Did you know that Alprazolam is the second most popular drug prescribed in the benzodiazepine group? Over the last 20 years prescriptions for alprazolam have increased more than eightfold despite a modest decrease in the annual number of benzodiazepine prescriptions dispensed. Of particular concern are the patients who have been using benzodiazepines
for more than six months.
The October edition of the Australian Prescriber has a good article on this topic which is enclosed for you to download. Some of the interesting points outlined in the article include the following:
- “Benzodiazepine-related problems include diversion, misuse, dependency, driving impairment, and morbidity and mortality related to overdose and withdrawal.
- In older patients they have been associated with cognitive decline, dementia and falls. There is evidence of increased mortality with long-term use.
- In February 2014, in response to increasing illicit use, alprazolam was rescheduled to Schedule 8.
- Any patient who has taken a benzodiazepine for longer than 3–4 weeks is likely to have withdrawal symptoms if the drug is ceased abruptly. The risk of inducing dependence can be reduced by issuing prescriptions limited to 1–2 weeks supply.
- Abrupt cessation of benzodiazepines after a period of 1–6 months of use can cause life-threatening seizures so the dose should be gradually reduced. Patients with a lower risk of relapse are those taking a daily dose of 10 mg diazepam equivalent or less at the start of tapering, and those who have made a substantial dose reduction themselves before the start of tapering.
- Other low-risk characteristics are less severe benzodiazepine dependence (measured on a dependence scale), no previous withdrawal attempts, high life satisfaction and no use of alcohol.15,17 Patients without unstable psychiatric or medical comorbidity, no history of seizures and no concurrent drug abuse or dependence are also at a lower risk of harm from benzodiazepine withdrawal.”
The article also discusses prescribing interventions, substitution, psychotherapies and pharmacotherapies which all have a part to play in the the management of benzodiazepine dependence.