Bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety
Appropriate prescription is an essential part of the rational use of medicines, where the therapeutic benefits should be looked for over the risks. The higher the consumption of medications, the greater the risk of adverse reactions-interactions. Polymedication is a risk factor for numerous...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2019
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/25705 |
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I10-R327-article-25705 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
polypharmacy inappropriate prescribing benzodiazepines deprescriptions pharmacoepimediology polifarmacia prescripción inadecuada benzodiazepinas deprescripciones farmacoepidemiología |
| spellingShingle |
polypharmacy inappropriate prescribing benzodiazepines deprescriptions pharmacoepimediology polifarmacia prescripción inadecuada benzodiazepinas deprescripciones farmacoepidemiología Perea, HS Aguirre, JA Bernet, J Bobadilla, MG Cecchetto , E Ledesma, MJ López, AC Roitter, CV Bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety |
| topic_facet |
polypharmacy inappropriate prescribing benzodiazepines deprescriptions pharmacoepimediology polifarmacia prescripción inadecuada benzodiazepinas deprescripciones farmacoepidemiología |
| author |
Perea, HS Aguirre, JA Bernet, J Bobadilla, MG Cecchetto , E Ledesma, MJ López, AC Roitter, CV |
| author_facet |
Perea, HS Aguirre, JA Bernet, J Bobadilla, MG Cecchetto , E Ledesma, MJ López, AC Roitter, CV |
| author_sort |
Perea, HS |
| title |
Bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety |
| title_short |
Bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety |
| title_full |
Bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety |
| title_fullStr |
Bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety |
| title_full_unstemmed |
Bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety |
| title_sort |
bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety |
| description |
Appropriate prescription is an essential part of the rational use of medicines, where the therapeutic benefits should be looked for over the risks. The higher the consumption of medications, the greater the risk of adverse reactions-interactions. Polymedication is a risk factor for numerous problems. The concept of therapeutic overload arises: when a patient consumes medications that he does not need. Medicalization leads to non-medical problems being defined and treated as diseases. Benzodiazepines are among the most consumed medications. Such consumption may cause: sedation, cognitive impairment, falls / fractures, traffic accidents, tolerance-dependence, withdrawal symptoms, respiratory infections and increased mortality, the elderly being more susceptible. The application of deprescription programs would reduce these risks and the consumption of drugs, detecting and avoiding polypharmacy, inadequate and suboptimal prescriptions.
The purpose of this study was to select information about benzodiazepines deprescription strategies.
A non-systematic evaluation of relevant benzodiazepines information, recommendations / deprescription strategies was carried out in independent pharmacotherapeutic bulletins belonging to ISDB.
The results show that treatment duration should not exceed 2-4 weeks for insomnia and 8-12 weeks for anxiety. In both cases it must be based on non-pharmacological strategies. Providing written and adequate information to the user about risks increases the effectiveness of deprescription. The individualized interview with follow-up of the general practitioner proved to be the most successful deprescription strategy. In benzodiazepines with low risk of dependence (low potency-long half-life): reduce total daily dose by 10-25% at intervals of 2-4 weeks. In benzodiazepines with high risk of dependence (high potency-short / intermediate half-life): replace diazepam at equivalent doses and its gradual reduction between 2-2.5 mg every 2-4 weeks.In case of withdrawal symptoms, keep the same dose for a few weeks and continue the dose reduction slowly. The process can take more than a year.Other pharmacological alternatives are not recommended (hypnotics-Z) or do not have sufficient evidence (antihistamines, melatonin, antidepressants, medicinal plants).
It can be concluded that given the high prevalence of benzodiazepines consumption and the important consequences of its inappropriate use, it must be a priority for institutions and professionals to adopt the necessary measures for prudent prescription and, if necessary, deprescription |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2019 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/25705 |
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I10-R327-article-257052024-08-27T18:26:05Z Bibliographic review about medical deprescriptions of benzodiazepines to patients with insomnia / anxiety Revisión bibliográfica sobre deprescripción de benzodiacepinas en pacientes con insomnio/ansiedad Perea, HS Aguirre, JA Bernet, J Bobadilla, MG Cecchetto , E Ledesma, MJ López, AC Roitter, CV polypharmacy inappropriate prescribing benzodiazepines deprescriptions pharmacoepimediology polifarmacia prescripción inadecuada benzodiazepinas deprescripciones farmacoepidemiología Appropriate prescription is an essential part of the rational use of medicines, where the therapeutic benefits should be looked for over the risks. The higher the consumption of medications, the greater the risk of adverse reactions-interactions. Polymedication is a risk factor for numerous problems. The concept of therapeutic overload arises: when a patient consumes medications that he does not need. Medicalization leads to non-medical problems being defined and treated as diseases. Benzodiazepines are among the most consumed medications. Such consumption may cause: sedation, cognitive impairment, falls / fractures, traffic accidents, tolerance-dependence, withdrawal symptoms, respiratory infections and increased mortality, the elderly being more susceptible. The application of deprescription programs would reduce these risks and the consumption of drugs, detecting and avoiding polypharmacy, inadequate and suboptimal prescriptions. The purpose of this study was to select information about benzodiazepines deprescription strategies. A non-systematic evaluation of relevant benzodiazepines information, recommendations / deprescription strategies was carried out in independent pharmacotherapeutic bulletins belonging to ISDB. The results show that treatment duration should not exceed 2-4 weeks for insomnia and 8-12 weeks for anxiety. In both cases it must be based on non-pharmacological strategies. Providing written and adequate information to the user about risks increases the effectiveness of deprescription. The individualized interview with follow-up of the general practitioner proved to be the most successful deprescription strategy. In benzodiazepines with low risk of dependence (low potency-long half-life): reduce total daily dose by 10-25% at intervals of 2-4 weeks. In benzodiazepines with high risk of dependence (high potency-short / intermediate half-life): replace diazepam at equivalent doses and its gradual reduction between 2-2.5 mg every 2-4 weeks.In case of withdrawal symptoms, keep the same dose for a few weeks and continue the dose reduction slowly. The process can take more than a year.Other pharmacological alternatives are not recommended (hypnotics-Z) or do not have sufficient evidence (antihistamines, melatonin, antidepressants, medicinal plants). It can be concluded that given the high prevalence of benzodiazepines consumption and the important consequences of its inappropriate use, it must be a priority for institutions and professionals to adopt the necessary measures for prudent prescription and, if necessary, deprescription La prescripción adecuada es parte esencial del uso racional del medicamento, buscando que el beneficio terapéutico supere riesgos. A mayor consumo de medicamentos, mayor riesgo de reacciones adversas-interacciones. La polimedicación es factor de riesgo de numerosos problemas. Surge así el concepto de sobrecarga terapéutica: cuando un paciente consume medicamentos que no necesita. La medicalización lleva a que problemas no médicos sean definidos y tratados como enfermedades. Las benzodiacepinas (BD) están entre los medicamentos más consumidos. Dicho consumo puede provocar: sedación, deterioro cognitivo, caídas/fracturas, accidentes tránsito, tolerancia-dependencia, síndrome abstinencia, infecciones respiratorias e incremento de mortalidad, siendo los ancianos más susceptibles. La aplicación de programas de deprescripción disminuiría dichos riesgos y el consumo de fármacos, detectando y evitando la polifarmacia, las prescripciones inadecuadas y subóptimas. El objetivo de este estudio fue seleccionar información acerca de estrategias de deprescripción de BD. Se realizó una búsqueda no sistemática evaluativa de información relevante de BD, recomendaciones/estrategias de deprescripción en boletines farmacoterapéuticos independientes pertenecientes a ISDB. Los resultados evidencian que la duración del tratamiento no debe exceder 2-4 semanas para insomnio y 8-12 semanas para ansiedad. En ambos casos debe basarse en estrategias no farmacológicas.Proporcionar información escrita y adecuada al usuario sobre riesgos, aumenta la eficacia de deprescripción.La entrevista individualizada con seguimiento del médico generalista demostró ser la estrategia de deprescripción más exitosa.En BD con bajo riesgo de dependencia (baja potencia-vida media larga): reducir dosis total diaria un 10-25% en intervalos de 2-4 semanas.En BD con alto riesgo de dependencia (alta potencia-vida media corta/intermedia): sustituir por diazepam a dosis equivalentes y su reducción gradual entre 2-2,5 mg cada 2-4 semanas.Ante síntomas de abstinencia, mantener misma dosis unas semanas y continuar la reducción de dosis lentamente. El proceso puede durar más de un año.Otras alternativas farmacológicas no son recomendables (hipnóticos-Z) o no tienen evidencia suficiente (antihistamínicos, melatonina, antidepresivos, plantas medicinales). Se puede concluir que, dadas la alta prevalencia de consumo de BD y las importantes consecuencias de su uso inadecuado, debe ser prioridad por parte de instituciones y profesionales adoptar medidas necesarias para prescripción prudente y, de ser necesario, deprescripción Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2019-10-10 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/25705 Revista de la Facultad de Ciencias Médicas de Córdoba.; 2019: Suplemento JIC XX Revista de la Facultad de Ciencias Médicas de Córdoba; 2019: Suplemento JIC XX Revista da Faculdade de Ciências Médicas de Córdoba; 2019: Suplemento JIC XX 1853-0605 0014-6722 10.31053/1853.0605.v76.nSuplemento spa https://revistas.unc.edu.ar/index.php/med/article/view/25705/27401 Derechos de autor 2019 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |