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Zamboni L, Portoghese I, Casari R, Fusina F, Santin L, Lecca LI, Campagnari S, Carli S, Zandonai T, Lugoboni F. High-dose benzodiazepine use and QTc interval prolongation, a latent class analysis study. Sci Rep 2024; 14:155. [PMID: 38168538 PMCID: PMC10762262 DOI: 10.1038/s41598-023-50489-3] [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: 07/13/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
Benzodiazepine (BDZ) addiction is a widespread and multifaceted phenomenon. For many patients, especially females, the concomitant use of other drugs also increases their risk of QTc prolongation, possibly leading to complications such as seizures and even sudden death. However, the relationship between BDZ use and QTc prolongation is currently unclear. The present study aims to examine patterns of polysubstance use among a sample of Italian adults with BDZ dependence in relation with their QTc prolongation risk. We used Latent Class Analysis (LCA) on data collected from 251 inpatients of the Addiction Medicine Unit in Verona to group patients into three classes according to their substance use and their QTc prolongation risk. Results showed no significant relationship between QTc prolongation and BDZ use in any of the classes considered. We conclude that BDZs, even if used long-term and at high dosages, can be considered safe in terms of cardiovascular complications for patients.
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Affiliation(s)
- Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy.
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy.
| | - Igor Portoghese
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari , Italy
| | - Rebecca Casari
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Francesca Fusina
- Department of General Psychology, University of Padova, Padua, Italy
| | - Laura Santin
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Luigi Isaia Lecca
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari , Italy
| | - Simone Campagnari
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Silvia Carli
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Thomas Zandonai
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain
- Addiction Science Lab at the Department of Psychology and Cognitive Science , University of Trento, Trento, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
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Campagnari S, Zamboni L, Fusina F, Casari R, Lugoboni F. Case Report: High doses of Zolpidem and QT interval lengthening: Is there a relationship? A case series. Front Psychiatry 2022; 13:1033061. [PMID: 36339861 PMCID: PMC9632434 DOI: 10.3389/fpsyt.2022.1033061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
Zolpidem is indicated in cases of severe insomnia in adults and, as for BDZs, its assumption should be limited to short periods under close medical supervision. Since several drugs cause corrected QT interval (QTc) elongation, the authors investigated whether high daily doses of Zolpidem could cause QTc elongation. The study was conducted in the Addiction Medicine Unit of the G.B. Rossi University Hospital in Verona. The data were collected from hospitalizations carried out between January 2015 and February 2020 and refer to a total of 74 patients, 38 males and 36 females, who were treated for detoxification from high doses of Zolpidem with the "Verona Detox Approach With Flumazenil." One patient out of 74 had QTc elongation (479 ms). The patient was male and took a daily dose of 50 mg of Zolpidem; he did not take concomitant therapies that could cause QTc lengthening. He had no electrolyte alterations, no contemporary or previous intake of barbiturates, heroin, cocaine, THC, alcohol, NMDA or nicotine which could cause an elongation of the QTc interval. The present study highlights the low risk of QTc elongation due to high dosages of Zolpidem; however, if, on one hand, we can affirm that Zolpidem is a safe drug, on the other, the widespread use of high dosages of this drug for prolonged periods of time is problematic and worrying.
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Affiliation(s)
- Simone Campagnari
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy.,Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Francesca Fusina
- Department of General Psychology, University of Padua, Padua, Italy.,Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Rebecca Casari
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
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Zandonai T, Peiró AM, Fusina F, Lugoboni F, Zamboni L. Benzodiazepines in sport, an underestimated problem: Recommendations for sports medicine physicians' practice. Front Psychiatry 2022; 13:1066330. [PMID: 36620691 PMCID: PMC9810623 DOI: 10.3389/fpsyt.2022.1066330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
In the last years, only few studies in literature have focused on the use and abuse of benzodiazepines (BZDs) in sport. Benzodiazepine-related problems include misuse, addiction, driving impairments, and morbidity and mortality related to overdose and withdrawal. Two clinical cases regarding elite endurance athletes evidenced that they had started to use BZDs to counteract insomnia, to recover faster from training sessions and to manage muscle pain. One of the important points that emerged from their stories was that their sports doctors did not recognize the drugs' addictive properties, and did not intervene to gradually reduce the dosage. Experts have previously provided recommendations for BZD therapy management in clinical practice. In this article, we would like to address sports medicine physicians specifically and provide guidelines to help them manage situations involving BZD prescription, the recognition of addiction, and intervention strategies.
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Affiliation(s)
- Thomas Zandonai
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Alicante, Spain.,Neuropharmacology on Pain and Functional Diversity, Institute of Health and Biomedical Research of Alicante (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, Spain.,Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Ana María Peiró
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Alicante, Spain.,Neuropharmacology on Pain and Functional Diversity, Institute of Health and Biomedical Research of Alicante (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, Spain.,Pain Unit, Department of Health of Alicante, University General Hospital, Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, University General Hospital, Alicante, Spain
| | - Francesca Fusina
- Padova Neuroscience Center, University of Padova, Padua, Italy.,Department of General Psychology, University of Padova, Padua, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
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