Jornal Médico – Ricardo Pinto and Sofia Reis: (Dis)pharmacology of Benzodiazepines

Read the opinion of Ricardo Pinto, intern in General and Family Medicine (FGM) at Centro de Saúde Dr. Rui Adriano Freitas from the Health Service of the Autonomous Region of Madeira (SESARAM) and Sofia Rei, FGM intern on the Caniço Health Center of SESARAM, concerning the excessive degree of Benzodiazepines and the dangerous results on the affected person’s well being.

Benzodiazepines (BZDs) are sometimes prescribed in hospitals, particularly on the Primary Health Care (PHC) degree, as a result of they’re thought of to be very efficient sedative-hypnotics. However, the danger of unintended effects, in addition to the event of tolerance, dependence, potential abuse and withdrawal, as a result of inappropriate and lengthy-time period use, make BZD overuse a severe public well being downside.

BZDs, which trigger gamma-aminobutyric acid (GABA) to inhibit neurotransmission, are used not just for nervousness and sleep problems, but additionally for the therapy of alcoholism and opioid withdrawal syndrome, work, and, as anticonvulsants, muscle groups. stimulants, and as a “bridge” to the use of antidepressants in circumstances of melancholy.

Research reveals that the BZDs which can be prescribed probably the most are these with a half-life, which have nervousness and hypnotic properties, displaying nervousness, insomnia and melancholy as the principle causes for his or her use. On the opposite hand, these with a brief half-life have a better potential, and the simultaneous use of different psychoactive substances, comparable to alcohol, will increase the severity and magnitude of its damaging results. Women devour twice as a lot BZD as males, particularly these between the ages of 55 and 79, explaining the upper use of well being care providers.

Portugal is one of the nations that prescribes this group of medicine, which is utilized in extra nations than different European nations (comparable to Italy, Norway and Denmark), and due to this fact reveals a low compliance with medical approvals. This implies that, opposite to the suggestions of the Directorate-General for Health (DGS) for lengthy-time period use of the drug and in sure conditions (comparable to insomnia and nervousness), therapy is all the time maintained. limitless methods, probably the most really helpful intervals are 4 weeks within the case of insomnia and twelve weeks within the case of nervousness.

Contrary to what’s seen in developed nations, the place 15 to 30% of folks over 65 take BZD, it isn’t accepted by the American Society of Geriatrics as a primary selection within the therapy of insomnia, melancholy or delirium, for the reason that danger of dependence will increase with age, inflicting disruption of therapy being tough and exposing the aged to the unintended effects of this drug.

The major unintended effects of BZDs – in direct proportion to the dose and length of therapy – embrace falls, motor modifications, restlessness, psychological disturbances, lowered studying potential and anterograde reminiscence, which may be confused with the onset of dementia, whose interactions will not be totally defined. . BZD use has additionally been proven to be related to withdrawal signs, disruptive occasions (comparable to irritability, melancholy and psychotic signs) and even elevated mortality.

In order to cut back the problems related to BZD consumption, it is very important take a precautionary strategy, to know which of them are accredited for this group of medicine, to fastidiously observe the accredited therapy strategies, and to pick out sufferers who wouldn’t have medical data. rehabilitation help.

The effectiveness of the therapy needs to be re-evaluated often, in order that, when the therapeutic objectives and/or the desired most time are reached, their suspension is adjusted progressively. In addition, a observe-up session with the household physician, the place the advantages of stopping BZD are mentioned with the affected person, is one other technique that has one of the best outcomes.

In brief, as vital as setting deadlines and explaining different therapies, is to tell sufferers of the dangers of lengthy-time period use of BZD, encouraging those that need to cease. In this context, household medical doctors, as the primary level of contact with the well being system, and being the principle guides of this pharmacological group, have the chance to take care of its infinite use and change this paradigm.

References

Cadilhe S. Benzodiazepines – the quantity of medicine and the connection with the explanations for his or her use. Rev Port Clin General. 2004; 20:193-202.

National Coordination of Medicines and Health Products Strategy. Overuse of benzodiazepines and z-hypnotics in nervousness and insomnia. 2017.

Directorate General for Health. Symptomatic therapy of nervousness and insomnia with benzodiazepines and related medicine. DGS Standard 055/2011. 2015; 1-10.

Domingues SG, Gomes VRP. Benzodiazepines and dementia danger: what’s the proof? Rev Port Med General Fam. 2018; 34:149-55.

Faria Vaz A, et al. The use of benzodiazepines: a significant public well being downside. Therapeutic Bulletin – ARSLVT. 2017; 1:1-6.

Faria Vaz A, et al. Methods for distinguishing benzodiazepines. Therapeutic Bulletin – ARSLVT. 2017; Appendix I:1-9.

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