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benzodiazepine, adverse, morbidity

L E Edwards, L B Hutchison, C D Hornik, P B Smith, C M Cotten, M Bidegain
Infant delirium is an under-recognized clinical entity in neonatal intensive care, and earlier identification and treatment could minimize morbidities associated with this condition. We describe a case of a 6-month-old former 32 weeks gestation infant undergoing a prolonged mechanical ventilation course diagnosed with delirium related to the combination of his underlying illness and the use of multiple sedative and analgesic mediations. Initiation of the atypical antipsychotic risperidone allowed for weaning from continuous infusions of benzodiazepines and opiods, and lower dosages of bolus-dosed sedation and analgesics...
March 16, 2017: Journal of Neonatal-perinatal Medicine
Jessica J Falco-Walter, Thomas Bleck
Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists...
April 25, 2016: Journal of Clinical Medicine
Yoko Murphy, Emily Wilson, Elliot M Goldner, Benedikt Fischer
Benzodiazepines are commonly prescribed psycho-pharmaceuticals (e.g., for anxiety, tension, and insomnia); they are generally considered safe but have potential adverse effects. Benzodiazepine use in Canada versus internationally is comparably high, yet no recent comprehensive review of use, misuse, or related (e.g., morbidity, mortality) harm at the population level exists; the present review aimed to fill this gap. We searched four key scientific literature databases (Medline, CINAHL, EBM Reviews, and Web of Science) with relevant search terms, and collected relevant "gray literature" (e...
July 2016: Clinical Drug Investigation
B Guldiken, J Rémi, Soheyl Noachtar
Phenytoin is an established drug in the treatment of acute repetitive seizures and status epilepticus. One of its main advantages over benzodiazepines is the less sedative effect. However, the possibility of cardiovascular adverse effects with the intravenous use of phenytoin cause a reluctance to its usage, and this has lead to a search for safer anticonvulsant drugs. In this study, we aimed to review the studies which evaluated the safety of phenytoin with respect to cardiovascular adverse effects. The original clinical trials and case reports listed in PUBMED in English language between the years of 1946-2014 were evaluated...
May 2016: Journal of Neurology
Laura Edwards, Stephen DeMeo, Chi D Hornik, C Michael Cotten, P Brian Smith, Carolyn Pizoli, Julie M Hauer, Margarita Bidegain
Gabapentin was used for the treatment of term and preterm infants with suspected visceral hyperalgesia caused by a variety of neurologic and gastrointestinal morbidities. Improved feeding tolerance and decreased irritability were seen, as well as decreased usage of opioids and benzodiazepines. Adverse events occurred with abrupt discontinuation of this medication.
February 2016: Journal of Pediatrics
Anders Sköldunger, Johan Fastbom, Anders Wimo, Laura Fratiglioni, Kristina Johnell
BACKGROUND: Inappropriate drug use (IDU) is an important risk factor for adverse outcomes in older persons. We aimed to investigate IDU and the risk of hospitalizations and mortality in older persons and in persons with dementia and to estimate the costs of IDU-related hospitalizations. METHODS: We analyzed 4108 individuals aged ≥60 years from the Swedish National Study on Aging and Care (SNAC) data from Kungsholmen and Nordanstig (2001-2004). IDU was assessed by indicators developed by the Swedish National Board of Health and Welfare...
August 2015: Drugs & Aging
Mei-Sing Ong, Karen L Olson, Aurel Cami, Chunfu Liu, Fang Tian, Nandini Selvam, Kenneth D Mandl
BACKGROUND: Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or "doctor-shopping," contributes to the problem. OBJECTIVE: To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics. DESIGN: A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011...
February 2016: Journal of General Internal Medicine
André S Pollmann, Andrea L Murphy, Joel C Bergman, David M Gardner
BACKGROUND: Long-term sedative use is prevalent and associated with significant morbidity, including adverse events such as falls, cognitive impairment, and sedation. The development of dependence can pose significant challenges when discontinuation is attempted as withdrawal symptoms often develop. We conducted a scoping review to map and characterize the literature and determine opportunities for future research regarding deprescribing strategies for long-term benzodiazepine and Z-drug (zopiclone, zolpidem, and zaleplon) use in community-dwelling adults...
July 4, 2015: BMC Pharmacology & Toxicology
Ashok K Dubey, Shailendra S Handu, Pramod K Mediratta
Primary insomnia is mainly treated with drugs acting on benzodiazepine receptors and a few other classes of drugs used for different co-morbidities. A novel approach to treat insomnia has been introduced recently, with the approval of suvorexant, the first in a new class of orexin receptor antagonists. Orexin receptors in the brain have been found to play an important role in the regulation of various aspects of arousal and motivation. The drugs commonly used for insomnia therapy to date, have often been associated with adverse effects, such as, day-time somnolence, amnesia, confusion, and gait disturbance, apart from the risk of dependence on chronic use...
April 2015: Journal of Pharmacology & Pharmacotherapeutics
Christina Voulgari, Raphael Giannas, Georgios Paterakis, Anna Kanellou, Nikolaos Anagnostopoulos, Stamata Pagoni
Clozapine is a second-generation antipsychotic agent from the benzodiazepine group indicated for treatment-resistant schizophrenia and other psychotic conditions. Using clozapine earlier on once a case appears to be refractory limits both social and personal morbidity of chronic psychosis. However treatment with second-generation antipsychotics is often complicated by adverse effects. We present a case of a 33-year-old Caucasian woman with a 25-year history of refractory psychotic mania after switching to a 2-year clozapine therapy...
2015: Case Reports in Medicine
E A Davies, M S O'Mahony
The International Conference on Harmonization considers older people a 'special population', as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions (ADRs). Medical practice is often based on single disease guidelines derived from clinical trials that have not included frail older people or those with multiple morbidities. This presents a challenge caring for older people, as drug doses in trials may not be achievable in real world patients and risks of ADRs are underestimated in clinical trial populations...
October 2015: British Journal of Clinical Pharmacology
Lynn R Webster, Gary M Reisfield, Nabarun Dasgupta
The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain...
January 2015: Postgraduate Medicine
James E Frampton
Pregabalin (Lyrica(®)), a well established anxiolytic agent, has been approved in the EU for the treatment of generalized anxiety disorder (GAD) in adults. It has a distinct mechanism of action relative to other anti-anxiety agents (α2δ binding at presynaptic voltage dependent calcium channels leading to inhibition of excitatory neurotransmission), a rapid onset of effect (typically ≤1 week) and broad spectrum activity against both the psychic and somatic symptoms of GAD. In long-term studies, pregabalin maintained improvements in anxiety symptoms that occurred in response to short-term treatment and delayed the time to relapse of GAD compared with placebo...
September 2014: CNS Drugs
Eugen Trinka, Julia Höfler, Alexander Zerbs, Francesco Brigo
INTRODUCTION: The effectiveness of valproate (VPA) in the treatment of focal and generalized epilepsies is well established. The drug has a wide spectrum of action, good tolerability, and has been available as an injectable formulation since 1993. Despite the lack of class A evidence, it has been used extensively in various forms of status epilepticus (SE). AIM: Our aim was to present a systematic review of data from randomized and non-randomized controlled trials to evaluate the efficacy and safety of intravenous VPA for the treatment of SE...
July 2014: CNS Drugs
Christopher H Warner, Carolynn M Warner, George N Appenzeller, Charles W Hoge
Posttraumatic stress disorder (PTSD) occurs in an estimated 8% of men and 20% of women who are exposed to traumatic events. PTSD is a trauma- and stress-related disorder associated with significant psychosocial morbidity, substance abuse, and other negative physical health outcomes. The hallmarks of PTSD include exposure to a traumatic event; reexperiencing the event or intrusion symptoms; avoidance of people, places, or things that serve as a reminder of the trauma; negative mood and thoughts associated with the trauma; and chronic hyperarousal symptoms...
December 15, 2013: American Family Physician
David H Jang, Meghan B Spyres, Lindsay Fox, Alex F Manini
Adverse cardiovascular events comprise a large portion of the morbidity and mortality in drug overdose emergencies. Adverse cardiovascular events encountered by emergency physicians treating poisoned patients include myocardial injury, hemodynamic compromise with shock, tachydysrhythmias, and cardiac arrest. Early signs of toxin-induced cardiovascular failure include bradycardia, tachycardia, and specific ECG findings. Treatment of toxicologic tachycardia relies on rapid supportive care along with proper use of benzodiazepines for sedation...
February 2014: Emergency Medicine Clinics of North America
Sapana Desai, Terence Chau, Liza George
Intensive care unit (ICU) delirium is widespread and occurs in 20% to 80% of patients. It can be assessed with ICU-validated scoring tools. The most commonly used tools include the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. Since ICU delirium is associated with increased morbidity and mortality, it is imperative that risk factors are identified and prevented. Risk factors include predisposing factors such as history of alcohol abuse, dementia, or hypertension and precipitating factors such as immobilization, oversedation, higher severity of illness, and use of certain psychoactive medications such as benzodiazepines...
October 2013: Critical Care Nursing Quarterly
Sruti R Patel
PURPOSE: To review the most common drugs implicated in overdoses admitted to the intensive care unit focusing on antidotes and reversal agents used in their management. SUMMARY: Poisonings and overdoses due to pharmaceutical agents result in more than 100 000 critical care unit admissions each year. Ingestion of toxic alcohols, calcium channel blockers, beta-adrenergic antagonists, benzodiazepines, opioids, acetaminophen, tricyclic antidepressants, and salicylates are associated with a high rate of morbidity and mortality...
October 2013: Critical Care Nursing Quarterly
Nicholas J Connors, Robert S Hoffman
Cocaine is a commonly abused illicit drug that causes significant morbidity and mortality. Although there is no true antidote to cocaine toxicity, current management strategies address the life-threatening systemic effects, namely hyperthermia, vasospasm, and severe hypertension. Clinicians rely on rapid cooling, benzodiazepines, and α-adrenergic antagonists for management, with years of proven benefit. Experimental agents have been developed to more effectively treat acute toxicity. Pharmacodynamic approaches include antipsychotics that are thought to interfere with cocaine's actions at several neurotransmitter receptors...
November 2013: Journal of Pharmacology and Experimental Therapeutics
Jeffrey A Gudin, Shanthi Mogali, Jermaine D Jones, Sandra D Comer
The concurrent use of opioids, benzodiazepines (BZDs), and/or alcohol poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs and/or alcohol are at higher risk for fatal/nonfatal overdose and have more aberrant behaviors...
July 2013: Postgraduate Medicine
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