1
|
Weleff J, Anand A, Squeri M, Sieke R, Thompson NR, Barnett BS. An Analysis of Benzodiazepine Prescribing to Primary Care Patients in a Large Healthcare System from 2019-2020. J Psychoactive Drugs 2024; 56:245-256. [PMID: 36940298 DOI: 10.1080/02791072.2023.2191610] [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] [Received: 09/28/2022] [Accepted: 03/04/2023] [Indexed: 03/22/2023]
Abstract
We sought to quantify benzodiazepine prescribing by primary care providers from 2019 to 2020 and identify correlates of prescribing. We hypothesized prescribing would increase post-COVID-19 lockdown. We conducted a retrospective cohort study of adult patients with primary care visits in 2019 or 2020 in a large Ohio healthcare system. Demographics, diagnosis codes, and receipt of benzodiazepine prescriptions were collected. Using multivariable logistic regression, we examined factors associated with benzodiazepine prescription receipt during the whole study period and post-lockdown. 455,537 adult patients had 1,643,473 visits. Benzodiazepines were prescribed in 3.2% (53,049/1,643,473) of visits. Effect sizes for positive associations with benzodiazepine prescription were largest for anxiety disorders. For negative associations, they were largest for Black patients and patients with cocaine use disorder. Benzodiazepine prescribing was positively associated with multiple groups having contraindications, though effect sizes were small. Contrary to our hypothesis, odds of receiving a prescription were 8.8% lower post-lockdown. Benzodiazepine prescribing rates in our system compared favorably to national rates. Year over year odds of receiving a prescription were slightly lower post-lockdown. Racial disparities were present and deserve further study. Strategies to reduce benzodiazepine prescribing to patients with anxiety may yield the largest reductions for benzodiazepine prescribing in primary care settings.
Collapse
Affiliation(s)
- Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Akhil Anand
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- EC-10 Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Michael Squeri
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rachel Sieke
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
- Neurological Institute, Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, USA
| | - Brian S Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- EC-10 Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
2
|
Diaz L, Eiden C, Jouanjus E, Frauger E, Fouilhé N, Djezzar S, Gibaja V, Boucher A, Le Boisselier R, Libert F, Caous AS, Monzon E, Guerlais M, Daveluy A, Fauconneau B, Peyrière H. Alprazolam misuse: Analysis of French Addictovigilance Network data from 2011 to 2020. Therapie 2023; 78:647-657. [PMID: 36918317 DOI: 10.1016/j.therap.2023.02.002] [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] [Received: 10/19/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Alprazolam, a high-potency and short-acting anxiolytic benzodiazepine, is one of the most misused benzodiazepines in France. In the context of various reports on alprazolam misuse during the COVID-19 pandemic, the objective of this study was to assess alprazolam abuse potential by analyzing French addictovigilance and international data. METHODS Data collected from 2011 to 2020 using the following epidemiological tools of the French Addictovigilance Network were analyzed: spontaneous reports (SRs), OPPIDUM (addiction care center data), OSIAP (falsified prescriptions), DRAMES (substance-related deaths), and chemical submission surveys. Moreover, the VigiBase™ database was analyzed to evaluate alprazolam abuse liability worldwide. RESULTS During the study period, 675 SRs concerning alprazolam misuse were recorded (sex ratio: ̴1; median age: 39 years). The desired effects were intensification of the therapeutic anxiolytic effect, euphoric effect, and management of substance withdrawal. Alprazolam was the third and first benzodiazepine listed in OPPIDUM and OSIAP surveys. Analysis of the SR and OPPIDUM data showed a recent increase in the alprazolam-opioid combination. In DRAMES data, alprazolam was directly linked to 11 deaths (associated with opioids in 10/11). VigiBase™ data analysis highlighted that France was the third country with the most cases of alprazolam misuse. The disproportionality analysis showed that in France, alprazolam was associated with higher risk of misuse and dependence compared with other benzodiazepines: reporting odds ratio=1.43, (95% CI: 1.04-1.95) and=1.97 (95% CI:1.50-2.59), respectively. CONCLUSIONS This study highlighted an increase in various signals of alprazolam abuse in France, and an increased use of the alprazolam-opioid combination that was also linked to most of the recorded alprazolam-linked deaths. These signals have been reported also in the international literature, and should be thoroughly investigated.
Collapse
Affiliation(s)
- Laurine Diaz
- Addictovigilance Centre, Lapeyronie Hospital, CHU de Montpellier, Univ Montpellier, 34000 Montpellier, France
| | - Céline Eiden
- Addictovigilance Centre, Lapeyronie Hospital, CHU de Montpellier, Univ Montpellier, 34000 Montpellier, France
| | - Emilie Jouanjus
- Addictovigilance Centre, Medecine Faculty, CHU, 31000 Toulouse, France
| | | | | | - Samira Djezzar
- Addictovigilance Centre, Fernand Widal Hospital, 75000 Paris, France
| | | | | | | | - Frédéric Libert
- Addictovigilance Centre-CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | | | - Emilie Monzon
- Agence Nationale de Sécurité des Médicaments et Produits de Santé (ANSM), 93210 Saint Denis La Plaine, France
| | | | - Amélie Daveluy
- Addictovigilance Centre-CHU Bordeaux, 33000 Bordeaux, France
| | | | - Hélène Peyrière
- Addictovigilance Centre, Lapeyronie Hospital, CHU de Montpellier, Univ Montpellier, 34000 Montpellier, France; Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, CHU Montpellier, 34000 Montpellier, France.
| |
Collapse
|
3
|
Koniuszewski F, Vogel FD, Dajić I, Seidel T, Kunze M, Willeit M, Ernst M. Navigating the complex landscape of benzodiazepine- and Z-drug diversity: insights from comprehensive FDA adverse event reporting system analysis and beyond. Front Psychiatry 2023; 14:1188101. [PMID: 37457785 PMCID: PMC10345211 DOI: 10.3389/fpsyt.2023.1188101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Medications which target benzodiazepine (BZD) binding sites of GABAA receptors (GABAARs) have been in widespread use since the nineteen-sixties. They carry labels as anxiolytics, hypnotics or antiepileptics. All benzodiazepines and several nonbenzodiazepine Z-drugs share high affinity binding sites on certain subtypes of GABAA receptors, from which they can be displaced by the clinically used antagonist flumazenil. Additional binding sites exist and overlap in part with sites used by some general anaesthetics and barbiturates. Despite substantial preclinical efforts, it remains unclear which receptor subtypes and ligand features mediate individual drug effects. There is a paucity of literature comparing clinically observed adverse effect liabilities across substances in methodologically coherent ways. Methods In order to examine heterogeneity in clinical outcome, we screened the publicly available U.S. FDA adverse event reporting system (FAERS) database for reports of individual compounds and analyzed them for each sex individually with the use of disproportionality analysis. The complementary use of physico-chemical descriptors provides a molecular basis for the analysis of clinical observations of wanted and unwanted drug effects. Results and Discussion We found a multifaceted FAERS picture, and suggest that more thorough clinical and pharmacoepidemiologic investigations of the heterogenous side effect profiles for benzodiazepines and Z-drugs are needed. This may lead to more differentiated safety profiles and prescription practice for particular compounds, which in turn could potentially ease side effect burden in everyday clinical practice considerably. From both preclinical literature and pharmacovigilance data, there is converging evidence that this very large class of psychoactive molecules displays a broad range of distinctive unwanted effect profiles - too broad to be explained by the four canonical, so-called "diazepam-sensitive high-affinity interaction sites". The substance-specific signatures of compound effects may partly be mediated by phenomena such as occupancy of additional binding sites, and/or synergistic interactions with endogenous substances like steroids and endocannabinoids. These in turn drive the wanted and unwanted effects and sex differences of individual compounds.
Collapse
Affiliation(s)
- Filip Koniuszewski
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Florian D. Vogel
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Irena Dajić
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Seidel
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Markus Kunze
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Matthäus Willeit
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Margot Ernst
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| |
Collapse
|
4
|
Zhu C, Wang XY, Zhao J, Long B, Xiao X, Pan LY, Yuan TF, Chen JH. Effect of transdermal drug delivery therapy on anxiety symptoms in schizophrenic patients. Front Neurosci 2023; 17:1177214. [PMID: 37360162 PMCID: PMC10289061 DOI: 10.3389/fnins.2023.1177214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To evaluate the efficacy and safety of transdermal drug delivery therapy for schizophrenia with anxiety symptoms. Methods A total of 80 schizophrenic patients (34 males and 56 females) with comorbid anxiety disorders were randomly assigned to the treatment group (n = 40) and the control group (n = 40) with 6 weeks of follow-up. The patients in the treatment group received the standard antipsychotic drug treatment along with transdermal drug delivery therapy. The evaluation of the patients included the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD-17), and treatment emergent symptom scale (TESS) at baseline, 3 weeks, and 6 weeks after transdermal drug delivery therapy. The Positive and Negative Symptom Scale (PANSS) was assessed at baseline and after 6 weeks of treatment. Results After 3 and 6 weeks of treatment, the HAMA scale scores in the treatment group were lower than those in the control group (p < 0.001). However, there were no significant differences in the HAMD-17 scale scores, PANSS total scores, and subscale scores between the two groups (p > 0.05). Additionally, no significant differences in adverse effects were observed between the two groups during the intervention period (p > 0.05). After 6 weeks of penetration therapy, there was a low negative correlation between total disease duration and the change in HAMA scale score (pretreatment-posttreatment) in the treatment group. Conclusion Combined traditional Chinese medicine directed penetration therapy can improve the anxiety symptoms of patients with schizophrenia and has a safe profile.
Collapse
Affiliation(s)
- Cuifang Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Traditional Chinese Medicine for Mental Health, Shanghai, China
| | - Xin-Yue Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Traditional Chinese Medicine for Mental Health, Shanghai, China
| | - Bin Long
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Traditional Chinese Medicine for Mental Health, Shanghai, China
| | - Xudong Xiao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Traditional Chinese Medicine for Mental Health, Shanghai, China
| | - Ling-Yi Pan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ti-Fei Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Hua Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Traditional Chinese Medicine for Mental Health, Shanghai, China
| |
Collapse
|
5
|
Kinney KL, Zheng Y, Morris MC, Schumacher JA, Bhardwaj SB, Rowlett JK. Predicting benzodiazepine prescriptions: A proof-of-concept machine learning approach. Front Psychiatry 2023; 14:1087879. [PMID: 36970256 PMCID: PMC10036348 DOI: 10.3389/fpsyt.2023.1087879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction Benzodiazepines are the most commonly prescribed psychotropic medications, but they may place users at risk of serious adverse effects. Developing a method to predict benzodiazepine prescriptions could assist in prevention efforts. Methods The present study applies machine learning methods to de-identified electronic health record data, in order to develop algorithms for predicting benzodiazepine prescription receipt (yes/no) and number of benzodiazepine prescriptions (0, 1, 2+) at a given encounter. Support-vector machine (SVM) and random forest (RF) approaches were applied to outpatient psychiatry, family medicine, and geriatric medicine data from a large academic medical center. The training sample comprised encounters taking place between January 2020 and December 2021 (N = 204,723 encounters); the testing sample comprised data from encounters taking place between January and March 2022 (N = 28,631 encounters). The following empirically-supported features were evaluated: anxiety and sleep disorders (primary anxiety diagnosis, any anxiety diagnosis, primary sleep diagnosis, any sleep diagnosis), demographic characteristics (age, gender, race), medications (opioid prescription, number of opioid prescriptions, antidepressant prescription, antipsychotic prescription), other clinical variables (mood disorder, psychotic disorder, neurocognitive disorder, prescriber specialty), and insurance status (any insurance, type of insurance). We took a step-wise approach to developing a prediction model, wherein Model 1 included only anxiety and sleep diagnoses, and each subsequent model included an additional group of features. Results For predicting benzodiazepine prescription receipt (yes/no), all models showed good to excellent overall accuracy and area under the receiver operating characteristic curve (AUC) for both SVM (Accuracy = 0.868-0.883; AUC = 0.864-0.924) and RF (Accuracy = 0.860-0.887; AUC = 0.877-0.953). Overall accuracy was also high for predicting number of benzodiazepine prescriptions (0, 1, 2+) for both SVM (Accuracy = 0.861-0.877) and RF (Accuracy = 0.846-0.878). Discussion Results suggest SVM and RF algorithms can accurately classify individuals who receive a benzodiazepine prescription and can separate patients by the number of benzodiazepine prescriptions received at a given encounter. If replicated, these predictive models could inform system-level interventions to reduce the public health burden of benzodiazepines.
Collapse
Affiliation(s)
- Kerry L. Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Yufeng Zheng
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States
| | - Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Julie A. Schumacher
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Saurabh B. Bhardwaj
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - James K. Rowlett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| |
Collapse
|
6
|
Ribas Roca J, Everett T, Dongarwar D, Salihu HM. Racial-Ethnic Disparities in Benzodiazepine Prescriptions for Anxiety in US Emergency Departments. J Racial Ethn Health Disparities 2023; 10:334-342. [PMID: 34993917 DOI: 10.1007/s40615-021-01224-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Benzodiazepines are commonly used to treat anxiety and panic disorders. White patients are more likely to receive a benzodiazepine prescription than non-White patients in different medical settings. Racial-ethnic disparities have also been found in prescription of opioids from the emergency room. It is not known whether racial disparities in benzodiazepine prescriptions exist at the emergency department level. This study aims to analyze the relationship between benzodiazepine prescriptions for anxiety in an emergency department setting. DESIGN Data for this cross-sectional study was obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) Years 2009-2018. Patients ≥ 18 years of age presenting to the emergency department with anxiety were identified. Adjusted survey logistic regression was conducted to evaluate the patient characteristics and receipt of benzodiazepines. RESULTS This study analyzed 1,174,556,119 emergency department (ED) visits out of which 2.8% had a diagnosis of anxiety disorder. Prevalence of anxiety was higher in the following groups: females, younger age range (18-34 years old), and non-Hispanic (NH) White. Rates of benzodiazepine prescription for patients with anxiety were higher for NH-White and Hispanic patients at 29% and 28% respectively than for NH-Black and NH-Other (24% and 21% respectively). Compared to NH-White patients, NH-Black patients were 36% less likely to be prescribed a benzodiazepine (prevalence ratio (PR) = 0.64; 95% confidence interval (CI) = 0.54-0.76) and Hispanic patients were 19% less likely to be prescribed a benzodiazepine (PR = 0.81; 95% CI = 0.68-0.96). Age, sex, or type of insurance did not show a statistically significant influence in the prescription of benzodiazepines. CONCLUSIONS These findings reveal that NH-Black and Hispanic patients with anxiety are significantly less likely to be prescribed benzodiazepines than their NH-White counterparts in the ED. Further studies are needed to determine the root causes of these health disparities and strategies to combat them.
Collapse
Affiliation(s)
- Jose Ribas Roca
- Baylor College of Medicine, One Baylor Plaza, MS: BCM 350, Houston, TX, 77030-3411, USA.
| | - Tara Everett
- Baylor College of Medicine, One Baylor Plaza, MS: BCM 350, Houston, TX, 77030-3411, USA
| | - Deepa Dongarwar
- Baylor College of Medicine, One Baylor Plaza, MS: BCM 350, Houston, TX, 77030-3411, USA
| | - Hamisu M Salihu
- Baylor College of Medicine, One Baylor Plaza, MS: BCM 350, Houston, TX, 77030-3411, USA
| |
Collapse
|
7
|
Moura LMVR, Yan Z, Donahue MA, Smith LH, Schwamm LH, Hsu J, Newhouse JP, Haneuse S, Blacker D, Hernandez-Diaz S. No short-term mortality from benzodiazepine use post-acute ischemic stroke after accounting for bias. J Clin Epidemiol 2023; 154:136-145. [PMID: 36572369 PMCID: PMC10033385 DOI: 10.1016/j.jclinepi.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Older adults receive benzodiazepines for agitation, anxiety, and insomnia after acute ischemic stroke (AIS). No trials have been conducted to determine if benzodiazepine use affects poststroke mortality in the elderly. METHODS We examined the association between initiating benzodiazepines within 1 week after AIS and 30-day mortality. We included patients ≥65 years, admitted for new nonsevere AIS (NIH-Stroke-Severity[NIHSS]≤ 20), 2014-2020, with no recorded benzodiazepine use in the previous 3 months and no contraindication for use. We linked a stroke registry to electronic health records, used inverse-probability weighting to address confounding, and estimated the risk difference (RD). A process of cloning, weighting, and censoring was used to avoid immortal time bias. RESULTS Among 2,584 patients, 389 received benzodiazepines. The crude 30-day mortality risk from treatment initiation was 212/1,000 among patients who received benzodiazepines, while the 30-day mortality was 34/1,000 among those who did not. When follow-up was aligned on day of AIS admission and immortal time was assigned to the two groups, the estimated risks were 27/1,000 and 22/1,000, respectively. Upon further adjustment for confounders, the RD was 5 (-12 to 19) deaths/1,000 patients. CONCLUSION The observed higher 30-day mortality associated with benzodiazepine initiation within 7 days was largely due to bias.
Collapse
Affiliation(s)
- Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
| | - Zhiyu Yan
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Maria A Donahue
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Louisa H Smith
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - John Hsu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Joseph P Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; National Bureau of Economic Research, Cambridge, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Kennedy School, Cambridge, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
What Is Known about Midazolam? A Bibliometric Approach of the Literature. Healthcare (Basel) 2022; 11:healthcare11010096. [PMID: 36611556 PMCID: PMC9819597 DOI: 10.3390/healthcare11010096] [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: 09/24/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/30/2022] Open
Abstract
Midazolam is a drug with actions towards the central nervous system producing sedative and anticonvulsants effects, used for sedation and seizures treatments. A better understanding about its effects in the different scenarios presented in the literature could be helpful to gather information regarding its clinical indications, pharmacological interactions, and adverse events. From this perspective, the aim of this study was to analyze the global research about midazolam mapping, specifically the knowledge of the 100 most-cited papers about this research field. For this, a search was executed on the Web of Science-Core Collection database using bibliometric methodological tools. The search strategy retrieved 34,799 articles. A total of 170 articles were evaluated, with 70 articles being excluded for not meeting the inclusion criteria. The 100 most-cited articles rendered 42,480 citations on WoS-CC, ranging from 253 to 1744. Non-systematic review was the most published study type, mainly from North America, during the period of 1992 to 2002. The most frequent keywords were midazolam and pharmacokinetics. Regarding the authors, Thummel and Kunze were the ones with the greatest number of papers included. Our findings showed the global research trends about midazolam, mainly related to its different effects and uses throughout the time.
Collapse
|
9
|
Zhu H, Li M, Pan B, Yang Q, Cao X, Wang Q, Chen Y, Ding G, Tian J, Ge L. A critical appraisal of clinical practice guidelines on insomnia using the RIGHT statement and AGREE II instrument. Sleep Med 2022; 100:244-253. [PMID: 36116294 DOI: 10.1016/j.sleep.2022.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Clinical Practice Guidelines (CPGs) have an indispensable role in guiding the selection of various treatments for insomnia, however, little is known about the quality of released insomnia CPGs. This study aims to critically appraise the quality of existing insomnia CPGs and identify quality limitations. METHODS PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang, China Biology Medicine disc, and 6 databases of international guideline developing institutions were systematically searched. CPGs on the diagnosis or treatment of insomnia were included. Reviewers independently extracted basic information and development methods, and assessed methodological quality and reporting quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and Reporting Items for practice Guidelines in Healthcare (RIGHT) checklist respectively. Intraclass correlation coefficients (ICCs) were used to measure the agreement among reviewers and assess inter-rater reliability. RESULTS Twenty-six CPGs were identified that focused on adults, children, or children with autistic spectrum disorder, patients in the intensive care unit, patients with cancer and pregnant, lactating or menopausal women. Twenty-two CPGs used nine grading systems to rate the level of evidence and strength of recommendation. 53.85% CPGs were classified as "recommended with modification" according to the AGREE II scores (ICC from 0.64 to 0.90), and 2 CPGs were "recommended". The "clarity of presentation" domain achieved the highest mean score (67.9% ± 11.04%) but the "applicability" domain (37.1% ± 12.67%) achieved the lowest. The average reporting rate of RIGHT items in all guidelines was 67.87%. CONCLUSIONS The quality of guidelines varied substantially. Guideline developers should realize the importance of guideline applicability, patients' preferences and values.
Collapse
Affiliation(s)
- Hongfei Zhu
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mengting Li
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Bei Pan
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qiuyu Yang
- Evidence Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiao Cao
- Evidence Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Chinese GRADE Centre, Lanzhou University, Lanzhou, China
| | - Guowu Ding
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.
| | - Jinhui Tian
- Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Long Ge
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Chinese GRADE Centre, Lanzhou University, Lanzhou, China.
| |
Collapse
|
10
|
Economou NT, Ferini-Strambi L, Steiropoulos P. Sleep-Related Drug Therapy in Special Conditions: Children. Sleep Med Clin 2022; 17:531-542. [PMID: 36150812 DOI: 10.1016/j.jsmc.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pharmacologic treatment of the most common pediatric sleep disorders lacks evidence, and alternative methods, which have been proved to alleviate the symptoms, are preferred in most cases. The implementation of specific guidelines is of great importance because sleep disorders in children are not rare and they can negatively affect children's development and their cognitive and social skills. This article summarizes the current therapeutic management of sleep disorders in children, bearing in mind the absence of evidence-based guidelines on this topic.
Collapse
Affiliation(s)
- Nicholas-Tiberio Economou
- Sleep Unit, Department of Psychiatry, University of Athens, 74 Vas Sofias Avenue, Athens 11528, Greece; Enypnion Sleep-Epilepsy Center, Bioclinic Hospital Athens, 15 M. Geroulanou Street, Athens 11524, Greece
| | - Luigi Ferini-Strambi
- Division of Neuroscience, University Vita-Salute San Raffaele, Via Stamira d'Ancona 20, Milan 20127, Italy
| | - Paschalis Steiropoulos
- Department of Pulmonology, Medical School, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis 68100, Greece.
| |
Collapse
|
11
|
Edinoff AN, Nix CA, Odisho AS, Babin CP, Derouen AG, Lutfallah SC, Cornett EM, Murnane KS, Kaye AM, Kaye AD. Novel Designer Benzodiazepines: Comprehensive Review of Evolving Clinical and Adverse Effects. Neurol Int 2022; 14:648-663. [PMID: 35997362 PMCID: PMC9397074 DOI: 10.3390/neurolint14030053] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/16/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
As tranquilizers, benzodiazepines have a wide range of clinical uses. Recently, there has been a significant rise in the number of novel psychoactive substances, including designer benzodiazepines. Flubromazolam(8-bromo-6-(2-fluorophenyl)-1-methyl-4H-[1,2,4]triazolo[4,3-a][1,4]benzodiazeZpine) is a triazolo-analogue of flubromazepam. The most common effects noted by recreational users include heavy hypnosis and sedation, long-lasting amnesia, and rapid development of tolerance. Other effects included anxiolysis, muscle-relaxing effects, euphoria, loss of control, and severe withdrawals. Clonazolam, or 6-(2-chlorophenyl)-1-methyl-8-nitro-4H-[1,2,4]triazolo[4,3-α]-[1,4]-benzodiazepine, is a triazolo-analog of clonazepam. It is reported to be over twice as potent as alprazolam. Deschloroetizolam (2-Ethyl-9-methyl-4-phenyl-6H-thieno[3,2-f][1,2,4]triazolo[4,3-a][1,4]diazepine) is part of the thienodiazepine drug class, which, like benzodiazepines, stimulates GABA-A receptors. Meclonazepam ((3S)-5-(2-chlorophenyl)-3-methyl-7-nitro-1,3-dihydro-1,4-benzodiazepin-2-one) is a designer benzodiazepine with additional anti-parasitic effects. Although it has proven to be an efficacious therapy for schistosomiasis, its sedative side effects have prevented it from being marketed as a therapeutic agent. The use of DBZs has been a subject of multiple recent clinical studies, likely related to increasing presence and availability on the internet drug market and lack of regulation. Many studies have aimed to identify the prevalence of DBZs and their effects on those using them. This review discussed these designer benzodiazepines and the dangers and adverse effects that the clinician should know.
Collapse
Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA 02114, USA
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
- Louisiana Addiction Research Center, Shreveport, LA 71103, USA
- Correspondence: ; Tel.: +1-(617)-726-2000
| | - Catherine A. Nix
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
- Louisiana Addiction Research Center, Shreveport, LA 71103, USA
| | - Amira S. Odisho
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Caroline P. Babin
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Alyssa G. Derouen
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Salim C. Lutfallah
- School of Medicine, Louisiana State University New Orleans, New Orleans, LA 70112, USA
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71103, USA
| | - Kevin S. Murnane
- Department of Psychiatry, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA 02114, USA
- Louisiana Addiction Research Center, Shreveport, LA 71103, USA
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, Department of Pharmacy Practice, University of the Pacific, Stockton, CA 95211, USA
| | - Alan D. Kaye
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71103, USA
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| |
Collapse
|
12
|
Flores-Pérez C, Alfonso Moreno-Rocha L, Luis Chávez-Pacheco J, Angélica Noguez-Méndez N, Flores-Pérez J, Fernanda Alcántara-Morales M, Cortés-Vásquez L, Sarmiento-Argüello L. Sedation level with midazolam: a pediatric surgery approach. Saudi Pharm J 2022; 30:906-917. [PMID: 35903521 PMCID: PMC9315275 DOI: 10.1016/j.jsps.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022] Open
Abstract
Midazolam (MDZ) is a short-acting benzodiazepine that is widely used to induce and maintain general anesthesia during diagnostic and therapeutic procedures in pediatric patients due to its sedative properties. The aim of this study was to perform a systematic review without a meta-analysis to identify scientific articles and clinical assays concerning MDZ-induced sedation for a pediatric surgery approach. One hundred and twenty-eight results were obtained. After critical reading, 37 articles were eliminated, yielding 91 publications. Additional items were identified, and the final review was performed with a total of 106 publications. In conclusion, to use MDZ accurately, individual patient characteristics, the base disease state, comorbidities, the treatment burden and other drugs with possible pharmacological interactions or adverse reactions must be considered to avoid direct alterations in the pharmacokinetics and pharmacodynamics of MDZ to obtain the desired effects and avoid overdosing in the pediatric population.
Collapse
|
13
|
Hirschbeck A, Leao DS, Wagner E, Hasan A, Roeh A. Psychiatric medication and physical performance parameters - Are there implications for treatment? Front Psychiatry 2022; 13:985983. [PMID: 36147967 PMCID: PMC9488519 DOI: 10.3389/fpsyt.2022.985983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The impact of psychiatric medications and their enhancing or impairing effects on physical performance remains inconclusive. Therefore, with this systematic review we provide a comprehensive overview of frequently used psychotropic drugs and their effects on physical performance for the purpose of providing empirical information and deriving prescription and therapy recommendations for clinical practice. METHODS We systematically searched PubMed, PsycInfo, and Cochrane databases and extracted human studies investigating the effect of psychotropic drugs on parameters associated with the level of physical performance, such as exercise time, oxygen consumption, heart rate, muscle contraction or blood lactate concentration in physically healthy participants. 36 studies - comprising a broad range of psychotropic agents, such as antidepressants, antipsychotics, sedatives, and stimulants - were selected for final analyses. RESULTS Most studies (N = 32) were randomized controlled trials (RCT) with a double-blind crossover design. Antidepressants (N = 21) were the most frequently studied drug class, with contradictory results e.g., performance enhancement in warm environment but not in temperate conditions for bupropion or inconsistent findings between studies for other antidepressants. Antipsychotics (N = 3) mainly showed impairing effects on physical performance, while stimulants (N = 4) were often performance-enhancing. Sedatives (N = 9) may cause a hangover effect. CONCLUSION The examined studies with heterogeneous design showed different effects of psychiatric medications on physical performance. Antipsychotics seemed to be performance impairing, while the findings for antidepressants and sedatives were more inconsistent. Stimulants were the only group with consistent performance-enhancing effects. However, most studies were conducted with a small sample size (N < 10), mostly in well-trained subjects rather than in patients with psychiatric disorders, and most studies used single-dose designs. These issues impede the formulation of generalized conclusions for treatment regimes and should therefore be considered in further longitudinal studies for clinically reliable statements. Nevertheless, answering our research question is quite relevant for clinical practice and therapeutic prescription and should be further investigated especially considering the high drop-out rates in drug treatment. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276103], identifier [CRD42021276103].
Collapse
Affiliation(s)
- Anna Hirschbeck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Douglas Silva Leao
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Astrid Roeh
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| |
Collapse
|
14
|
Further evidence on the interplay between benzodiazepine and Z-drug abuse and emotion dysregulation. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
15
|
Faßbender K, Bey K, Lippold JV, Aslan B, Hurlemann R, Ettinger U. GABAergic modulation of performance in response inhibition and interference control tasks. J Psychopharmacol 2021; 35:1496-1509. [PMID: 34278874 DOI: 10.1177/02698811211032440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inhibitory control is a crucial executive function with high relevance to mental and physical well-being. However, there are still unanswered questions regarding its neural mechanisms, including the role of the major inhibitory neurotransmitter, γ-aminobutyric acid (GABA). AIMS This study examined the effects of lorazepam (0.5 mg and 1 mg), a positive allosteric modulator at the GABAA receptor, on response inhibition and interference control. We also explored the heterogeneity of inhibitory control and calculated delta plots to explore whether lorazepam affects the gradual build-up of inhibition and activation over time. METHODS N = 50 healthy participants performed antisaccade, Eriksen flanker and Simon tasks in a within-subjects, placebo-controlled, double-blind randomized design. RESULTS Lorazepam increased reaction time (RT) and error rates dose dependently in all tasks (p ⩽ 0.005). In the antisaccade and Simon tasks, lorazepam increased congruency effects for error rate (p ⩽ 0.029) but not RT (p ⩾ 0.587). In the Eriksen flanker task, both congruency effects were increased by the drug (p ⩽ 0.031). Delta plots did not reflect drug-induced changes in inhibition and activation over time. Delta plots for RT in the Simon task were negative-going, as expected, whereas those for the antisaccade and flanker tasks were positive-going. CONCLUSIONS This study provides evidence for GABAergic involvement in performance on response inhibition and interference control tasks. Furthermore, our findings highlight the diversity of the broader construct of inhibitory control while also pointing out similarities between different inhibitory control tasks. In contrast to RT and error rates, the cognitive processes indexed by delta plots may not be sensitive to GABAergic modulation.
Collapse
Affiliation(s)
- Kaja Faßbender
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Behrem Aslan
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - René Hurlemann
- Department of Psychiatry, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | | |
Collapse
|
16
|
Edinoff AN, Nix CA, Hollier J, Sagrera CE, Delacroix BM, Abubakar T, Cornett EM, Kaye AM, Kaye AD. Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurol Int 2021; 13:594-607. [PMID: 34842811 PMCID: PMC8629021 DOI: 10.3390/neurolint13040059] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Benzodiazepines (BZDs) are among one of the most widely prescribed drug classes in the United States. BZDs are a class of psychoactive drugs known for their depressant effect on the central nervous system (CNS). They quickly diffuse through the blood-brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects. Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy. One of the debilitating side effects of BZDs is their addictive potential. The dependence on BZDs generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed. Regular use of BZDs has been shown to cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. Some of these withdrawal symptoms can be life threatening. The current treatment for withdrawal is through tapering with clonazepam. Many drugs have been tested as a treatment for withdrawal, with few proving efficacious in randomized control trials. Future research is warranted for further exploration into alternative methods of treating BZD withdrawal. This call to action proves especially relevant, as those seeking treatment for BZD dependence and withdrawal are on the rise in the United States.
Collapse
Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
- Correspondence: ; Tel.: +1-(318)-675-8969
| | - Catherine A. Nix
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
| | - Janice Hollier
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
| | - Caroline E. Sagrera
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Blake M. Delacroix
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Tunde Abubakar
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| |
Collapse
|
17
|
Liu Y, Su C, Zhang Y, Zhang D, Li Y, Gu J, Wang E, Sun D. High-throughput and trace analysis of diazepam in plasma using DART-MS/MS and its pharmacokinetic application. Anal Biochem 2021; 635:114435. [PMID: 34715069 DOI: 10.1016/j.ab.2021.114435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 01/27/2023]
Abstract
A high-throughput quantitative analytical method based on Direct Analysis in Real Time tandem mass spectrometry (DART-MS/MS) has been developed and validated for the determination of diazepam in rat plasma, whereby analyzing of each sample needs merely 25 μL plasma, simple solid phase extraction sample preparation and 15 s acquisition time. The multiple reaction monitoring (MRM) transitions at m/z 285.2 → 193.1 and 316.0 → 270.0 were selected for the monitoring of diazepam and its internal standard clonazepam respectively. A good linearity within the range of 10-2000 ng/mL, an intra- and inter-day precisions within <7.78% as to an accuracy ranging from 1.04% to 7.92% have been achieved. The method has been successfully applied to the pharmacokinetic study of diazepam in rats' plasma after a single intragastric administration at a dose of 10 mg/kg. The results indicate that this method fulfills the requirements of the bioanalysis in sensitivity and accuracy. It shows considerable promise for application of DART-MS to the quantitative investigation of other drugs.
Collapse
Affiliation(s)
- Yingze Liu
- School of Pharmaceutical Sciences, Jilin University, Changchun, 130012, PR China; Beijing Institute of Drug Metabolism, Beijing, 102209, PR China
| | - Chong Su
- Zhuhai United Laboratories co.,LTD, PR China
| | - Yuyao Zhang
- Research Center for Drug Metabolism, School of Life Sciences, Jilin University, Changchun, 130012, PR China
| | - Di Zhang
- Research Center for Drug Metabolism, School of Life Sciences, Jilin University, Changchun, 130012, PR China
| | - Yaoshuang Li
- Research Center for Drug Metabolism, School of Life Sciences, Jilin University, Changchun, 130012, PR China
| | - Jingkai Gu
- Research Center for Drug Metabolism, School of Life Sciences, Jilin University, Changchun, 130012, PR China; Beijing Institute of Drug Metabolism, Beijing, 102209, PR China
| | - Ensi Wang
- School of Pharmaceutical Sciences, Jilin University, Changchun, 130012, PR China
| | - Dong Sun
- Research Center for Drug Metabolism, School of Life Sciences, Jilin University, Changchun, 130012, PR China; Beijing Institute of Drug Metabolism, Beijing, 102209, PR China.
| |
Collapse
|
18
|
Clark AE, Goodwin SR, Marks RM, Belcher AM, Heinlein E, Bennett ME, Roche DJO. A Narrative Literature Review of the Epidemiology, Etiology, and Treatment of Co-Occurring Panic Disorder and Opioid Use Disorder. J Dual Diagn 2021; 17:313-332. [PMID: 34582313 PMCID: PMC9487392 DOI: 10.1080/15504263.2021.1965407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Panic disorder is a debilitating psychiatric disorder that often co-occurs with substance use disorders. Given the current opioid epidemic, the high reported rates of comorbid panic disorder and opioid use disorder are particularly concerning. In this narrative review, we describe the literature on panic disorder and opioid use disorder co-occurrence. METHODS 86 studies, 26 reviews, 2 commentaries, and 5 guidelines pertaining to opioid use disorder, panic disorder, and their comorbidity were identified using all EBSCO databases, PubMed, and Google Scholar. RESULTS First, we review epidemiological literature on the prevalence of the comorbid condition above and beyond each disorder on its own. Additionally, we discuss the challenges that complicate the differential diagnosis of panic disorder and opioid use disorder and contribute to difficulties establishing rates of comorbidity. Second, we review three theoretical models that have been proposed to explain high rates of co-occurring panic disorder and opioid use disorder: the precipitation hypothesis, the self-medication hypothesis, and the shared vulnerability hypothesis. Third, we outline how co-occurring panic and opioid use disorder may impact treatment for each condition. CONCLUSION Based on findings in the field, we provide recommendations for future research as well as treatment considerations for co-occurring panic and opioid use disorders.
Collapse
Affiliation(s)
- Ashton E Clark
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | - Shelby R Goodwin
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | | | | | - Emily Heinlein
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA.,Baltimore VA Medical Center, Baltimore, Maryland, USA
| | - Daniel J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| |
Collapse
|
19
|
Song SR, You TM. Minimal sedation using oral sedatives for multi-visit dental treatment in an adult patient with dental phobia. J Dent Anesth Pain Med 2021; 21:369-376. [PMID: 34395905 PMCID: PMC8349675 DOI: 10.17245/jdapm.2021.21.4.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
In adult patients with dental phobia, dental treatment may be difficult, or may not be possible. Depending on the level of fear or anxiety, non-pharmacological or pharmacological behavior management techniques are used in the dental treatment of such patients. Among the pharmacological behavior management techniques, minimal sedation, that is, the lowest depth of sedation, can be easily obtained in adult patients using oral sedatives, does not require special equipment or tools, and does not affect ventilatory and cardiovascular function. Diazepam is an anxiolytic drug belonging to the benzodiazepine family that, in addition to relieving anxiety, produces muscle relaxation, and is a representative drug used in adult patients with fear of dental treatment. Herein, we report the case of a 50-year-old woman with severe dental fear who successfully underwent long-term dental treatment in approximately 20 visits with minimal sedation using oral diazepam. In addition, we reviewed the considerations for the use of benzodiazepines for minimal sedation.
Collapse
Affiliation(s)
- Seung-Rye Song
- Department of Advanced General Dentistry, Dankook University College of Dentistry, Cheonan, Korea
| | - Tae Min You
- Department of Advanced General Dentistry, Dankook University College of Dentistry, Cheonan, Korea
| |
Collapse
|
20
|
Tiwari R, Tam DNH, Shah J, Moriyama M, Varney J, Huy NT. Effects of sleep intervention on glucose control: A narrative review of clinical evidence. Prim Care Diabetes 2021; 15:635-641. [PMID: 33849816 DOI: 10.1016/j.pcd.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/21/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Optimizing sleep has been recently gained exposure as a promising lifestyle consideration to aid in the control of diabetes. The evidence to support the impact of sleep quantity and quality on blood glucose control is largely acknowledged. This study aimed to review all published randomized controlled trials (RCTs) investigating the relationship between sleep and glucose control to synthesize an accurate overview. METHOD Literature from PubMed and Google Scholar was searched using the listed search terms to obtain RCTs on the role of sleep in glucose homeostasis. Seven RCTs were eligible and included in our review. References in these RCTs were screened for the presentation of the pathophysiology of metabolic disturbances relating to the sleep duration, and the relevant factors affecting blood glucose concentration. RESULTS Sleep deprivation and poor sleep quality are connected with blood glucose disturbance and reduction of insulin sensitivity. This leaves diabetic patients at an increased risk of glucose level fluctuations. However, the function of β-cells was likely to be conserved after 14-days of sleep deprivation. Sleep extension from 7 to 14 days improved blood glucose control and insulin sensitivity in both healthy and diabetes participants. Diabetes sleep education and personalized interventions that reduced stress and improved sleep quality contributed to glucose homeostasis in diabetic patients. Overall improving one's sleep hygiene was found to improve glucose control in diabetic patients. CONCLUSION Longer or short-term sleep deprivation may negatively affect glucose homeostasis, although the body temporarily compensates for the impaired function of β-cells when reduced sleep lasted up to 14 days. Thus, we recommend optimum sleep duration and optimistic sleep duration and sleep quality for decreasing risk and progression of diabetes.
Collapse
Affiliation(s)
- Ranjit Tiwari
- Faculty of Medicine, Institute of Medicine, Tribhuvan University, Kathmandu, 44600, Nepal; Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan.
| | - Dao Ngoc Hien Tam
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Asia Shine Trading & Service CO., LTD, Ho Chi Minh City, Viet Nam.
| | - Jaffer Shah
- Drexel University College of Medicine, Philadelphia, PA, USA.
| | - Michiko Moriyama
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima 734-8553, Japan.
| | - Joseph Varney
- American University of the Caribbean, School of Medicine, St Maarten, SXM.
| | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang 550000, Viet Nam; School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.
| |
Collapse
|
21
|
Vinckenbosch FRJ, Vermeeren A, Vuurman EFPM, van der Sluiszen NNJJM, Verster JC, van de Loo AJ, van Dijken JH, Veldstra JL, Brookhuis KA, De Waard D, Ramaekers JG. An explorative approach to understanding individual differences in driving performance and neurocognition in long-term benzodiazepine users. Hum Psychopharmacol 2021; 36:e2778. [PMID: 33547849 PMCID: PMC8365705 DOI: 10.1002/hup.2778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/03/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Previous research reported cognitive and psychomotor impairments in long-term users of benzodiazepine receptor agonists (BZRAs). This article explores the role of acute intoxication and clinical complaints. METHODS Neurocognitive and on-road driving performance of 19 long-term (≥6 months) regular (≥twice weekly) BZRA users with estimated plasma concentrations, based on self-reported use, exceeding the therapeutic threshold (CBZRA +), and 31 long-term regular BZRA users below (CBZRA -), was compared to that of 76 controls. RESULTS BZRA users performed worse on tasks of response speed, processing speed, and sustained attention. Age, but not CBZRA or self-reported clinical complaints, was a significant covariate. Road-tracking performance was explained by CBZRA only. The CBZRA + group exhibited increased mean standard deviation of lateral position comparable to that at blood-alcohol concentrations of 0.5 g/L. CONCLUSIONS Functional impairments in long-term BZRA users are not attributable to self-reported clinical complaints or estimated BZRA concentrations, except for road-tracking, which was impaired in CBZRA + users. Limitations to address are the lack of assessment of objective clinical complaints, acute task related stress, and actual BZRA plasma concentrations. In conclusion, the results confirm previous findings that demonstrate inferior performance across several psychomotor and neurocognitive domains in long-term BZRA users.
Collapse
Affiliation(s)
| | - Annemiek Vermeeren
- Department of Neuropsychology and PsychopharmacologyMaastricht UniversityMaastrichtThe Netherlands
| | - Eric F. P. M. Vuurman
- Department of Neuropsychology and PsychopharmacologyMaastricht UniversityMaastrichtThe Netherlands
| | | | - Joris C. Verster
- Division PharmacologyUtrecht UniversityUtrechtThe Netherlands,Institute for Risk Assessment SciencesUtrecht UniversityUtrechtThe Netherlands,Centre for Human PsychopharmacologySwinburne UniversityMelbourne, VictoriaAustralia
| | - Aurora J.A.E. van de Loo
- Division PharmacologyUtrecht UniversityUtrechtThe Netherlands,Institute for Risk Assessment SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Joke H. van Dijken
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Janet L. Veldstra
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Karel A. Brookhuis
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Dick De Waard
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Johannes G. Ramaekers
- Department of Neuropsychology and PsychopharmacologyMaastricht UniversityMaastrichtThe Netherlands
| |
Collapse
|
22
|
Joglekar NN, Patel Y, Keller MS. Evaluation of Clinical Decision Support to Reduce Sedative-Hypnotic Prescribing in Older Adults. Appl Clin Inform 2021; 12:436-444. [PMID: 34107541 PMCID: PMC8189759 DOI: 10.1055/s-0041-1730030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE We sought to characterize the performance of inpatient and outpatient computerized clinical decision support (CDS) alerts aimed at reducing inappropriate benzodiazepine and nonbenzodiazepine sedative medication prescribing in older adults 18 months after implementation. METHODS We reviewed the performance of two CDS alerts in the outpatient and inpatient settings in 2019. To examine the alerts' effectiveness, we analyzed metrics including overall alert adherence, provider-level adherence, and reasons for alert trigger and override. RESULTS In 2019, we identified a total of 14,534 and 4,834 alerts triggered in the outpatient and inpatient settings, respectively. Providers followed only 1% of outpatient and 3% of inpatient alerts. Most alerts were ignored (68% outpatient and 60% inpatient), while providers selected to override the remaining alerts. In each setting, the top 2% of clinicians were responsible for approximately 25% of all ignored or overridden alerts. However, a small proportion of clinicians (2% outpatient and 4% inpatient) followed the alert at least half of the time and accounted for a disproportionally large fraction of the total followed alerts. Our analysis of the free-text comments revealed that many alerts were to continue outpatient prescriptions or for situational anxiety. CONCLUSION Our findings highlight the importance of evaluation of CDS performance after implementation. We found large variation in response to the inpatient and outpatient alerts, both with respect to follow and ignore rates. Reevaluating the alert design by providing decision support by indication may be more helpful and may reduce alert fatigue.
Collapse
Affiliation(s)
- Natasha N. Joglekar
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Boston, Massachusetts, United Sates
| | - Yatindra Patel
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United Sates
| | - Michelle S. Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United Sates,Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, United Sates,Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California, United Sates,Address for correspondence Michelle S. Keller, PhD, MPH Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical CenterLos Angeles, CA 90048United Sates
| |
Collapse
|
23
|
Oh TK, Song IA. Five-year mortality trends associated with sleep disorders in South Korea: a population-based cohort study. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Skryabin VY, Zastrozhin MS, Grishina EA, Ryzhikova KA, Shipitsyn VV, V Barna I, Galaktionova TE, Ivanov AV, Sorokin AS, Bryun EA, Sychev DA. Using the CYP3A Activity Evaluation to Predict the Efficacy and Safety of Diazepam in Patients With Alcohol Withdrawal Syndrome. J Pharm Pract 2021; 35:518-523. [PMID: 33622083 DOI: 10.1177/0897190021997000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diazepam is one of the most commonly prescribed tranquilizers for the therapy of alcohol withdrawal syndrome (AWS). Despite its popularity, there is currently no precise information on the effect of genetic polymorphisms on the efficacy and safety of diazepam therapy. OBJECTIVE The objective of our study was to study the effect of CYP3A isoenzymes activity on the efficacy and safety of diazepam in patients with AWS. METHODS The study was conducted on 30 Russian male patients suffering from the AWS who received diazepam in injections at a dosage of 30.0 mg / day for 5 days. The efficacy and safety assessment was performed using psychometric scales and scales for assessing the severity of adverse drug reactions. RESULTS Based on the results of the study, we revealed the differences in the efficacy of therapy in patients with different CYP3A4 C>T intron 6 (rs35599367) genotypes: (CC) -9.0 [-13.0; -5.0], (CT+TT) -13.5 [-15.0; -10.0], p = 0.014. The scores on the UKU scale, which was used to evaluate the safety of therapy, were also different: (CC) 7.5 [6.0; 11.0], (CT+TT) 11.0 [8.0; 12.0], p = 0.003. CONCLUSION Possible relationship between the CYP3A activity, evaluated by the content of the urinary endogenous substrate of the given isoenzyme and its metabolite, the 6-beta-hydroxy cortisol (6-β-HC) / cortisol ratio, and the efficacy of diazepam was demonstrated. This possible relationship was also supported by the genotyping results. This should be taken into consideration when prescribing this drug to such patients in order to reduce the risk of pharmacoresistance.
Collapse
Affiliation(s)
- Valentin Yu Skryabin
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - Mikhail S Zastrozhin
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Elena A Grishina
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Kristina A Ryzhikova
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Valery V Shipitsyn
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - Ilya V Barna
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - Tatiana E Galaktionova
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - Andrey V Ivanov
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - Alexander S Sorokin
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - Evgeny A Bryun
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Dmitry A Sychev
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia
| |
Collapse
|
25
|
Richardson K, Savva GM, Boyd PJ, Aldus C, Maidment I, Pakpahan E, Loke YK, Arthur A, Steel N, Ballard C, Howard R, Fox C. Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies. Health Technol Assess 2021; 25:1-202. [PMID: 33410736 PMCID: PMC7812417 DOI: 10.3310/hta25010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sleep disturbance affects around 60% of people living with dementia and can negatively affect their quality of life and that of their carers. Hypnotic Z-drugs (zolpidem, zopiclone and zaleplon) are commonly used to treat insomnia, but their safety and efficacy have not been evaluated for people living with dementia. OBJECTIVES To estimate the benefits and harms of Z-drugs in people living with dementia with sleep disturbance. DESIGN A series of observational cohort studies using existing data from (1) primary care linked to hospital admission data and (2) clinical cohort studies of people living with dementia. DATA SOURCES Primary care study - Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality data. Clinical cohort studies - the Resource Use and Disease Course in Dementia - Nursing Homes (REDIC) study, National Alzheimer's Coordinating Centre (NACC) clinical data set and the Improving Well-being and Health for People with Dementia (WHELD) in nursing homes randomised controlled trial. SETTING Primary care study - 371 primary care practices in England. Clinical cohort studies - 47 nursing homes in Norway, 34 Alzheimer's disease centres in the USA and 69 care homes in England. PARTICIPANTS Primary care study - NHS England primary care patients diagnosed with dementia and aged > 55 years, with sleep disturbance or prescribed Z-drugs or low-dose tricyclic antidepressants, followed over 2 years. Clinical cohort studies - people living with dementia consenting to participate, followed over 3 years, 12 years and 9 months, for REDIC, NACC and WHELD, respectively. INTERVENTIONS The primary exposure was prescription or use of Z-drugs. Secondary exposures included prescription or use of benzodiazepines, low-dose tricyclic antidepressants and antipsychotics. MAIN OUTCOME MEASURES Falls, fractures, infection, stroke, venous thromboembolism, mortality, cognitive function and quality of life. There were insufficient data to investigate sleep disturbance. RESULTS The primary care study and combined clinical cohort studies included 6809 and 18,659 people living with dementia, with 3089 and 914 taking Z-drugs, respectively. New Z-drug use was associated with a greater risk of fractures (hazard ratio 1.40, 95% confidence interval 1.01 to 1.94), with risk increasing with greater cumulative dose (p = 0.002). The hazard ratio for Z-drug use and hip fracture was 1.59 (95% confidence interval 1.00 to 2.53) and for mortality was 1.34 (95% confidence interval 1.10 to 1.64). No excess risks of falls, infections, stroke or venous thromboembolism were detected. Z-drug use also did not have an impact on cognition, neuropsychiatric symptoms, disability or quality of life. LIMITATIONS Primary care study - possible residual confounding because of difficulties in identifying patients with sleep disturbance and by dementia severity. Clinical cohort studies - the small numbers of people living with dementia taking Z-drugs and outcomes not necessarily being measured before Z-drug initiation restricted analyses. CONCLUSIONS We observed a dose-dependent increase in fracture risk, but no other harms, with Z-drug use in dementia. However, multiple outcomes were examined, increasing the risk of false-positive findings. The mortality association was unlikely to be causal. Further research is needed to confirm the increased fracture risk. Decisions to prescribe Z-drugs may need to consider the risk of fractures, balanced against the impact of improved sleep for people living with dementia and that of their carers. Our findings suggest that when Z-drugs are prescribed, falls prevention strategies may be needed, and that the prescription should be regularly reviewed. FUTURE WORK More research is needed on safe and effective management strategies for sleep disturbance in people living with dementia. STUDY REGISTRATION This study is registered as European Union electronic Register of Post-Authorisation Studies (EU PAS) 18006. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 1. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
- Quadram Institute, Norwich, UK
| | - Penelope J Boyd
- School of Health Sciences, University of East Anglia, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Clare Aldus
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Eduwin Pakpahan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
26
|
Madsen BK, Zetner D, Møller AM, Rosenberg J. Melatonin for preoperative and postoperative anxiety in adults. Cochrane Database Syst Rev 2020; 12:CD009861. [PMID: 33319916 PMCID: PMC8092422 DOI: 10.1002/14651858.cd009861.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety in relation to surgery is a well-known problem. Melatonin offers an alternative treatment to benzodiazepines for ameliorating this condition in the preoperative and postoperative periods. OBJECTIVES To assess the effects of melatonin on preoperative and postoperative anxiety compared to placebo or benzodiazepines. SEARCH METHODS We searched the following databases on 10 July 2020: CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science. For ongoing trials and protocols, we searched clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomized, placebo-controlled or standard treatment-controlled (or both) studies that evaluated the effects of preoperatively administered melatonin on preoperative or postoperative anxiety. We included adult patients of both sexes (15 to 90 years of age) undergoing any kind of surgical procedure for which it was necessary to use general, regional, or topical anaesthesia. DATA COLLECTION AND ANALYSIS One review author conducted data extraction in duplicate. Data extracted included information about study design, country of origin, number of participants and demographic details, type of surgery, type of anaesthesia, intervention and dosing regimens, preoperative anxiety outcome measures, and postoperative anxiety outcome measures. MAIN RESULTS We included 27 randomized controlled trials (RCTs), involving 2319 participants, that assessed melatonin for treating preoperative anxiety, postoperative anxiety, or both. Twenty-four studies compared melatonin with placebo. Eleven studies compared melatonin to a benzodiazepine (seven studies with midazolam, three studies with alprazolam, and one study with oxazepam). Other comparators in a small number of studies were gabapentin, clonidine, and pregabalin. No studies were judged to be at low risk of bias for all domains. Most studies were judged to be at unclear risk of bias overall. Eight studies were judged to be at high risk of bias in one or more domain, and thus, to be at high risk of bias overall. Melatonin versus placebo Melatonin probably results in a reduction in preoperative anxiety measured by a visual analogue scale (VAS, 0 to 100 mm) compared to placebo (mean difference (MD) -11.69, 95% confidence interval (CI) -13.80 to -9.59; 18 studies, 1264 participants; moderate-certainty evidence), based on a meta-analysis of 18 studies. Melatonin may reduce immediate postoperative anxiety measured on a 0 to 100 mm VAS compared to placebo (MD -5.04, 95% CI -9.52 to -0.55; 7 studies, 524 participants; low-certainty evidence), and may reduce delayed postoperative anxiety measured six hours after surgery using the State-Trait Anxiety Inventory (STAI) (MD -5.31, 95% CI -8.78 to -1.84; 2 studies; 73 participants; low-certainty evidence). Melatonin versus benzodiazepines (midazolam and alprazolam) Melatonin probably results in little or no difference in preoperative anxiety measured on a 0 to 100 mm VAS (MD 0.78, 95% CI -2.02 to 3.58; 7 studies, 409 participants; moderate-certainty evidence) and there may be little or no difference in immediate postoperative anxiety (MD -2.12, 95% CI -4.61 to 0.36; 3 studies, 176 participants; low-certainty evidence). Adverse events Fourteen studies did not report on adverse events. Six studies specifically reported that no side effects were observed, and the remaining seven studies reported cases of nausea, sleepiness, dizziness, and headache; however, no serious adverse events were reported. Eleven studies measured psychomotor and cognitive function, or both, and in general, these studies found that benzodiazepines impaired psychomotor and cognitive function more than placebo and melatonin. Fourteen studies evaluated sedation and generally found that benzodiazepine caused the highest degree of sedation, but melatonin also showed sedative properties compared to placebo. Several studies did not report on adverse events; therefore, it is not possible to conclude with certainty, from the data on adverse effects collected in this review, that melatonin is better tolerated than benzodiazepines. AUTHORS' CONCLUSIONS When compared with placebo, melatonin given as premedication (as tablets or sublingually) probably reduces preoperative anxiety in adults (measured 50 to 120 minutes after administration), which is potentially clinically relevant. The effect of melatonin on postoperative anxiety compared to placebo (measured in the recovery room and six hours after surgery) was also evident but was much smaller, and the clinical relevance of this finding is uncertain. There was little or no difference in anxiety when melatonin was compared with benzodiazepines. Thus, melatonin may have a similar effect to benzodiazepines in reducing preoperative and postoperative anxiety in adults.
Collapse
Affiliation(s)
- Bennedikte K Madsen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Dennis Zetner
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Ann Merete Møller
- Cochrane Anaesthesia, Critical and Emergency Care Group, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
- Cochrane Colorectal Group, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| |
Collapse
|
27
|
Richardson K, Loke YK, Fox C, Maidment I, Howard R, Steel N, Arthur A, Boyd PJ, Aldus C, Ballard C, Savva GM. Adverse effects of Z-drugs for sleep disturbance in people living with dementia: a population-based cohort study. BMC Med 2020; 18:351. [PMID: 33228664 PMCID: PMC7683259 DOI: 10.1186/s12916-020-01821-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/20/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sleep disturbance is common in dementia and often treated with Z-drugs (zopiclone, zaleplon, and zolpidem). While some observational studies suggest that Z-drugs are associated with adverse events such as falls and fracture risks in older people, this has not been studied in dementia. METHODS We used data from 27,090 patients diagnosed with dementia between January 2000 and March 2016 from the Clinical Practice Research Datalink linked to Hospital Episodes Statistics data in England. We compared adverse events for 3532 patients newly prescribed Z-drugs by time-varying dosage to (1) 1833 non-sedative-users with sleep disturbance; (2) 10,214 non-sedative-users with proximal GP consultation matched on age, sex, and antipsychotic use; and (3) 5172 patients newly prescribed benzodiazepines. We defined higher dose Z-drugs and benzodiazepines as prescriptions equivalent to ≥ 7.5 mg zopiclone or > 5 mg diazepam daily. Cox regression was used to estimate hazard ratios (HRs) for incident fracture, hip fracture, fall, mortality, acute bacterial infection, ischaemic stroke/transient ischaemic attack, and venous thromboembolism over a 2-year follow-up, adjusted for demographic- and health-related covariates. RESULTS The mean (SD) age of patients was 83 (7.7) years, and 16,802 (62%) were women. Of 3532 patients prescribed Z-drugs, 584 (17%) were initiated at higher doses. For patients prescribed higher dose Z-drugs relative to non-users with sleep disturbance, the HRs (95% confidence interval) for fractures, hip fractures, falls, and ischaemic stroke were 1.67 (1.13-2.46), 1.96 (1.16-3.31), 1.33 (1.06-1.66), and 1.88 (1.14-3.10), respectively. We observed similar associations when compared to non-sedative-users with proximal GP consultation. Minimal or inconsistent excess risks were observed at ≤ 3.75 mg zopiclone or equivalent daily, and for mortality, infection, and venous thromboembolism. We observed no differences in adverse events for Z-drugs compared to benzodiazepines, except lower mortality rates with Z-drugs (HR [95% confidence interval] of 0.73 [0.64-0.83]). CONCLUSIONS Higher dose Z-drug use in dementia is associated with increased fracture and stroke risks, similar or greater to that for higher dose benzodiazepines. Higher dose Z-drugs should be avoided, if possible, in people living with dementia, and non-pharmacological alternatives preferentially considered. Prescriptions for higher dose Z-drugs in dementia should be regularly reviewed. TRIAL REGISTRATION ENCePP e-register of studies, EUPAS18006.
Collapse
Affiliation(s)
- Kathryn Richardson
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Robert Howard
- Division of Psychiatry, UCL Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Penelope J Boyd
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Clare Aldus
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Clive Ballard
- Medical School, University of Exeter, Exeter, EX1 2LU, UK
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.,Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UQ, UK
| |
Collapse
|
28
|
Vicente B, Saldivia S, Hormazabal N, Bustos C, Rubí P. Etifoxine is non-inferior than clonazepam for reduction of anxiety symptoms in the treatment of anxiety disorders: a randomized, double blind, non-inferiority trial. Psychopharmacology (Berl) 2020; 237:3357-3367. [PMID: 33009629 DOI: 10.1007/s00213-020-05617-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/21/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine whether etifoxine, a non-benzodiazepine drug of the benzoxazine family, is non-inferior compared with clonazepam in the treatment of anxiety disorders. METHOD A randomized controlled double blind trial with parallel groups was conducted. A total of 179 volunteer patients with a diagnosis of anxiety disorder (DSM-IV), between 18 and 64 years of age, participated in this study. The experimental group received 150 mg/day of etifoxine and the control 1 mg/day of clonazepam, both in three daily doses for 12 weeks. This treatment was completed by 87 participants, and 70 were available for follow-up at 24 weeks from start of treatment. The primary objective was a non-inferiority comparison between etifoxine and clonazepam in the decrease of anxiety symptoms (HAM-A) at 12 weeks of treatment. Secondary outcomes included the evaluation of medication side effects (UKU), anxiety symptoms at 24 weeks of treatment, and clinical improvement (CGI). Data analysis included multiple imputation of missing data. The effect of etifoxine on the HAM-A, UKU, and CGI was evaluated with the intention of treatment, and a sensitivity analysis of the results was conducted. Non-inferiority would be declared by a standardized mean difference (SMD) between clonazepam and etifoxine not superior to 0.31 in favour of clonazepam. RESULTS Using imputed data, etifoxine shows non-inferiority to clonazepam on the reduction of anxiety symptoms at the 12-week (SMD = 0.407; 95% CI, 0.069, 0.746) and 24-week follow-ups (SMD = 0.484; 95% CI, 0.163, 0.806) and presented fewer side effects (SMD = 0.58; 95% CI, 0.287, 0.889). LOCF analysis shows that etifoxine is non-inferior to clonazepam on reduction of anxiety symptoms and adverse symptoms even when no change was assigned as result to participant whom withdrew. Non-inferiority could be declared for clinical improvement (SMD = 0.326; 95% CI, - 0.20, 0.858). CONCLUSION Etifoxine was non-inferior to clonazepam on reduction of anxiety symptoms, adverse effects, and clinical improvement.
Collapse
Affiliation(s)
- Benjamín Vicente
- Department of Psychiatry and Mental Health, Universidad de Concepción, Av. Juan Bosco s/n, Casilla 160-C, Concepción, Chile.
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Universidad de Concepción, Av. Juan Bosco s/n, Casilla 160-C, Concepción, Chile
| | | | - Claudio Bustos
- Department of Psychiatry and Mental Health, Universidad de Concepción, Av. Juan Bosco s/n, Casilla 160-C, Concepción, Chile
| | - Patricia Rubí
- Department of Psychiatry and Mental Health, Universidad de Concepción, Av. Juan Bosco s/n, Casilla 160-C, Concepción, Chile
| |
Collapse
|
29
|
Lghoul-Oulad Saïd F, Hek K, Flinterman LE, Herings RM, Warlé-van Herwaarden MF, de Bie S, Valkhoff VE, Alsma J, Mosseveld M, Vanrolleghem AM, Stricker BH, Sturkenboom MC, De Smet PA, van den Bemt PM. Prevalence and incidence rate of hospital admissions related to medication between 2008 and 2013 in The Netherlands. Pharmacoepidemiol Drug Saf 2020; 29:1659-1668. [PMID: 33051958 PMCID: PMC7756305 DOI: 10.1002/pds.5122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/27/2020] [Accepted: 08/27/2020] [Indexed: 11/08/2022]
Abstract
Purpose In 2009 a Dutch guideline was published containing recommendations to reduce Hospital Admissions Related to Medications (HARMs). This study aims to examine time‐trends of HARMs and their potential preventability between 2008 and 2013 in The Netherlands. Methods A retrospective prevalence study was conducted using the Dutch PHARMO Database Network. A semi‐automated pre‐selection was used to make a crude identification of possible HARMs of which four samples were selected. These were independently assessed with respect to causality and potential preventability by a physician and pharmacist. The results were stratified by age into 18‐64 years and 65 years and older. For these groups the net prevalences and incidence rates of HARMs and potentially preventable HARMs were calculated for the years 2008, 2009, 2011 and 2013. Results Four samples of 467 (2008), 447 (2009), 446 (2011) and 408 (2013) admissions were assessed. The net prevalence of HARMs in the 18‐64 years group was approximately four times smaller compared to the older group with a mean prevalence of 2.7% (95% confidence interval [CI]:2.4%‐3.0%) and 10.2% (95%CI: 9.7%‐10.7%) respectively. The potential preventability was 25.1% (18.4%‐31.8%) and 48.3% (95%CI: 44.8%‐51.8%), respectively. The prevalence of HARMs in both groups did not change significantly between 2008 and 2013 with 2.4% (95%CI: 1.9%‐3.0%) and 10.0% (95%CI: 9.0%‐11.0%) in 2008 and 3.1% (2.7%‐3.5%) and 10.4% (95%CI: 9.4%‐11.4%) in 2013, respectively. Conclusion Despite efforts to reduce HARMs, the prevalence did not decrease over time. Additional measures are therefore necessary, especially in the elderly population.
Collapse
Affiliation(s)
- Fouzia Lghoul-Oulad Saïd
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Gorlaeus Laboratories, Leiden University, Leiden, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Hek
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Linda E Flinterman
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Ron Mc Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | - Sandra de Bie
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vera E Valkhoff
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jelmer Alsma
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mees Mosseveld
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ann M Vanrolleghem
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruno Hch Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Peter Agm De Smet
- Departments of IQ healthcare and of clinical pharmacy, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Patricia Mla van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
30
|
Ietswaart R, Arat S, Chen AX, Farahmand S, Kim B, DuMouchel W, Armstrong D, Fekete A, Sutherland JJ, Urban L. Machine learning guided association of adverse drug reactions with in vitro target-based pharmacology. EBioMedicine 2020; 57:102837. [PMID: 32565027 PMCID: PMC7379147 DOI: 10.1016/j.ebiom.2020.102837] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are one of the leading causes of morbidity and mortality in health care. Understanding which drug targets are linked to ADRs can lead to the development of safer medicines. METHODS Here, we analyse in vitro secondary pharmacology of common (off) targets for 2134 marketed drugs. To associate these drugs with human ADRs, we utilized FDA Adverse Event Reports and developed random forest models that predict ADR occurrences from in vitro pharmacological profiles. FINDINGS By evaluating Gini importance scores of model features, we identify 221 target-ADR associations, which co-occur in PubMed abstracts to a greater extent than expected by chance. Amongst these are established relations, such as the association of in vitro hERG binding with cardiac arrhythmias, which further validate our machine learning approach. Evidence on bile acid metabolism supports our identification of associations between the Bile Salt Export Pump and renal, thyroid, lipid metabolism, respiratory tract and central nervous system disorders. Unexpectedly, our model suggests PDE3 is associated with 40 ADRs. INTERPRETATION These associations provide a comprehensive resource to support drug development and human biology studies. FUNDING This study was not supported by any formal funding bodies.
Collapse
Affiliation(s)
- Robert Ietswaart
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, United States.
| | - Seda Arat
- The Jackson Laboratory, Farmington, CT 06032, United States.
| | - Amanda X Chen
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02142, United States; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Saman Farahmand
- Computational Sciences PhD program, University of Massachusetts Boston, Boston, MA 02125, United States
| | - Bumjun Kim
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, United States
| | | | - Duncan Armstrong
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, United States
| | - Alexander Fekete
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, United States
| | - Jeffrey J Sutherland
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, United States.
| | - Laszlo Urban
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, United States.
| |
Collapse
|
31
|
Prescription patterns of benzodiazepine and benzodiazepine-related drugs in the peripartum period: A population-based study. Psychiatry Res 2020; 288:112993. [PMID: 32334277 DOI: 10.1016/j.psychres.2020.112993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022]
Abstract
Using prescription drugs during pregnancy is challenging and approached with caution. In this study, we present population-based information on prescription patterns of benzodiazepines and benzodiazepine-related drugs in the peripartum period. A population-based study of 1,154,817 pregnancies between 1997 and 2015 in Denmark, of which 205,406 (17.8%) pregnancies in women with a psychiatric history. Prescription drugs starting with Anatomical Therapeutic Chemical codes N05BA, N05CD, and N05CF from 12 months before pregnancy to 12 months following pregnancy were identified. We used generalised estimating equations to estimate the adjusted 5 year risk difference in the proportion of women redeeming benzodiazepines from 1 year to 5 years after. Logistic regression was used to analyze the association between characteristics and discontinuation of benzodiazepines during pregnancy. The prevalence of benzodiazepine prescriptions was 1.9% before pregnancy, 0.6% during pregnancy, and 1.3% after pregnancy. In women with a psychiatric history, the prevalence was 5-6 times higher. A significant decrease in prescriptions to women with a psychiatric history was observed, which was less profound among women with no psychiatric history. Approximately 90% of women discontinue benzodiazepines during pregnancy, with a higher percentage of women discontinuing from 1997 to 2015. The observed decrease is likely explained by changing treatment guidelines.
Collapse
|
32
|
Abstract
After participating in this activity, learners should be better able to:• Assess the misuse potential of clonazepam• Characterize the nonmedical use of clonazepam• Identify the health problems associated with long-term use of clonazepam ABSTRACT: Clonazepam, a benzodiazepine, is commonly used in treating various conditions, including anxiety disorders and epileptic seizures. Due to its low price and easy availability, however, it has become a commonly misused medication, both in medical and recreational contexts. In this review, we aim to highlight the behavioral and pharmacological aspects of clonazepam and its history following its approval for human use. We examine the circumstances commonly associated with the nonmedical use of clonazepam and raise points of particular concern. Clonazepam, alone or in combination with other psychoactive substances, can lead to unwanted effects on health, such as motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders. Prolonged use of clonazepam may lead to physical dependence and tolerance. There is therefore a need to find safer therapeutic alternatives for treating seizures and anxiety disorders. Greater awareness of its frequent nonmedical use is also needed to achieve safer overall use of this medication.
Collapse
|
33
|
Bais B, Molenaar NM, Bijma HH, Hoogendijk WJG, Mulder CL, Luik AI, Lambregtse-van den Berg MP, Kamperman AM. Prevalence of benzodiazepines and benzodiazepine-related drugs exposure before, during and after pregnancy: A systematic review and meta-analysis. J Affect Disord 2020; 269:18-27. [PMID: 32217339 DOI: 10.1016/j.jad.2020.03.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Maternal use of benzodiazepines during pregnancy is common and has increased over the last decades. In this systematic review and meta-analysis, we studied the literature to estimate the worldwide use of benzodiazepines before, during and after pregnancy, which could help to estimate benzodiazepine exposure and to prioritize and guide future investigations. METHODS We systematically searched Embase, Medline Ovid, Web of Science and Cochrane Central up until July 2019 for studies reporting on benzodiazepine use before (12 months), during and after pregnancy (12 months). Random effects meta-analysis was conducted to calculate pooled prevalence estimates, as well as stratified according to substantive variables. RESULTS We identified 32 studies reporting on 28 countries, together reporting on 7,343,571 pregnancies. The worldwide prevalence of benzodiazepine use/prescriptions during pregnancy was 1.9% (95%CI 1.6%-2.2%; I2 97.48%). Highest prevalence was found in the third trimester (3.1%; 95%CI 1.8%-4.5%; I2 99.83%). Lorazepam was the most frequently used/prescribed benzodiazepine (1.5%; 95%CI 0.5%-2.5%; I2 99.87%). Highest prevalence was found in Eastern Europe (14.0%; 95%CI 12.1%-15.9%; I2 0.00%). LIMITATIONS All analyses revealed considerable heterogeneity. CONCLUSIONS Our meta-analysis confirmed that benzodiazepine use before, during and after pregnancy is prevalent. The relatively common use of benzodiazepines with possible risks for both mother and (unborn) child is worrying and calls for prescription guidelines for women, starting in the preconception period. Given the substantial proportion of children exposed to benzodiazepines in utero, future research should continue to study the short- and long-term safety of maternal benzodiazepine use during pregnancy and to explore non-pharmacological alternative treatments.
Collapse
Affiliation(s)
- Babette Bais
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - Nina M Molenaar
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands; Icahn School of Medicine at Mount Sinaï, New York, United States
| | - Hilmar H Bijma
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Cornelis L Mulder
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands; Parnassia Bavo Group, Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Child and Adolescent Psychiatry/Psychology, Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Astrid M Kamperman
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
34
|
Abstract
The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19-29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of pneumonia and some of these cases may be associated with adverse drug events. In this narrative review, we summarize the findings from current observational studies on the association between psychotropic drug use and pneumonia in older adults. In addition to studies assessing the use of psychotropics, we included antiepileptic drugs, as they are also central nervous system-acting drugs, whose use is becoming more common in the aging population. The use of antipsychotics, benzodiazepine, and benzodiazepine-related drugs are associated with increased risk of pneumonia in older adults (≥ 65 years of age), and these findings are not limited to this age group. Minimal and conflicting evidence has been reported on the association between antidepressant drug use and pneumonia, but differences between study populations make it difficult to compare findings. Studies regarding antiepileptic drug use and risk of pneumonia in older persons are lacking, although an increased risk of pneumonia in antiepileptic drug users compared with non-users in persons with Alzheimer's disease has been reported. Tools such as the American Geriatric Society Beers Criteria and the STOPP/START criteria for potentially inappropriate medications aids prescribers to avoid these drugs in order to reduce the risk of adverse drug events. However, risk of pneumonia is not mentioned in the current criteria and more research on this topic is needed, especially in vulnerable populations, such as persons with dementia.
Collapse
Affiliation(s)
- Blair Rajamaki
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
| |
Collapse
|
35
|
Latif R, Makar RR, Hosni EA, El Gazayerly ON. The impact of bioceramic nanocarriers on the intranasal delivery of zaleplon nanoscale powder through new adsorption techniques: Improvement in bioavailability and hypnotic effect. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2019.101375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
Nagakura Y, Miwa M, Yoshida M, Miura R, Tanei S, Tsuji M, Takeda H. Spontaneous pain-associated facial expression and efficacy of clinically used drugs in the reserpine-induced rat model of fibromyalgia. Eur J Pharmacol 2019; 864:172716. [DOI: 10.1016/j.ejphar.2019.172716] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/20/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023]
|
37
|
Outpatient benzodiazepine utilization in Croatia: drug use or misuse. Int J Clin Pharm 2019; 41:1526-1535. [DOI: 10.1007/s11096-019-00915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
|
38
|
Cheng S, Siddiqui TG, Gossop M, Kristoffersen ES, Lundqvist C. Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study. BMJ Open 2019; 9:e031483. [PMID: 31492795 PMCID: PMC6731874 DOI: 10.1136/bmjopen-2019-031483] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Timely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. DESIGN A prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING Somatic departments of the Akershus University Hospital, Norway. PARTICIPANTS 246 patients aged 65-90 were included. OUTCOME MEASURES Prolonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients' characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence. RESULTS Forty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75-84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88). CONCLUSION CNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs. TRIAL REGISTRATION NUMBER NCT03162081.
Collapse
Affiliation(s)
- Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, King's College, London, United Kingdom
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
39
|
Gerlach LB, Strominger J, Kim HM, Maust DT. Discontinuation of Chronic Benzodiazepine Use Among Adults in the United States. J Gen Intern Med 2019; 34:1833-1840. [PMID: 31240606 PMCID: PMC6712149 DOI: 10.1007/s11606-019-05098-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Guidelines recommend most benzodiazepine (BZD) treatment be short-term, though chronic BZD use is increasing. OBJECTIVE Determine the rate of BZD discontinuation among chronic users and identify patient- and provider-level factors associated with discontinuation. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using nationwide insurance claims data from 2014 to 2016 of US adults ≥ 18 years old with chronic BZD use (i.e., > 120 days) during the baseline year. MAIN OUTCOMES AND MEASURES The primary outcome was BZD discontinuation among chronic users after 1 year of follow-up. A series of multilevel logistic regression models examined the association of BZD discontinuation with patient and provider characteristics. Covariates included patient sociodemographics, medical and psychiatric comorbidity, co-prescribed opioids and other psychotropics, and characteristics of the prescribed BZD. KEY RESULTS Of 141,008 chronic BZD users, 13.4% discontinued use after 1 year. Females had lower odds of discontinuation (AOR 0.83, 99% CI 0.79-0.87), while African-American patients had higher odds (AOR 1.12, 99% CI 1.03-1.22). Those prescribed a high-potency BZD had lower odds of discontinuation (AOR 0.51, 99% CI 0.47-0.54), as did those prescribed an opioid (AOR 0.94, 99% CI 0.89-0.99). After adjusting for patient- and provider-level factors, differences between providers accounted for 5.8% of variation in BZD discontinuation (p < 0.001). The median odds ratio for provider was 1.54, an association with discontinuation larger than almost all patient-level clinical variables. CONCLUSIONS A small minority of patients prescribed chronic BZD in a given year are no longer prescribed BZDs 1 year later. There is significant variation in the likelihood of discontinuation accounted for by non-clinical factors such as race, geography, and a patient's provider, which had a stronger association with the odds of discontinuation than almost every other patient-level variable. Provider-facing elements of interventions to reduce BZD prescribing may be critical.
Collapse
Affiliation(s)
- Lauren B Gerlach
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Julie Strominger
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Hyungjin Myra Kim
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| |
Collapse
|
40
|
Piña IL, Di Palo KE, Ventura HO. Psychopharmacology and Cardiovascular Disease. J Am Coll Cardiol 2019; 71:2346-2359. [PMID: 29773162 DOI: 10.1016/j.jacc.2018.03.458] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 11/25/2022]
Abstract
This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions. Drug-drug interactions are more common and potentially dangerous in elderly patients, in whom the conditions often coexist. The most common drug-drug interactions involve the P450 system of enzymes.
Collapse
Affiliation(s)
- Ileana L Piña
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
| | - Katherine E Di Palo
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, New Orleans, Louisiana; The University of Queensland School of Medicine, St. Lucia, Queensland, Australia
| |
Collapse
|
41
|
Zikic O, Nikolic G, Kostic J. Clinical picture of benzodiazepine dependence: The role of different types of benzodiazepines. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1581283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Olivera Zikic
- Department for Psychiatry, Medical Faculty, University of Nis, Nis, Serbia
- Clinical Center Nis, Mental Health Protection Center, Clinical Centre Nis, Nis, Serbia
| | - Gordana Nikolic
- Department for Psychiatry, Medical Faculty, University of Nis, Nis, Serbia
- Clinical Center Nis, Mental Health Protection Center, Clinical Centre Nis, Nis, Serbia
| | - Jelena Kostic
- Department for Psychiatry, Medical Faculty, University of Nis, Nis, Serbia
- Clinical Center Nis, Mental Health Protection Center, Clinical Centre Nis, Nis, Serbia
| |
Collapse
|
42
|
How do we compare with best practice? A completed audit of benzodiazepine and z-hypnotic prescribing. Ir J Psychol Med 2019; 35:321-324. [PMID: 30501665 DOI: 10.1017/ipm.2016.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare benzodiazepine and z-hypnotic prescribing practices in an inpatient psychiatric unit to best practice standards. METHODS Medication charts of all inpatients in the psychiatric unit, over a 1-week period, were reviewed. Details of current benzodiazepine and z-hypnotic prescriptions were collected. Information collected included the substance prescribed, duration and administration instructions. Feedback was communicated to medical practitioners through a presentation and email. A re-audit was completed 4 months later. RESULTS There were increases in total benzodiazepine and z-hypnotic prescribing despite intervention. A reduction of 2 mg occurred in the mean regular dose of benzodiazepine prescribed. Lorazepam was the most prescribed benzodiazepine throughout. In both data sets, at least 50% of regular z-hypnotics and benzodiazepines were initiated before admission. There was an increase of 14% in regular benzodiazepines initiated in hospital exceeding 4 weeks in duration. In neither data collection did regular z-hypnotics initiated in hospital exceed this cut off. A greater number of individuals were in the process of being withdrawn from regular benzodiazepine or z-hypnotic prescriptions in the re-audit. There were minimal improvements in 'as required' prescribing as regards documentation of an indication, time limit and maximum dose. CONCLUSION The increase in overall prescribing, despite intervention, maybe because these medications continued to be indicated in the acute presentations needing inpatient treatment. The small improvements in 'as required' prescribing patterns suggest that the intervention was limited in effecting change in this area.
Collapse
|
43
|
Abstract
IMPORTANCE Benzodiazepines are implicated in a growing number of overdose-related deaths. OBJECTIVES To quantify patterns in outpatient benzodiazepine prescribing and to compare them across specialties and indications. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study (January 1, 2003, through December 31, 2015) used nationally representative National Ambulatory Medical Care Survey data. The yearly population-based sample of outpatient visits among adults, ranging from 20 884 visits in 2003 (representing 737 million visits) to 24 273 visits in 2015 (representing 841 million visits) was analyzed. Prescribing patterns were examined by specialty and indication and used to calculate the annual coprescribing rate of benzodiazepines with other sedating medications. Data were analyzed from July 1, 2017, through November 30, 2018. MAIN OUTCOMES AND MEASURES Annual benzodiazepine visit rate. RESULTS Among the 386 457 ambulatory care visits from 2003 through 2015, a total of 919 benzodiazepine visits occurred in 2003 and 1672 in 2015, nationally representing 27.6 million and 62.6 million visits, respectively. The benzodiazepine visit rate doubled from 3.8% (95% CI, 3.2%-4.4%) to 7.4% (95% CI, 6.4%-8.6%; P < .001) of visits. Visits to primary care physicians accounted for approximately half of all benzodiazepine visits (52.3% [95% CI, 50.0%-54.6%]). The benzodiazepine visit rate did not change among visits to psychiatrists (29.6% [95% CI, 23.3%-36.7%] in 2003 to 30.2% [95% CI, 25.6%-35.2%] in 2015; P = .90), but increased among all other physicians, including primary care physicians (3.6% [95% CI, 2.9%-4.4%] to 7.5% [95% CI, 6.0%-9.5%]; P < .001). The benzodiazepine visit rate increased slightly for anxiety and depression (26.6% [95% CI, 22.6%-31.0%] to 33.5% [95% CI, 28.8%-38.6%]; P = .003) and neurologic conditions (6.8% [95% CI, 4.8%-9.5%] to 8.7% [95% CI, 6.2%-12.1%]; P < .001), but more so for back and/or chronic pain (3.6% [95% CI, 2.6%-4.9%] to 8.5% [95% CI, 6.0%-11.9%]; P < .001) and other conditions (1.8% [95% CI, 1.4%-2.2%] to 4.4% [95% CI, 3.7%-5.2%]; P < .001); use did not change for insomnia (26.9% [95% CI, 19.3%-36.0%] to 25.6% [95% CI, 15.3%-39.6%]; P = .72). The coprescribing rate of benzodiazepines with opioids quadrupled from 0.5% (95% CI, 0.3%-0.7%) in 2003 to 2.0% (95% CI, 1.4%-2.7%) in 2015 (P < .001); the coprescribing rate with other sedating medications doubled from 0.7% (95% CI, 0.5%-0.9%) to 1.5% (95% CI, 1.1%-1.9%) (P < .001). CONCLUSIONS AND RELEVANCE The outpatient use of benzodiazepines has increased substantially. In light of increasing rates of overdose deaths involving benzodiazepines, understanding and addressing prescribing patterns may help curb the growing use of benzodiazepines.
Collapse
Affiliation(s)
- Sumit D. Agarwal
- Division of General Internal Medicine and Primary
Care, Department of Medicine, Brigham and Women’s Hospital, Boston,
Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Bruce E. Landon
- Department of Health Care Policy, Harvard Medical
School, Boston, Massachusetts
- Division of General Medicine and Primary Care,
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
44
|
Mou N, Duan Z, Ma P, Fu R, Fan D. Study on the hypnotic effect of rare protopanaxadiol-type and protopanaxatriol-type ginsenosides. RSC Adv 2019; 9:20483-20491. [PMID: 35514702 PMCID: PMC9065700 DOI: 10.1039/c9ra01549c] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/26/2019] [Indexed: 01/08/2023] Open
Abstract
Ginsenosides, as major active components of ginseng, possess various pharmacological activities, including anti-tumor, anti-diabetic and hypotensive effects. However, the sedative and hypnotic effect of ginsenosides and the involved mechanism remain unclear. In the present study, the hypnotic effect of rare protopanaxadiol-type (PD) ginsenosides, consisting of Rg3, Rk1, Rg5, and protopanaxatriol-type (PT) ginsenosides, consisting of Rh1, Rk3, Rh4, was investigated and compared in rodent models through behavioral pharmacology methods. Both rare PD and PT ginsenosides decreased spontaneous locomotion activity in normal mice and reduced sleep latency, and extended sleep duration in pentobarbital-treated mice. Moreover, PD and PT ginsenosides attenuated the insomnia induced by caffeine in mice. These hypnotic effects of PD and PT ginsenosides were potentiated by 5-hydroxytryptophan (5-HTP), a precursor of serotonin, and inhibited by p-chlorophenylalanine (PCPA), a 5-HT synthesis inhibitor. Flumazenil (FLU, a specific gamma aminobutyric acid (GABA) antagonist) also impaired the hypnotic effect of both PD and PT ginsenosides. The aforementioned results indicated that PD and PT ginsenosides exhibit sedative and hypnotic activity, and PT ginsenosides show higher activity than PD ginsenosides at high doses (96 mg kg−1). Furthermore, the bioactivity of these two types of ginsenosides might be mediated via the serotonergic and GABAergic systems. Ginsenosides, as major active components of ginseng, possess various pharmacological activities, including anti-tumor, anti-diabetic and hypotensive effects.![]()
Collapse
Affiliation(s)
- Ning Mou
- Shaanxi Key Laboratory of Degradable Biomedical Materials
- School of Chemical Engineering
- Northwest University
- Xi'an 710069
- China
| | - Zhiguang Duan
- Shaanxi Key Laboratory of Degradable Biomedical Materials
- School of Chemical Engineering
- Northwest University
- Xi'an 710069
- China
| | - Pei Ma
- Shaanxi Key Laboratory of Degradable Biomedical Materials
- School of Chemical Engineering
- Northwest University
- Xi'an 710069
- China
| | - Rongzhan Fu
- Shaanxi Key Laboratory of Degradable Biomedical Materials
- School of Chemical Engineering
- Northwest University
- Xi'an 710069
- China
| | - Daidi Fan
- Shaanxi Key Laboratory of Degradable Biomedical Materials
- School of Chemical Engineering
- Northwest University
- Xi'an 710069
- China
| |
Collapse
|
45
|
Radhakrishnan A, Jayakumari N, Kumar VM, Gulia KK. α-Asarone: a hypnotic with a potential for long-term use. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
46
|
Abstract
Sleep disorders in children may lead to neurodevelopmental and neurocognitive deficits; it is important to diagnose and treat them properly. Apart from the existing challenges in diagnosis, another drawback is that few therapies are currently approved. In this article, a comprehensive summary of the most common pediatric sleep disorders, along with the various pharmacologic and nonpharmacologic approaches for their management, is presented. Special attention has been paid to the currently available treatment options for pediatric insomnia, obstructive sleep apnea, parasomnias, narcolepsy, and restless legs syndrome, and comparisons are made with the corresponding treatment options for sleep disorders in adults.
Collapse
|
47
|
α-Asarone in management of sleep deprivation induced memory deficits and anxiety in rat model. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0181-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
48
|
Cook B, Creedon T, Wang Y, Lu C, Carson N, Jules P, Lee E, Alegría M. Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse. Drug Alcohol Depend 2018; 187:29-34. [PMID: 29626743 PMCID: PMC5959774 DOI: 10.1016/j.drugalcdep.2018.02.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Benzodiazepines (BZDs) are widely prescribed during psychiatric treatment. Unfortunately, their misuse has led to recent surges in overdose emergency visits and drug-related deaths. METHODS Electronic health record data from a large healthcare system were used to describe racial/ethnic, sex, and age differences in BZD use and dependence. Among patients with a BZD prescription, we assessed differences in the likelihood of subsequently receiving a BZD dependence diagnosis, number of BZD prescriptions, receiving only one BZD prescription, and receiving 18 or more BZD prescriptions. We also estimated multivariate hazard models and generalized linear models, assessing racial/ethnic differences after adjustment for covariates. RESULTS In both unadjusted and adjusted analyses, Whites were more likely than Blacks, Hispanics, and Asians to have a BZD dependence diagnosis and to receive a BZD prescription. Racial/ethnic minority groups received fewer BZD prescriptions, were more likely to have only one BZD prescription, and were less likely to have 18 or more BZD prescriptions. We identified greater BZD misuse among older patients but no sex differences. CONCLUSIONS Findings from this study add to the emerging evidence of high relative rates of prescription drug abuse among Whites. There is a concern, given their greater likelihood of having only one BZD prescription, that Blacks, Hispanics, and Asians may be discontinuing BZDs before their clinical need is resolved. Research is needed on provider readiness to offer racial/ethnic minorities BZDs when indicated, patient preferences for BZDs, and whether lower prescription rates among racial/ethnic minorities offer protection against the progression from prescription to addiction.
Collapse
Affiliation(s)
- Benjamin Cook
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, 1035 Cambridge St., Cambridge, MA, 02141, USA.
| | - Timothy Creedon
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, 1035 Cambridge St., Cambridge, MA, 02141, USA
| | - Ye Wang
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Chunling Lu
- Harvard School of Public Health 677 Huntington Ave., Boston, MA 02115, USA
| | - Nicholas Carson
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, 1035 Cambridge St., Cambridge, MA, 02141, USA
| | - Piter Jules
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, 1035 Cambridge St., Cambridge, MA, 02141, USA
| | - Esther Lee
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, 1035 Cambridge St., Cambridge, MA, 02141, USA
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| |
Collapse
|
49
|
Mokhar A, Tillenburg N, Dirmaier J, Kuhn S, Härter M, Verthein U. Potentially inappropriate use of benzodiazepines and z-drugs in the older population-analysis of associations between long-term use and patient-related factors. PeerJ 2018; 6:e4614. [PMID: 29844949 PMCID: PMC5969046 DOI: 10.7717/peerj.4614] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/23/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction The long-term use of benzodiazepines (BZD) and z-drugs in older populations is associated with a variety of sociodemographic and health-related factors. Recent studies reported that long-term BZD and z-drugs use is associated with increased age, female sex, and severe negative psychological (e.g., depression) and somatic (e.g., chronic disease) factors. The current study explores the sociodemographic and health-related factors associated with long-term BZD and z-drugs use in the elderly. Methods We conducted a cross-sectional survey among randomly selected patients of one health insurance plan (“AOK North-West”) with BZD and z-drugs prescriptions in the past 12 months. The sample was stratified by appropriate German prescription guidelines (yes vs. no) and age (50–65 vs. >65 years). To examine the association of selected sociodemographic and psychological variables (e.g., sex, employment status, quality of life, depression) with long-term use, a binary logistic regression analysis was conducted. Results In total, data from 340 patients were analyzed. The mean age was 72.1 (SD = 14.5) years, and the most commonly used substances were zopiclon (38.1%), oxazepam (18.1%), and lorazepam (13.8%). The mean defined daily dose (DDD) was 0.73 (SD = 0.47). Insomnia was the main reason for prescribing BZD and z-drugs. The long-term use of BZD and z-drugs was significantly associated with unemployment (OR = 2.9, 95% CI [1.2–7.1]) and generally problematic medication use (OR = 0.5, 95% CI [0.2–1.0]). Discussion Unemployment status and problematic medication use had a significant association with the patient-reported, long-term use of BZD and z-drugs. Divergent prescription patterns might suggest problematic patterns of BZD and z-drugs use. The causal connection between the identified factors and problematic BZD and z-drugs prescription is not discussed in this paper. Nevertheless, employment status and possible evidence of general problematic drug use may be a warning signal to the prescribers of BZD and z-drugs.
Collapse
Affiliation(s)
- Aliaksandra Mokhar
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niklas Tillenburg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Kuhn
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
50
|
Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge. Psychogeriatrics 2018; 18:155-165. [PMID: 29878472 DOI: 10.1111/psyg.12319] [Citation(s) in RCA: 234] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/27/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022]
Abstract
In contrast to newborns, who spend 16-20 h in sleep each day, adults need only about sleep daily. However, many elderly may struggle to obtain those 8 h in one block. In addition to changes in sleep duration, sleep patterns change as age progresses. Like the physical changes that occur during old age, an alteration in sleep pattern is also a part of the normal ageing process. As people age, they tend to have a harder time falling asleep and more trouble staying asleep. Older people spend more time in the lighter stages of sleep than in deep sleep. As the circadian mechanism in older people becomes less efficient, their sleep schedule is shifted forward. Even when they manage to obtain 7 or 8 h sleep, they wake up early, as they have gone to sleep quite early. The prevalence of sleep disorders is higher among older adults. Loud snoring, which is more common in the elderly, can be a symptom of obstructive sleep apnoea, which puts a person at risk for cardiovascular diseases, headaches, memory loss, and depression. Restless legs syndrome and periodic limb movement disorder that disrupt sleep are more prevalent in older persons. Other common medical problems of old age such as hypertension diabetes mellitus, renal failure, respiratory diseases such as asthma, immune disorders, gastroesophageal reflux disease, physical disability, dementia, pain, depression, and anxiety are all associated with sleep disturbances.
Collapse
Affiliation(s)
- Kamalesh K Gulia
- Division of Sleep Research, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Velayudhan Mohan Kumar
- Division of Sleep Research, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| |
Collapse
|