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benzodiazepines discontinuation

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https://www.readbyqxmd.com/read/29906718/review-adjunctive-pharmacologic-approaches-for-benzodiazepine-tapers
#1
REVIEW
Justine W Welsh, Valeria Tretyak, R Kathryn McHugh, Roger D Weiss, Olivera Bogunovic
BACKGROUND: Many patients require discontinuation of benzodiazepines due to a reduction in drug efficacy over time, the development of a sedative use disorder, or unwanted side effects. Benzodiazepine discontinuation can pose a significant challenge for prescribing clinicians due to potential withdrawal symptoms and a recurrence of psychiatric complaints. METHODS: A PubMed literature search was conducted using the medical subject heading of benzodiazepines in combination with the following key words: discontinuation, withdrawal, detoxification, cessation, dependence, addiction, substance use disorders, or long term...
May 31, 2018: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29851670/de-novo-myoclonic-status-epilepticus-after-benzodiazepine-withdrawal
#2
Pedro Vicente Ferreira Naves, Marcelo Calderaro, Luis Otavio Caboclo
Myoclonic status epilepticus (MSE) in patients without epilepsy, or de novo MSE, is a rare condition associated with several acute symptomatic etiologies, including drugs and toxins. We describe a 94-year-old woman with Alzheimer dementia and long use of mirtazapine 30 mg/d and alprazolam 1 mg/d who developed MSE approximately 24 hours after abrupt discontinuation of alprazolam. The patient was taking sulfamethoxazole/trimethoprim for urinary tract infection, diagnosed 2 weeks before admission. She had no history of seizures...
May 30, 2018: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/29800375/a-non-comparative-prospective-pilot-study-of-ketamine-for-sedation-in-adult-septic-shock
#3
Jason M Reese, Victoria Fernandes Sullivan, Nathan L Boyer, Cristin A Mount
Introduction: Sedation and analgesia in the intensive care unit (ICU) for patients with sepsis can be challenging. Opioids and benzodiazepines can lower blood pressure and decrease respiratory drive. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that provides both amnesia and analgesia without depressing respiratory drive or blood pressure. The purpose of this pilot study was to assess the effect of ketamine on the vasopressor requirement in adult patients with septic shock requiring mechanical ventilation...
May 24, 2018: Military Medicine
https://www.readbyqxmd.com/read/29752906/tramadol-understanding-the-risk-of-serotonin-syndrome-and-seizures
#4
REVIEW
Sameer Hassamal, Karen Miotto, William Dale, Itai Danovitch
Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol's serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence of tramadol-induced serotonin syndrome and seizures is modest in the general population but if left untreated, the morbidity and mortality can be high, and therefore prompt recognition and management is essential...
May 9, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29752012/impact-of-multidisciplinary-chart-reviews-on-opioid-dose-reduction-and-monitoring-practices
#5
Julianna Rivich, Jocelyn McCauliff, Allison Schroeder
INTRODUCTION: The Veterans Affairs (VA) Eastern Colorado Health Care System implemented an Opioid Safety Initiative (OSI); this included multidisciplinary chart reviews of patients with chronic, non-malignant pain on high-dose opioid therapy to provide safety recommendations to prescribers through the electronic medical record. Our study objective was to evaluate the impact of these documented recommendations. Outcomes included change in total daily opioid dose, concurrent prescribing of opioids and benzodiazepines, adherence to local VA/Veterans Integrated Service Network (VISN) policy, and monitoring practices...
April 27, 2018: Addictive Behaviors
https://www.readbyqxmd.com/read/29739132/assessment-of-switching-to-suvorexant-versus-the-use-of-add-on-suvorexant-in-combination-with-benzodiazepine-receptor-agonists-in-insomnia-patients-a-retrospective-study
#6
Masakazu Hatano, Hiroyuki Kamei, Risa Inagaki, Haruna Matsuzaki, Manako Hanya, Shigeki Yamada, Nakao Iwata
Objective: Suvorexant is a novel hypnotic drug that does not interact with the conventional γ-aminobutyric acid (GABA)-A receptor. We investigated the method by which suvorexant was introduced in insomnia patients who were taking benzodiazepine receptor agonists (BzRA). Methods: This was a retrospective study. We extracted clinical data for patients who were prescribed suvorexant and were already using BzRA. The patients were assigned to two groups, the switching and add-on groups...
May 31, 2018: Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/29733095/assessment-of-outcomes-following-high-dose-opioid-tapering-in-a-veterans-healthcare-system
#7
Lauren Hundley, Shelley Spradley, Scott Donelenko
OBJECTIVE: To assess the impact of tapering of chronic high dose opioid therapy in veterans prompted by the implementation of the Opioid Safety Initiative in 2013. DESIGN: IRB and VA Office of Research and Development-approved retrospective, observational chart review. SETTING: North Florida/South Georgia Veterans Health System Patients: Veterans on high dose opioid therapy (≥300 mg of morphine equivalents per day) for chronic non-cancer pain as of 1/1/2012 with an opioid agreement discontinuation note documented in the medical record were included...
March 2018: Journal of Opioid Management
https://www.readbyqxmd.com/read/29713452/challenges-of-the-pharmacological-management-of-benzodiazepine-withdrawal-dependence-and-discontinuation
#8
REVIEW
Dimy Fluyau, Neelambika Revadigar, Brittany E Manobianco
Background: Benzodiazepines (BZDs) are among the most prescribed sedative hypnotics and among the most misused and abused medications by patients, in parallel with opioids. It is estimated that more than 100 million Benzodiazepine (BZD) prescriptions were written in the United States in 2009. While medically useful, BZDs are potentially dangerous. The co-occurring abuse of opioids and BZD, as well as increases in BZD abuse, tolerance, dependence, and short- and long-term side effects, have prompted a worldwide discussion about the challenging aspects of medically managing the discontinuation of BZDs...
May 2018: Therapeutic Advances in Psychopharmacology
https://www.readbyqxmd.com/read/29698346/a-mixed-presentation-of-serotonin-syndrome-vs-neuroleptic-malignant-syndrome-in-a-12-year-old-boy
#9
Christie Sun, Hannah Sweet, Alicia B Minns, Desiree Shapiro, Willough Jenkins
BACKGROUND: Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Although the mechanisms differ, they can be clinically difficult to distinguish. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy. CASE: A 12-year-old boy with a history of developmental delay, attention-deficit hyperactivity disorder, and posttraumatic stress disorder presented to the emergency department with behavior changes consisting of delayed reactions, gait instability, drooling, and slowed movements...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29697713/alzhatv-a-nonpharmacological-intervention-to-manage-behavioral-and-psychological-symptoms-in-nursing-home-dementia-patients
#10
Smita U Varshney, Juhi U Varshney, Rajesh R Tampi, William V McCall, Upkar Varshney
BACKGROUND: Currently, 5 million seniors who reside in the community or assisted living or nursing facilities are affected by Alzheimer's disease and other neurocognitive disorders. They experience various psychiatric symptoms. Also, their family members are stressed from caregiving, and may feel guilty for not doing more. METHODS: We created an innovative nonpharmacological intervention, AlzhaTV, to decrease behavioral and psychological symptoms associated with neurocognitive disorders...
May 2018: Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists
https://www.readbyqxmd.com/read/29626743/examining-racial-ethnic-differences-in-patterns-of-benzodiazepine-prescription-and-misuse
#11
Benjamin Cook, Timothy Creedon, Ye Wang, Chunling Lu, Nicholas Carson, Piter Jules, Esther Lee, Margarita Alegría
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...
June 1, 2018: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29568537/a-province-wide-cross-sectional-study-of-demographics-and-medication-use-of-patients-in-hemodialysis-units-across-ontario
#12
Marisa Battistella, Racquel Jandoc, Jeremy Y Ng, Eric McArthur, Amit X Garg
Background: Hemodialysis patients are at an increased risk of polypharmacy as they have the highest pill burden of all chronically ill patient populations, with an estimated average of 12 medications per day. Objectives: The aim of this study was to evaluate prescribing patterns of outpatient medications in patients receiving in-center hemodialysis. This was done to identify potential candidate medications for future quality improvement initiations to optimize prescribing...
2018: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/29543325/pharmacological-interventions-for-benzodiazepine-discontinuation-in-chronic-benzodiazepine-users
#13
REVIEW
Lone Baandrup, Bjørn H Ebdrup, Jesper Ø Rasmussen, Jane Lindschou, Christian Gluud, Birte Y Glenthøj
BACKGROUND: Prolonged treatment with benzodiazepines is common practice despite clinical recommendations of short-term use. Benzodiazepines are used by approximately 4% of the general population, with increased prevalence in psychiatric populations and the elderly. After long-term use it is often difficult to discontinue benzodiazepines due to psychological and physiological dependence. This review investigated if pharmacological interventions can facilitate benzodiazepine tapering. OBJECTIVES: To assess the benefits and harms of pharmacological interventions to facilitate discontinuation of chronic benzodiazepine use...
March 15, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29530369/adherence-and-persistence-to-ropinirole-pramipexole-and-gabapentin-in-patients-with-newly-diagnosed-restless-legs-syndrome
#14
Juhyeun Kim, Abraham G Hartzema
STUDY OBJECTIVES: The objective of this study is to assess adherence and persistence of ropinirole, pramipexole, and gabapentin; to investigate factors associated with non-adherence and non-persistence in restless legs syndrome (RLS) patients. METHODS: We used the 2008-2014 Marketscan® Research Databases to conduct a retrospective data analysis. The study included newly diagnosed RLS patients who initiated ropinirole, pramipexole, or gabapentin therapy. During 365 days of follow-up, mean medication possession ratios (MPRs) for adherence and the proportion of adherent users were calculated...
April 2018: Sleep Medicine
https://www.readbyqxmd.com/read/29487083/drugs-for-insomnia-beyond-benzodiazepines-pharmacology-clinical-applications-and-discovery
#15
REVIEW
Tobias Atkin, Stefano Comai, Gabriella Gobbi
Although the GABAergic benzodiazepines (BZDs) and Z-drugs (zolpidem, zopiclone, and zaleplon) are FDA-approved for insomnia disorders with a strong evidence base, they have many side effects, including cognitive impairment, tolerance, rebound insomnia upon discontinuation, car accidents/falls, abuse, and dependence liability. Consequently, the clinical use of off-label drugs and novel drugs that do not target the GABAergic system is increasing. The purpose of this review is to analyze the neurobiological and clinical evidence of pharmacological treatments of insomnia, excluding the BZDs and Z-drugs...
April 2018: Pharmacological Reviews
https://www.readbyqxmd.com/read/29442341/the-influence-of-hospitalisation-on-the-initiation-continuation-and-discontinuation-of-benzodiazepines-and-z-drugs-an-observational-study
#16
Thomas Grimmsmann, Markus Harden, Thomas Fiß, Wolfgang Himmel
BACKGROUND AND OBJECTIVES: Hospitalisation influences drug therapy in ambulatory care and this influence is generally negatively perceived. The few studies that have explored changes in benzodiazepine or sleep medication use as a function of hospitalisation failed to precisely determine the hospital's role in initiating, continuing and discontinuing these drugs on a valid basis. The aim of the study was to ascertain the overall influence of hospitalisation on the prescription of benzodiazepines and Z-drugs in outpatient care with a special focus on the role of different hospital departments and drug classes...
February 14, 2018: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29385766/benzodiazepines-ii-waking-up-on-sedatives-providing-optimal-care-when-inheriting-benzodiazepine-prescriptions-in-transfer-patients
#17
REVIEW
Jeffrey Guina, Brian Merrill
This review discusses risks, benefits, and alternatives in patients already taking benzodiazepines when care transfers to a new clinician. Prescribers have the decision-sometimes mutually agreed-upon and sometimes unilateral-to continue, discontinue, or change treatment. This decision should be made based on evidence-based indications (conditions and timeframes), comorbidities, potential drug-drug interactions, and evidence of adverse effects, misuse, abuse, dependence, or diversion. We discuss management tools involved in continuation (e...
January 30, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/29336611/interventions-to-improve-benzodiazepine-tapering-success-in-the-elderly-a-systematic-review
#18
Carol Dou, Johannes Rebane, Stan Bardal
BACKGROUND: Long-term benzodiazepine use in the elderly population is a significant public health problem that leads to impaired cognitive functioning, medication dependence and increased risks for adverse drug reactions. The aim of this review was to examine randomized controlled trials (RCTs) on the efficacy of different methods for tapering and discontinuing benzodiazepines. METHOD: We used four databases (Ovid, PubMed, Academic Search Complete, Web of Science) to retrieve randomized controlled trials published in peer-reviewed journals that explored different methods for tapering benzodiazepine use in a primarily geriatric population...
January 16, 2018: Aging & Mental Health
https://www.readbyqxmd.com/read/29317396/pregabalin-as-adjunctive-therapy-in-benzodiazepine-discontinuation
#19
Kaylee Caniff, Emily Telega, Jolene R Bostwick, Kristen N Gardner
PURPOSE: The available evidence for the use of pregabalin as adjunctive therapy in the discontinuation of benzodiazepines is reviewed. SUMMARY: Pregabalin has been studied as an adjunctive pharmacologic treatment for the discontinuation of long-term benzodiazepine use. Unlike carbamazepine, pregabalin has little potential for drug interactions, and its adverse effects are mostly mild and transient. Pregabalin reduces the release of excitatory neurotransmitters by binding to regulatory subunits of voltage-activated calcium channels...
January 15, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29310960/cannabinoid-hyperemesis-syndrome-pathophysiology-and-treatment-in-the-emergency-department
#20
John R Richards
BACKGROUND: Cannabinoid hyperemesis syndrome (CHS) is a challenging clinical disorder. CHS patients frequently present to the emergency department and may require treatment for intractable emesis, dehydration, and electrolyte abnormalities. Thought to be a variant of cyclic vomiting syndrome, CHS has become more prevalent with increasing cannabis potency and use, as enabled by various states having legalized the recreational use of cannabis. OBJECTIVE: This aim of this review is to investigate the pathophysiology of CHS and evaluate the published literature on pharmacologic treatment in the emergency department...
March 2018: Journal of Emergency Medicine
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