Benzodiazepines
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What are benzodiazepines?
Minor tranquillisers and sleeping pills
Properties: Relieve anxiety Sedative Anti-convulsant Muscle relaxant
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List of benzodiazepinesHalf life (hrs)
Generic name Brand names
10-14 Alprazolam Xanax, Kalma
22-54 Clonazepam Rivotril, Paxam
20-48 Diazepam Valium, Antenax, Ducene
25-30 Flunitrazepam Rohypnol, Hypnodorm
15-38 Nitrazepam Mogadon, Alodorm
6-10 Oxazepam Serepax, Murelax, Alepam
5-10 Temazepam Normison, Temaze, Euhypnos, Temtabs, Nocturne
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Indications for valid prescribing of benzodiazepines Anxiety disorders Sleep Muscle Relaxant Medical procedures Alcohol withdrawal
They are not validly prescribed for: o Grief, anger, depression, drug withdrawal.
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RACGP Guidelines Should be prescribed for the shortest
possible time, lowest possible dose Ideally no more than 7 days Maximum 2-4 weeks “limited to patients whose symptoms are
disabling or who are subjected to unacceptable distress”
Only when other treatments have failed
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Benzodiazepine Dependency Estimated 50-80% of people using
benzodiazepines continuously to 6-12 months will become dependent.
Those who become dependent will experience withdrawal, although severity will vary.
For long term users, withdrawal symptoms may be present while on the regular dose (“Breakthrough withdrawal”)
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Benzodiazepine binding sites Most commonly found in areas of the brain
controlling our consciousness, coordination, emotions, memory, muscle tone and thinking.
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Benzodiazepines are prescribed for; Most often women Older people Migrant population
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Benzodiazepine withdrawal Wide range of distressing symptoms
Anxiety and insomnia are common withdrawal symptoms –often the presenting problem
Can be protracted – weeks or months
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Benzodiazepine Withdrawal Onset: 2-3 days for short-acting
5-7 days for long-acting Symptoms typically last 2-4 weeks, up to a
few months Symptoms can be more intense at the
beginning and end of reduction Symptoms typically fluctuate Symptoms vary from mild to severe
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Common withdrawal symptoms Anxiety & panic attacks Insomnia Heightened sensitivity of the senses Muscle twitching and spasm Pins and needles Nausea Dizziness Depression Loss of memory Loss of appetite Hallucinations
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Specific Risks for Polydrug Users Greatly increased risk of overdose Increased risk taking behaviour – sharing
needles, sexual promiscuity, unsafe sex Disinhibition – more aggressive, socially
inappropriate, increased risk of sexual assault
Increased offending (with memory loss) Specific harms from IV use of benzos
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Overdose statistics (Victorian Institute of
Forensic Medicine 2005)
In all deaths involving heroin 2001-2005, benzodiazepines were found in 60% of cases (Cf 31% alcohol, 20% heroin alone)
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IV use of benzodiazepines Many of the benzodiazepines are an irritant,
essentially burning the vein lining. Veins narrow and block, reducing blood flow May cause severe infection of skin and bone. Particles in the tablets/capsules do not break
down small enough to inject If the vein is missed, tissue surrounding the
injection site may become infected, causing swelling, infection, abscesses or ulcers.
Can cause blood clots in the lungs
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Older people and medication Older people
37% sleeping tablets
15% antidepressants
Adult population
4% sleeping tablets
5% antidepressants
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Effects of benzodiazepines for older people Over sedation Falls and hip fractures Impaired blood pressure regulation Cognitive impairment & memory loss Nocturnal urinary incontinence Emotional changes- worsening depression Worsening sleep Respiratory problems
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