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Huang F, San X, Liu Q, Zhu H, Xu W. Signal mining and risk analysis of Alprazolam adverse events based on the FAERS database. Sci Rep 2024; 14:7489. [PMID: 38553504 PMCID: PMC10980721 DOI: 10.1038/s41598-024-57909-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
This study aims to evaluate the safety of Alprazolam by analyzing the FAERS database, provide data analysis for monitoring adverse drug reactions. This research encompasses adverse event (AE) reports related to Alprazolam from the first quarter of 2004 to the second quarter of 2023. Four signal mining and analysis methods were utilized, including Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM). Further exploration was conducted regarding patient characteristics and types of AEs. A total of 23,575 AE reports in which Alprazolam was the primary suspect drug were collected, identifying 347 Preferred Term (PT) signals and 27 System Organ Classes (SOCs). The number of AE reports increased annually, especially in 2015, 2018, 2019, and 2020. The main affected groups were females and the age range of 18 to 45. Psychiatric disorders, Nervous system disorders, and Gastrointestinal disorders were the most common the organ system in which the AEs occurred. There is a certain risk of drug abuse and suicide with Alprazolam. Most notably, several AEs not recorded in the Alprazolam leaflet appeared among the top 30 PTs in signal strength, including but not limited to Benzodiazepine drug level abnormal, Acquired amegakaryocytic thrombocytopenia, Cutaneous T-cell dyscrasia, and Coronary No-reflow Phenomenon. For the first time, AEs related to the cardiovascular system and platelet function were unveiled. The severe AE reports that resulted in "hospitalization" and "death" accounted for 30.96% and 21.86%. This study highlights the risks of suicide and misuse of Alprazolam. Other potential severe or fatal AEs, such as those related to the cardiovascular system, platelet function, and others, require further research to determine their precise mechanisms and risk factors.
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Affiliation(s)
- Feng Huang
- Department of Clinical Laboratory, Kunshan Maternity and Children's Health Care Hospital, Kunshan, 215300, Jiangsu, China
- Department of Clinical Laboratory, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Kunshan, 215300, Jiangsu, China
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Xiao San
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Qingqian Liu
- Department of Clinical Laboratory, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Kunshan, 215300, Jiangsu, China
| | - Haohao Zhu
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, 214151, Jiangsu, China.
| | - Wenrong Xu
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China.
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Solanki B, Goel R, Gupta LK. Benzodiazepines Reduce Blood Pressure in Short Term: A Systematic Review and Meta-analysis. Curr Hypertens Rep 2023; 25:335-341. [PMID: 37581768 DOI: 10.1007/s11906-023-01256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE OF REVIEW Benzodiazepines, due to their anxiolytic properties, are prescribed to reduce anxiety and insomnia. They might have hypotensive effect via potentiation of the inhibitory effect of gamma-amino butyric acid (GABA) in the central nervous system and vasodilatory properties. However, studies comparing the effect of benzodiazepines in lowering blood pressure (BP) are equivocal. This systematic review and meta-analysis was planned to assess the efficacy of benzodiazepines in reducing blood pressure in short term among hypertensive patients. RECENT FINDINGS Various trials and retrospective analysis conducted previously have reported that benzodiazepines cause short- as well as long-term BP reduction in patients with increased anxiety with hypertension. On the other hand, several studies investigating the efficacy of benzodiazepines in patients with hypertension have reported inconclusive results. The primary question about the effect of benzodiazepines in lowering BP remains unanswered. In this meta-analysis of seven studies, benzodiazepines were found comparable to standard drugs in reducing systolic and diastolic BP in patients having hypertension. Although, the mean difference in systolic BP with benzodiazepines and placebo was statistically not significant, the difference can be considered as clinically meaningful. The current review offers preliminary evidence that benzodiazepines may have antihypertensive properties and may be used as add-on antihypertensive in a subset of patients in short term. The existing data are encouraging, but more clinical trials and mechanistic research are required to ascertain the long-term benefits.
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Affiliation(s)
- Bhupinder Solanki
- Department of Pharmacology, Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, 110001, India
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ridhi Goel
- Department of Pharmacology, Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, 110001, India
| | - Lalit K Gupta
- Department of Pharmacology, Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, 110001, India.
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Vilalta-Lacarra A, Vilalta-Franch J, Serrano-Sarbosa D, Martí-Lluch R, Marrugat J, Garre-Olmo J. Association of depression phenotypes and antidepressant treatment with mortality due to cancer and other causes: a community-based cohort study. Front Psychol 2023; 14:1192462. [PMID: 37711322 PMCID: PMC10497951 DOI: 10.3389/fpsyg.2023.1192462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
Objective This study aimed to assess the association of somatic depressive symptoms (SDS), cognitive/emotional depressive symptoms (C-EDS), and antidepressant treatment on mortality due to cancer and other causes in a community cohort. Methods A community-based sample recruited in 1995, 2000, and 2005 aged between 35 and 75 years was examined in two waves and followed for a median of 6.7 years. SDS and C-EDS phenotypes were assessed using the Patient Health Questionnaire-9. Medication used by participants was collected. Deaths and their causes were registered during follow-up. Cox proportional hazard models stratified by sex were performed to determine the association between depressive phenotypes and mortality. Results The cohort consisted of 5,646 individuals (53.9% women) with a mean age of 64 years (SD = 11.89). During the follow-up, 392 deaths were recorded, of which 27.8% were due to cancer. C-EDS phenotype was associated with an increased risk of cancer mortality in both men (HR = 2.23; 95% CI = 1.11-4.44) and women (HR = 3.69; 95% CI = 1.69-8.09), and SDS was significantly associated with non-cancer mortality in men (HR = 2.16; 95 CI % = 1.46-3.18). Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with both cancer (HR = 2.78; 95% CI = 1.10-6.98) and non-cancer mortality (HR = 2.94; 95% CI = 1.76-4.90) only in the male population. Conclusion C-EDS phenotype was related to an increased risk of cancer mortality at 6 years. In addition, the use of SSRIs in the male population was associated with cancer and all-cause mortality.
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Affiliation(s)
| | | | - Domènec Serrano-Sarbosa
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Institut d'Assistencia Sanitaria, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
| | - Ruth Martí-Lluch
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Vascular Health Research Group (ISV-Girona), Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina, Girona, Spain
| | - Jaume Marrugat
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- CIBERCV de Investigación en Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Department of Nursing, University of Girona, Girona, Spain
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Mamtani H, Chaturvedi SK. Alprazolam: Good for Some, Not Good for All! J Clin Psychopharmacol 2023; 43:204-208. [PMID: 37040158 DOI: 10.1097/jcp.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Although alprazolam is approved only for use in panic disorder and generalized anxiety disorder, it is used for numerous other conditions, not only by psychiatrists but also by medical professionals in general. This commentary critically analyzes the use of alprazolam. METHODS A narrative review approach was adopted, using relevant articles and textbooks, to compile pertinent literature for the aforementioned topic. RESULTS Among all its adverse reactions, the most bothersome concern about the use of alprazolam is its potential for abuse and dependence. This can be attributed to certain unique pharmacokinetic and pharmacodynamic properties of this benzodiazepine. Also, the withdrawal triggered by use of alprazolam is challenging to treat. Alternate pharmacological and non-pharmacological strategies for use in anxiety and insomnia are available, which might be safer than alprazolam. Also, policy changes can serve as an answer to curb alprazolam abuse to some extent. Alprazolam might still be a good choice for individuals who do not have a history of abuse of other substances, with adequate psychoeducation and close monitoring of their usage pattern. CONCLUSION There is a need to reconsider the need for long-term use of benzodiazepines in general, and alprazolam in particular. However, they still might be an appropriate choice in individuals where abuse and dependence are less likely.
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Affiliation(s)
- Harkishan Mamtani
- From the Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Santosh K Chaturvedi
- Department of Psychiatry, Leicestershire Partnership, NHS Trust, Leicester, United Kingdom
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Liu M, Lu L, Geng Q, Wang J, Bai C, Cheng G, Cui Y, Dong B, Fang J, Gao F, Huang R, Huang S, Li Y, Liu G, Liu Y, Lu Y, Ren Y, Mao J, Shi D, Su H, Sun X, Sun X, Tang X, Tian F, Tu H, Wang H, Wang Q, Wang X, Wang J, Wang L, Wang Y, Wang Y, Wang Z, Wen S, Wu H, Wu Y, Xiong P, Yu G, Yang N, Zhao X, Zhang H. Expert consensus on diagnosis and treatment of adult mental stress-induced hypertension in China (2022 Revision): Part B. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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