 0.05). In patients who received berberine, the abundance of firmicutes was significantly decreased, and the abundance of bacteroides was significantly increased, and in patients who received placebo, the abundance of firmicutes was significantly increased post-treatment, compared to baseline (both [Formula: see text]< 0.05). In conclusions, berberine may regulate intestinal flora and metabolism in patients with schizophrenia or bipolar disorder and mild metabolic disturbances induced by olanzapine.


Assuntos
Antipsicóticos , Berberina , Microbioma Gastrointestinal , Doenças Metabólicas , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Humanos , Olanzapina/efeitos adversos
4.
Salud Colect ; 17: e3583, 2021 Sep 27.
Artigo em Espanhol | MEDLINE | ID: mdl-34752020

RESUMO

Benzodiazepines and "Z-drugs" (BZD/Z) are overprescribed in many countries. This study evaluates their consumption in a social security sector health insurance provider with national coverage in Argentina. With a descriptive and observational approach, outpatient dispensations of BZD/Zs were analyzed for people over 18 years old from April 2020 to March 2021, disaggregated by sex, age, active ingredient, and half-life. An annual prevalence of use of 11.6% was found among the 431,445 adult affiliates, with higher rates in women and in those over age 60. Overall consumption of BZD/Zs was 77.6 defined daily doses (DDD) per 1000 enrollee-days. The average user received 5.1 annual dispensations and the equivalent of 1.4 DDD for each day of the year. BZD/Zs with long half-life were the most used. We found high levels of BZD/Z consumption and for longer periods than recommended. It is necessary to improve the quality of consumption and reduce the negative impact of inappropriate use of these drugs among treated individuals.


Assuntos
Benzodiazepinas , Preparações Farmacêuticas , Adolescente , Adulto , Argentina , Benzodiazepinas/efeitos adversos , Feminino , Humanos , Renda , Pessoa de Meia-Idade , Previdência Social
5.
JAMA ; 326(13): 1299-1309, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34609453

RESUMO

Importance: Assessing the scope of acute medication harms to patients should include both therapeutic and nontherapeutic medication use. Objective: To describe the characteristics of emergency department (ED) visits for acute harms from both therapeutic and nontherapeutic medication use in the US. Design, Setting, and Participants: Active, nationally representative, public health surveillance based on patient visits to 60 EDs in the US participating in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project from 2017 through 2019. Exposures: Medications implicated in ED visits, with visits attributed to medication harms (adverse events) based on the clinicians' diagnoses and supporting data documented in the medical record. Main Outcomes and Measures: Nationally weighted estimates of ED visits and subsequent hospitalizations for medication harms. Results: Based on 96 925 cases (mean patient age, 49 years; 55% female), there were an estimated 6.1 (95% CI, 4.8-7.5) ED visits for medication harms per 1000 population annually and 38.6% (95% CI, 35.2%-41.9%) resulted in hospitalization. Population rates of ED visits for medication harms were higher for patients aged 65 years or older than for those younger than 65 years (12.1 vs 5.0 [95% CI, 7.4-16.8 vs 4.1-5.8] per 1000 population). Overall, an estimated 69.1% (95% CI, 63.6%-74.7%) of ED visits for medication harms involved therapeutic medication use, but among patients younger than 45 years, an estimated 52.5% (95% CI, 48.1%-56.8%) of visits for medication harms involved nontherapeutic use. The proportions of ED visits for medication harms involving therapeutic use were lowest for barbiturates (6.3%), benzodiazepines (11.1%), nonopioid analgesics (15.7%), and antihistamines (21.8%). By age group, the most frequent medication types and intents of use associated with ED visits for medication harms were therapeutic use of anticoagulants (4.5 [95% CI, 2.3-6.7] per 1000 population) and diabetes agents (1.8 [95% CI, 1.3-2.3] per 1000 population) for patients aged 65 years and older; therapeutic use of diabetes agents (0.8 [95% CI, 0.5-1.0] per 1000 population) for patients aged 45 to 64 years; nontherapeutic use of benzodiazepines (1.0 [95% CI, 0.7-1.3] per 1000 population) for patients aged 25 to 44 years; and unsupervised medication exposures (2.2 [95% CI, 1.8-2.7] per 1000 population) and therapeutic use of antibiotics (1.4 [95% CI, 1.0-1.8] per 1000 population) for children younger than 5 years. Conclusions and Relevance: According to data from 60 nationally representative US emergency departments, visits attributed to medication harms in 2017-2019 were frequent, with variation in products and intent of use by age.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Doença Aguda , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Analgésicos não Narcóticos/efeitos adversos , Antibacterianos/efeitos adversos , Anticoagulantes/efeitos adversos , Barbitúricos/efeitos adversos , Benzodiazepinas/efeitos adversos , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Antagonistas dos Receptores Histamínicos/efeitos adversos , Hospitalização/estatística & dados numéricos , Humanos , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição/efeitos adversos , Vigilância em Saúde Pública , Distribuição por Sexo , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
6.
Sr Care Pharm ; 36(10): 493-500, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34593091

RESUMO

Drug-induced dystonias are rare but can occur with second-generation antipsychotics. They are usually dose-related and occur soon after dose initiation. This case describes the development of dystonia after two years of olanzapine 5 mg daily in an older person with Alzheimer's dementia. The dystonia resolved after diphenhydramine treatment on day two of hospitalization, but then the patient became delirious, which was treated with lorazepam on day three. Six days after admission, she developed tremors and rigidity that self-resolved. Her dystonia resolved after 11 days. The recurrence of symptoms during the hospitalization may have been a result of the progression of her dementia. This is the first known case of a patient developing dystonia after chronic use of low-dose olanzapine. This was not characterized as tardive dystonia because the dystonia was resolved with anticholinergic medication. This case illustrates the difficulty of using anticholinergics to treat dystonias in older people, which can precipitate delirium. Choosing an alternative antipsychotic with less extrapyramidal symptom risk is challenging as she had previous trials with quetiapine and risperidone. Clozapine was deemed an unfavorable alternative, as laboratory monitoring would be burdensome. Olanzapine-induced dystonias can develop anytime during therapy. Families must balance the desire for mood stabilization with antipsychotics side effects.


Assuntos
Antipsicóticos , Distonia , Idoso , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Distonia/induzido quimicamente , Feminino , Humanos , Olanzapina/efeitos adversos , Risperidona
8.
Artigo em Inglês | MEDLINE | ID: mdl-34574645

RESUMO

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse. Benzodiazepine receptor agonists (BZRAs) are associated with pharyngeal muscle relaxation, increased apnea duration, and hypoxia, which might worsen OSA. This study aimed to examine the association between the use of BZRAs and the risk of OSA. The study was conducted using data from the National Health Insurance Database of Taiwan between 2002 and 2011. We only included new users who were never exposed to any BZRAs and identified 1848 participants with OSA, and 1848 matched controls. A logistic regression model was used to determine the association between the use of BZRAs and the development of OSA. BZRA exposure was divided into usage patterns, dosage, duration, and pharmacokinetic class. We found an increased risk of OSA in current users and recent past users compared with distant past users. Patients with a higher cumulative dose of BZRAs were more likely to develop OSA compared to those with a lower cumulative dose. We found an increased risk of OSA in patients treated with BZRAs, especially for current users and those with higher cumulative doses. A reduced risk of OSA was found in Z-drug users compared with benzodiazepine users.


Assuntos
Receptores de GABA-A , Apneia Obstrutiva do Sono , Benzodiazepinas/efeitos adversos , Estudos de Casos e Controles , Humanos , Modelos Logísticos , Apneia Obstrutiva do Sono/induzido quimicamente , Apneia Obstrutiva do Sono/epidemiologia
9.
J Stud Alcohol Drugs ; 82(5): 553-563, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34546901

RESUMO

OBJECTIVE: Research concerning the combined effects of alcohol and benzodiazepines on driving-related skills is largely inconsistent. Because as many as 88% of benzodiazepine users report the additional consumption of alcohol, this review aims to provide an updated and concise synthesis of the available high-quality research. METHOD: We searched EBSCOhost, PubMed, Scopus, and Web of Science until April 1, 2020, for double-blind, placebo-controlled, repeated-measures intervention trials that examined the effects of alcohol (any dose provided as blood alcohol concentration [BAC]) in combination with oral benzodiazepines on neurocognitive tasks related to driving. RESULTS: We identified evidence of a substance and timing-dependent interaction for measures of reaction time, tracking, divided attention, and visual functioning. Administering alcohol in conjunction with or shortly after a benzodiazepine resulted in a stronger interactive effect than when administration occurred further apart. An additive and/or synergistic effect often occurred when a therapeutic dose of benzodiazepine was combined with alcohol at a BAC below .05%. CONCLUSIONS: Combined alcohol and benzodiazepine use was associated with significant impairments in driving-related neurocognitive skills. There is a clear need for more high-quality research in this area to better elucidate the mechanisms of alcohol and benzodiazepine interactions. Drivers may be unaware of impairments following the combination of these drugs at legal driving limits. Thus, drivers should be warned to take caution when consuming even small amounts of alcohol while under treatment with benzodiazepines.


Assuntos
Condução de Veículo , Benzodiazepinas , Benzodiazepinas/efeitos adversos , Concentração Alcoólica no Sangue , Cognição , Etanol/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Geriatr Psychol Neuropsychiatr Vieil ; 19(3): 305-312, 2021 Sep 01.
Artigo em Francês | MEDLINE | ID: mdl-34526288

RESUMO

The prevalence of paradoxical reactions to benzodiazepines is estimated of about 1% in the general population. The semiology can be very rich, diverse and misleading. Advanced age as well as cognitive disorders are classically described in the literature as risk factors for developing paradoxical reactions. However, the review of the literature has only identified a limited number of articles focusing on the elderly and only one article for patients with neurocognitive disorders. One may wonder about this paradox and whether these are unpublished clinical observations, or whether the elderly population is really at risk, especially patients with neurocognitive disorders. Semiology can be confused with underlying neurocognitive disorders. So, paradoxical reactions are ultimately only rarely or not evoked leading to a very high risk of iatrogeny. It is therefore important to be aware of these paradoxical effects in order to be able to evoke them quickly. The most striking semiological element would be the suddenness of onset of self-aggressive or hetero-aggressive behaviors.


Assuntos
Agressão , Benzodiazepinas , Idoso , Benzodiazepinas/efeitos adversos , Humanos
11.
BMJ Open ; 11(9): e044891, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535472

RESUMO

OBJECTIVES: To determine whether the terrorist attacks occurring in Paris on November 2015 have changed benzodiazepine use in the French population. DESIGN: Interrupted time series analysis. SETTING: National population-based cohort. PARTICIPANTS: 90 258 individuals included in the population-based CONSTANCES cohort from 2012 to 2017. OUTCOME MEASURES: Benzodiazepine use was evaluated according to two different indicators using objective data from administrative registries: weekly number of individuals with a benzodiazepine delivered prescriptions (BDP) and weekly number of defined daily dose (DDD). Two sets of analyses were performed according to sex and age (≤50 vs >50). Education, income and area of residence were additional stratification variables to search for at-risk subgroups. RESULTS: Among women, those with younger age (incidence rate ratios (IRR)=1.18; 95% CI=1.05 to 1.32 for BDP; IRR=1.14; 95% CI=1.03 to 1.27 for DDD), higher education (IRR=1.23; 95% CI=1.03 to 1.46 for BDP; IRR=1.23; 95% CI=1.01 to 1.51 for DDD) and living in Paris (IRR=1.27; 95% CI=1.05 to 1.54 for BDP) presented increased risks for benzodiazepine use. Among participants under 50, an overall increase in benzodiazepine use was identified (IRR=1.14; 95% CI=1.02 to 1.28 for BDP and IRR=1.12; 95% CI=1.01 to 1.25 for DDD) and in several strata. In addition to women, those with higher education (IRR=1.22; 95% CI=1.02 to 1.47 for BDP), lower income (IRR=1.17; 95% CI=1.02 to 1.35 for BDP) and not Paris residents (IRR=1.13; 95% CI=1.02 to 1.26 for BDP and IRR=1.13; 95% CI=1.03 to 1.26 for DDD) presented increased risks for benzodiazepine use. CONCLUSION: Terrorist attacks might increase benzodiazepine use at a population level, with at-risk subgroups being particularly concerned. Information and prevention strategies are needed to provide appropriate care after such events.


Assuntos
Benzodiazepinas , Terrorismo , Benzodiazepinas/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Análise de Séries Temporais Interrompida , Paris/epidemiologia
12.
Rev Neurol ; 73(6): 201-209, 2021 09 01.
Artigo em Espanhol | MEDLINE | ID: mdl-34515333

RESUMO

INTRODUCTION: The consequences of the use of of benzodiazepines in coronavirus disease 2019 have not yet been studied. We compared the hospital prognosis of patients hospitalized for coronavirus disease 2019 in benzodiazepine users and non-users. PATIENTS AND METHODS: Observational study with a retrospective cohort design. All consecutive patients admitted with a confirmed diagnosis of coronavirus disease 2019 were included. The patients under chronic treatment with benzodiazepines at the time of admission were studied and compared with non-users. The primary objective was to analyze the mortality of patients who used chronic benzodiazepines at the time of admission and compare them with those who did not use them. The secondary objective was to analyze the risk of severe disease due to coronavirus 2019, acute respiratory distress syndrome and admission to the Intensive Care Unit in both groups of patients. RESULTS: We included 576 patients, 138 (24.0%) used benzodiazepines. After adjusting for sex, age, baseline situation and all the different variables between both groups, benzodiazepine users did not show a higher odds of mortality (OR: 1,1, IC 95%: 0,7-1,9, p = 0,682) or higher risk of severe disease due to coronavirus 2019 (OR: 1.2, 95% CI: 0.7-1.8, p = 0.523). They also did not have a higher risk of acute respiratory distress syndrome (OR: 1.2, IC 95%: 0.8-1.9, p = 0.315) or more admission to the Intensive Care Unit (OR: 0.8, 95% CI: 0.4-1.4, p = 0.433). CONCLUSION: In our sample, treatment with benzodiazepines at the time of admission was not associated with a worse hospital prognosis in patients with coronavirus disease 2019.


Assuntos
Benzodiazepinas/uso terapêutico , COVID-19/mortalidade , Adulto , Idoso , Benzodiazepinas/efeitos adversos , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
13.
Artigo em Inglês | MEDLINE | ID: mdl-34501996

RESUMO

Most patients with Parkinson's disease (PD) gradually develop oropharyngeal dysphagia which is often associated with pneumonia risk. The possible association of benzodiazepine (BZD) and benzodiazepine related drugs (BZRD) use with pneumonia risk has received increasing attention but remains controversial. We investigated pneumonia risk associated with the use of BZDs and BZRDs in older adult patients with PD. This case-control study analyzed data of 551,975 older adult patients with PD between 2001 and 2018 in Taiwan. To minimize potential confounding, we used 1:4 propensity score matching to include older adult patients without pneumonia as controls. Incident pneumonia risk was significantly higher in current (adjusted odds ratio (aOR) = 1.25, 95% CI = 1.23-1.27) and past (aOR = 1.13, 95% CI = 1.11-1.15) users of BZDs. Regarding BZRDs, recent (aOR = 1.08, 95% CI = 1.06-1.11) and past (aOR = 0.89, 95% CI = 0.88-0.91) users had higher and lower risks of incident pneumonia, respectively. Pneumonia risk varied based on their use of BZDs and BZRDs. In these individuals, incident pneumonia risk was high in users of BZDs, such as midazolam, lorazepam, flunitrazepam, estazolam, and clonazepam. Regarding the use of BZRDs, zopiclone increased incident pneumonia risk.


Assuntos
Doença de Parkinson , Preparações Farmacêuticas , Pneumonia , Idoso , Benzodiazepinas/efeitos adversos , Estudos de Casos e Controles , Humanos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia , Pneumonia/induzido quimicamente , Pneumonia/epidemiologia , Fatores de Risco
14.
Subst Use Misuse ; 56(12): 1880-1891, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34369263

RESUMO

BACKGROUND: Side effects restrict the optimal use of antipsychotics. Little is known about the influence of substance use on side effects. The aim of this study was to compare antipsychotic side effects in patients with psychosis with and without substance use, while also taking medication history and diagnosis into consideration. METHODS: All patients (n = 226, mean age 34, females 33%) diagnosed with schizophrenia spectrum disorders (SSD; F20-F29) or other psychosis (F30-F32; F10-F19), were treated with olanzapine, quetiapine, risperidone or ziprasidone, and were assessed at baseline, 4-weeks, 14-weeks, and 27-weeks. The UKU-Side Effects Self-Rating Scale version was used to evaluate the side effect profiles, and the information on substance use was based on the Clinician Drug Use Scale. RESULTS: At baseline, 30% of the patients used substances, 54% were diagnosed with SSD, and 47% were antipsychotic naïve. The occurrence of side effects in total was not different in patients with substance use compared to without after 4-weeks of treatment, nor in the follow-up period. At 4-weeks there were some group differences in relation to substance use, diagnosis, and medication history for single side effects. Patients with substance use showed more increased dream activity, less reduced salivation, and more gynecomastia. Patients with SSD showed less neurological side effects, orgasm dysfunction, and tension/inner unrest. The medication naïve patients showed increased hypokinesia/akinesia. CONCLUSION: Substance use alone does not influence the general magnitude of side effects of antipsychotic medication and does not indicate a different prescription practice in patients with psychosis and substance use.


Assuntos
Transtornos Psicóticos , Transtornos Relacionados ao Uso de Substâncias , Adulto , Benzodiazepinas/efeitos adversos , Feminino , Humanos , Masculino , Olanzapina/efeitos adversos , Piperazinas , Transtornos Psicóticos/tratamento farmacológico , Fumarato de Quetiapina/efeitos adversos , Risperidona/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tiazóis
15.
Fortschr Neurol Psychiatr ; 89(11): 547-551, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34388828

RESUMO

OBJECTIVE: The Lippstädter Benzo-Check is intended to motivate those affected by unwanted effects of Benzodiazepines and Z-drugs. This study serves as the first check whether the Lippstädter Benzo-Check adequately recorded the symptoms of longterm-use before the withdrawal and, on the other hand, a depressive control group without taking the corresponding drugs unremarkable values ​​achieved. METHODS: 101 inpatient withdrawal patients with dependency on Benzodiazepines or Z-drugs and 154 day clinic patients without benzodiazepines or Z-drugs completed the Lippstädter Benzo-Check at the beginning of treatment. The total score and a subscore "dependency" were compared between the two groups. RESULTS: The total score ​​of the Lippstädter Benzo-check in the two collectives differ highly significantly, nevertheless around half oft he depressed patients are in the lowest of three warning areas - "the symptoms you have specified probably come from the long-term use oft he medication".The items "sleep disorder", "stealth", "loss of effectiveness", "fixation on medication" and "extension oft he indication" can be combined into a subscore ("dependency score"). This achieves a high selectivity for a cut-off value of<5 points, since 100% of the day clinic patients and only 10% of the withdrawal patients are below it. CONCLUSIONS: The results of this first study using the Lippstädter Benzo-Check as a screening tool for undesirable consequences on benzodiazepines or Z-drugs are encouraging, despite methodological limitations and the need for further investigations.


Assuntos
Benzodiazepinas , Preparações Farmacêuticas , Benzodiazepinas/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino
16.
Clin Ter ; 172(4): 271-272, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34247209

RESUMO

Abstract: Currently, the world is facing an unprecedent change of everyday life, due to the Covid-19 pandemic that has been affecting all the nations for more than one year. The public health systems were restructured in all the countries as a response to the constant emergency status, ne-glecting some services like toxicological analyses. In this scenario, the current spread of the New Psychoactive Substances is less controlled than before and the data on its expected mutation come from seizures analyses. Where the global distribution of drugs of abuse was affected by the restriction, fentanyl seizures did not drop during the pandemic. Moreover, new synthesis of fentanyl analogues resulted in new toxic adulterants as by products. Furthermore, diversion of benzodiazepines and new designer benzodiazepines were reported during the pandemic period. In this scenario, the scientific community and the international agencies should tighten their collaboration in order to monitor the emerging of new unknown substances.


Assuntos
Benzodiazepinas/efeitos adversos , COVID-19/epidemiologia , Contaminação de Medicamentos/estatística & dados numéricos , Fentanila/efeitos adversos , Psicotrópicos/efeitos adversos , Saúde Pública/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Humanos , Pandemias , SARS-CoV-2
17.
Artigo em Inglês | MEDLINE | ID: mdl-34297487

RESUMO

Objective: To determine the prevalence of sexual dysfunction in female patients with schizophrenia receiving olanzapine or risperidone and to understand its relationship with other psychosocial variables.Methods: This cross-sectional descriptive study evaluated 57 female stabilized schizophrenia outpatients receiving risperidone (n = 28) or olanzapine (n = 29) in the psychiatric departments of a tertiary care hospital in South India from January to May 2019. Sexual dysfunction was assessed with the Changes in Sexual Functioning Questionnaire, severity of psychosis with the Brief Psychiatric Rating Scale, and level of improvement with the Clinical Global Impressions-Improvement and Severity scales.Results: Among the subjects, 93% of women receiving risperidone experienced sexual dysfunction compared to 83% in the olanzapine group. Sexual responses such as pleasure, frequency of sexual contacts, desire, arousal, and orgasm were significantly low in both drug groups (P < .05). Logistic regression of sexual dysfunction as dependent variable with other important variables found no significant relationship.Conclusions: This study suggests that sexual dysfunction is an important undetected problem in the majority of female schizophrenia patients. Risperidone was associated with more sexual dysfunction. Sexual dysfunction is an understudied yet important consideration in the treatment of schizophrenia.


Assuntos
Antipsicóticos , Esquizofrenia , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Estudos Transversais , Feminino , Humanos , Olanzapina/efeitos adversos , Risperidona/efeitos adversos , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico
19.
Drug Ther Bull ; 59(8): 116, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34193516

RESUMO

Overview of: Sharma V, Simpson SH, Samanani S, et al Concurrent use of opioids and benzodiazepine/Z-drugs in Alberta, Canada and the risk of hospitalisation and death: a case cross-over study. BMJ Open 2020;10:e038692.


Assuntos
Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Fatores Etários , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Benzodiazepinas/efeitos adversos , Canadá/epidemiologia , Quimioterapia Combinada , Humanos , Mortalidade
20.
PLoS Med ; 18(7): e1003709, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34264928

RESUMO

BACKGROUND: Benzodiazepine hypnotics and the related nonbenzodiazepine hypnotics (z-drugs) are among the most frequently prescribed medications for older adults. Both can depress respiration, which could have fatal cardiorespiratory effects, particularly among patients with concurrent opioid use. Trazodone, frequently prescribed in low doses for insomnia, has minimal respiratory effects, and, consequently, may be a safer hypnotic for older patients. Thus, for patients beginning treatment with benzodiazepine hypnotics or z-drugs, we compared deaths during periods of current hypnotic use, without or with concurrent opioids, to those for comparable patients receiving trazodone in doses up to 100 mg. METHODS AND FINDINGS: The retrospective cohort study in the United States included 400,924 Medicare beneficiaries 65 years of age or older without severe illness or evidence of substance use disorder initiating study hypnotic therapy from January 2014 through September 2015. Study endpoints were out-of-hospital (primary) and total mortality. Hazard ratios (HRs) were adjusted for demographic characteristics, psychiatric and neurologic disorders, cardiovascular and renal conditions, respiratory diseases, pain-related diagnoses and medications, measures of frailty, and medical care utilization in a time-dependent propensity score-stratified analysis. Patients without concurrent opioids had 32,388 person-years of current use, 260 (8.0/1,000 person-years) out-of-hospital and 418 (12.9/1,000) total deaths for benzodiazepines; 26,497 person-years,150 (5.7/1,000) out-of-hospital and 227 (8.6/1,000) total deaths for z-drugs; and 16,177 person-years,156 (9.6/1,000) out-of-hospital and 256 (15.8/1,000) total deaths for trazodone. Out-of-hospital and total mortality for benzodiazepines (respective HRs: 0.99 [95% confidence interval, 0.81 to 1.22, p = 0.954] and 0.95 [0.82 to 1.14, p = 0.513] and z-drugs (HRs: 0.96 [0.76 to 1.23], p = 0.767 and 0.87 [0.72 to 1.05], p = 0.153) did not differ significantly from that for trazodone. Patients with concurrent opioids had 4,278 person-years of current use, 90 (21.0/1,000) out-of-hospital and 127 (29.7/1,000) total deaths for benzodiazepines; 3,541 person-years, 40 (11.3/1,000) out-of-hospital and 64 (18.1/1,000) total deaths for z-drugs; and 2,347 person-years, 19 (8.1/1,000) out-of-hospital and 36 (15.3/1,000) total deaths for trazodone. Out-of-hospital and total mortality for benzodiazepines (HRs: 3.02 [1.83 to 4.97], p < 0.001 and 2.21 [1.52 to 3.20], p < 0.001) and z-drugs (HRs: 1.98 [1.14 to 3.44], p = 0.015 and 1.65 [1.09 to 2.49], p = 0.018) were significantly increased relative to trazodone; findings were similar with exclusion of overdose deaths or restriction to those with cardiovascular causes. Limitations included composition of the study cohort and potential confounding by unmeasured variables. CONCLUSIONS: In US Medicare beneficiaries 65 years of age or older without concurrent opioids who initiated treatment with benzodiazepine hypnotics, z-drugs, or low-dose trazodone, study hypnotics were not associated with mortality. With concurrent opioids, benzodiazepines and z-drugs were associated with increased out-of-hospital and total mortality. These findings indicate that the dangers of benzodiazepine-opioid coadministration go beyond the documented association with overdose death and suggest that in combination with opioids, the z-drugs may be more hazardous than previously thought.


Assuntos
Analgésicos Opioides/efeitos adversos , Benzodiazepinas/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Mortalidade , Medicamentos sob Prescrição/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Medicare , Medicamentos sob Prescrição/administração & dosagem , Estudos Retrospectivos , Estados Unidos
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