Acute and carry-over effects of brotizolam compared to nitrazepam and placebo in monotonous simulated driving

Evaluation method regarding the effect of psychotropic drugs on driving performance: A literature review

Although automobile driving is necessary for many people, including patients with mental disorders, the influence of psychotropic drugs on driving performance remains unclear and requires scientific verification. Therefore, the objective of this study was to conduct a review of the literature in order to aid the development of a valid evaluation method regarding the influence of medication on driving performance. We conducted a literature search using two sets of terms on PubMed. One set was related to psychotropic drugs, and the other to driving tests. We excluded reviews and case studies and added literature found on other sites. A total of 121 relevant reports were found. The experiments were roughly divided into on-the-road tests (ORT) and driving simulators (DS). Although highway driving tests in ORT are most often used to evaluate driving performance, DS are becoming increasingly common because of their safety and low cost. The validity of evaluation methods for alcohol should be verified; however, we found that there were few validated tests, especially for DS. The scenarios and measurement indices of each DS were different, which makes it difficult to compare the results of DS studies directly. No evaluation indices, except for SD of lateral position, were sufficiently validated. Although highway ORT are the gold standard, DS were shown to have an increasing role in evaluating driving performance. The reliability of DS needs to be established, as does their validation with alcohol in order to accumulate more high-quality evidence.

Lorazepam impairs highway driving performance more than heavy alcohol consumption

While research indicates that benzodiazepine (BZD)-like drugs impair driving performance, it remains unclear (i) how far BZDs affect lane-keeping performance, compared with alcohol and (ii) to what extent this impact can realistically be measured in a simulated environment. To clarify these issues, 16 healthy male drivers who had never previously taken BZDs underwent a randomized, crossover, double-blind, placebo-controlled driving paradigm (with the BZD lorazepam) in both real-world and simulated settings. Two lane-keeping variables, namely inappropriate line crossings (ILCs) and standard deviation of lateral position (SDLP), were recorded during the driving sessions. Analyses revealed that (i) a single lorazepam dose (2 mg given by mouth) caused higher SDLP increases than a blood alcohol concentration of above 0.05%, and that (ii) this BZD effect was amplified in the simulated driving setting, mainly for ILCs. As a consequence, we recommend that physicians be made more aware of BZD-related risks and that researchers make a clear distinction between the effects of BZD intake per se and the impact of simulated driving settings.

Impact of psychotropic medications on simulated driving: a critical review

Driving a motor vehicle is central to the functional autonomy of patients with psychiatric illnesses. There have been many studies of the deleterious effects of psychotropic medications such as benzodiazepines, typical antipsychotics and tricyclic antidepressants (TCAs) on human motor skills; however, in the literature little attention has been paid to how such impairment affects driving ability. Computerised driving simulators offer a laboratory-based method of assessing the effects of specific psychotropic medications on driving abilities, in a standardised, controlled and safe manner. The purpose of the present article is to review research undertaken to-date on the effects of psychotropic medications on computer-simulated driving. A search of various databases, including MEDLINE, EMBASE and PsycInfo, was conducted. Forty-one articles assessing the impact of psychotropics on computer-simulated driving were identified. The pooled total number of subjects assessed in these simulator studies was 1336 (mean sample size 30.36 [SD 35.8]). The most common outcome measures in the various studies were speed, steering, deviation from lateral position (tracking, lane drifting), reaction time or braking accuracy, driving errors (e.g. errors in turning, coordination, gap acceptance, signalling, following distance) and vehicle collisions. The results of the studies were quite variable; however, the most common drug-related impairments included those of tracking and reaction time. Benzodiazepines and TCAs were most commonly associated with impairment, although the level of impairment was dependent on the population studied, the dose and the time of testing relative to drug administration. Computer-simulated driving provides a useful tool to research psychotropic-related impairment of driving abilities. Limitations of currently available data include the lack of generalisability, standardisation and small sample sizes.

Residual effects of sleep medication on driving ability

Most patients using hypnotics are ambulatory and presumably have a job and drive a car. Since driving a car is one of the most common but potentially dangerous daily activities, hypnotics should act rapidly when needed, but daytime sleepiness and other residual effects that may impair performance are unwanted. This review summarizes the effects of hypnotics on driving ability as determined with the on-the-road driving test during normal traffic. Supportive evidence from epidemiological data, and results from driving simulators and closed-road studies are also considered. On-the-road studies revealed that benzodiazepine hypnotics significantly impaired driving ability the morning following bedtime administration. Impairment was sometimes also significant in the afternoon (16-17 h after administration). Similar driving impairment was observed with zopiclone. However, the magnitude of impairment depends on various factors including the half-life and dosage of the drug, and the time after administration. The results from on-the-road driving studies are supported by evidence obtained in driving simulators and laboratory tests. Epidemiological data and on-the-road studies show that tolerance develops to the impairing effects of hypnotics. However, this is a slow process, and impairment may persist. Patients treated with benzodiazepine hypnotics or zopiclone should be cautioned when driving a car. Both zolpidem and zaleplon do not significantly affect driving performance the morning following bedtime administration. Middle-of-the-night administration of zolpidem significantly impairs driving ability in a dose-dependent manner. In contrast, zaleplon did not affect driving ability 4 h after middle-of-the-night administration.

Vigilance impairment after a single dose of benzodiazepines

While outpatients or other users of therapeutic drugs have to be informed about the risk of impaired functioning during driving or work, the prescribing physician needs to be familiar with the side effects of alternative drugs in order to select the most suitable treatment. With this aim, several types of benzodiazepine anxiolytics in low anxiolytic doses (diazepam 5 mg or 10 mg, nitrazepam 5 mg, oxazepam 10 mg, medazepam 10 mg, and alprazolam 0.2 or 0.5 mg-per 2m2 body surface) were tested under laboratory conditions for their effects on vigilance performance. In a double-blind design, 145 healthy volunteers performed a 60 min vigilance test (composed of discriminatory reactions to acoustic stimuli and a secondary visual tracking task) and four short psychomotor tests (lasting 1-7 min each) before and after a single dose of drug or placebo. Subjects described their perception of the drug effect with the help of a mood check list, and fatigue, sleepiness, and effort scales. Only diazepam 5 mg and 10 mg, alprazolam 0.5 mg, and nitrazepam 5 mg caused significant deterioration in vigilance performance along with perceived sleepiness and the need for a greater effort to overcome it. The onset of diazepam effect was quicker, whereas alprazolam effect lasted longer. No effect was noted in the short psychomotor tests except for the Bourdon Cancellation Test, where the first phase of diazepam effect was registered.

The use of microcomputer-based psychomotor tests for the evaluation of benzodiazepine effects on human performance: a review with emphasis on temazepam

1. The literature relating to the effects of benzodiazepines in general, and temazepam in particular, on human psychomotor performance as assessed using microcomputer-based testing batteries is surveyed. 2. The adverse effects of central nervous system depressants on performance is an important mediocolegal issue and frequently comes into question in on-the-road and on-the-job accidents. The use of microcomputer-based testing batteries allows for performance evaluation both in the laboratory and at-the-scene, as well as providing the opportunity to model a large number of different behaviours required in routine yet complex psychomotor tasks. 3. The conclusions in general are: (1) The benzodiazepines as a class of drugs impair both cognitive and motor performance. These effects are often subtle when low doses are involved or when testing occurs the morning following evening administration of the medication. (2) No single psychomotor task adequately simulates complex daily tasks such as automobile driving. A battery of tests that evaluates a number of the components of such tasks is necessary to determine adequately the full range of effects of these medications.