Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Tapering (deprescribing) of benzodiazepine tranquilizers

https://doi.org/10.14412/2074-2711-2019-1-89-95

Full Text:

Abstract

Deprescribing is the opposite of prescribing drugs, the purpose of which is to improve quality of life and reduce the risk of adverse drug reactions. The paper considers the process of deprescribing benzodiazepines. It analyzes relevant studies on this problem, as well as recommendations to help decide whether it is a need for deprescribing and how to accurately do this. There are also the results of original investigations demonstrating the tapering of benzodiazepine tranquilizers: comparison of simple tampering, use of psychotherapy, or replacement pharmacotherapy. The use of a deprescribing algorithm is the safest way to discontinue benzodiazepines in patients who do not have serious indications for their long-term use.

About the Authors

D. A. Sychev
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
2/1, Barrikadnaya St., Build. 1, Moscow 125993


A. V. Zhuchkov
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation

Anton Vladimirovich Zhuchkov

2/1, Barrikadnaya St., Build. 1, Moscow 125993



O. V. Tereshchenko
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
1, Ostrovityanov St., Moscow 117997


D. V. Ivashchenko
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
2/1, Barrikadnaya St., Build. 1, Moscow 125993


References

1. Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline. Can Fam Physician. 2018 May; 64(5):339-351.

2. Ladyzhenskii MYa, Gorodnichev AV, Kostyukova EG. Benzodiazepine anxiolytics: are they in demand today? Sovremennaya terapiya psikhicheskikh rasstroistv. 2014;(2):20-5. (In Russ.).

3. ОсадOsadshii YuYu, Voblenko RA, Archakov DS, et al. Place of benzodiazepines in modern therapy of mental disorders (review of evidence-based studies). Sovremennaya terapiya psikhicheskikh rasstroistv. 2016;(1):2-10. (In Russ.).

4. Paquin AM, Zimmerman K, Rudolph JL. Risk versus risk: a review of benzodiazepine reduction in older adults. Expert Opin Drug Saf. 2014 Jul;13(7):919-34. doi: 10.1517/14740338.2014.925444. Epub 2014 Jun 6.

5. Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014 Jun; 174(6):890-8. doi: 10.1001/jamainternmed.2014.949.

6. Vicens C, Bejarano F, Sempere E, et al. Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomised controlled trial in primary care. Br J Psychiatry. 2014 Jun;204(6):471-9. doi: 10.1192/bjp.bp.113.134650. Epub 2014 Feb 13.

7. Schweizer E, Rickels K, Case WG, et al. Long-term therapeutic use of benzodiazepines. II. Effects of gradual taper. Arch Gen Psychiatry. 1990 Oct;47(10):908-15.

8. Denis C, Fatseas M, Lavie E, et al. Pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings. Cochrane Database Syst Rev. 2013 Jun 18;(6):CD005194. doi: 10.1002/14651858.CD005194.pub3.

9. O’Connor K, Marchand A, Brousseau L, et al. Cognitive-behavioural, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine. Clin Psychol Psychother. 2008 Jan-Feb;15(1):1-14. doi: 10.1002/cpp.556.

10. Voshaar RC, Gorgels WJ, Mol AJ, et al. Predictors of long-term benzodiazepine abstinence in participants of a randomized controlled benzodiazepine withdrawal program. Can J Psychiatry. 2006 Jun;51(7):445-52.

11. Paquin AM, Zimmerman K, Rudolph JL. Risk versus risk: a review of benzodiazepine reduction in older adults. Expert Opin Drug Saf. 2014 Jul;13(7):919-34. doi: 10.1517/14740338.2014.925444. Epub 2014 Jun 6.

12. Busto U, Sellers EM, Naranjo CA, et al. Withdrawal reaction after long-term therapeutic use of benzodiazepines. N Engl J Med. 1986 Oct 2;315(14):854-9.

13. Rickels K, Schweizer E, Case WG, et al. Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. Arch Gen Psychiatry. 1990 Oct;47(10):899-907.

14. Voshaar RC, Gorgels WJ, Mol AJ, et al. Tapering off long-term benzodiazepine use with or without group cognitive-behavioural therapy: three-condition, randomised controlled trial. Br J Psychiatry. 2003 Jun;182:498-504.

15. Baillargeon L, Landreville P, Verreault R, et al. Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. CMAJ. 2003 Nov 11;169(10):1015-20.

16. Rickels K, Case WG, Schweizer E, et al. Long-term benzodiazepine users 3 years after participation in a discontinuation program. Am J Psychiatry. 1991 Jun;148(6):757-61.

17. Vikander B, Koechling UM, Borg S, et al. Benzodiazepine tapering: A prospective study. Nord J Psychiatry. 2010 Aug;64(4):273-82. doi: 10.3109/08039481003624173.

18. Nardi AE, Freire RC, Valenсa AM, et al. Tapering clonazepam in patients with panic disorder after at least 3 years of treatment. J Clin Psychopharmacol. 2010 Jun;30(3):290-3. doi: 10.1097/JCP.0b013e3181dcb2f3.

19. Salonoja M, Salminen M, Aarnio P, et al. One-time counselling decreases the use of benzodiazepines and related drugs among community-dwelling older persons. Age Ageing. 2010 May;39(3):313-9. doi: 10.1093/ageing/afp255. Epub 2010 Jan 20.

20. Pchelina PV, Tabidze AA, Poluektov MG. Comparative study of the effectiveness of cognitive behavioral therapy and zopiclon in chronic insomnia. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;117(4):48-55. (In Russ.).

21. Shapiro CM, Sherman D, Peck DF. Withdrawal from benzodiazepines by initially switching to zopiclone. Eur Psychiatry. 1995;10 Suppl 3:145s-51s. doi: 10.1016/0924-9338(96)80096-4.

22. Pat-Horenczyk R, Hacohen D, Herer P, et al. The effects of substituting zopiclone in withdrawal from chronic use of benzodiazepine hypnotics. Psychopharmacology (Berl). 1998 Dec; 140(4):450-7.

23. Garfinkel D, Zisapel N, Wainstein J, Laudon M. Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach. Arch Intern Med. 1999 Nov 8; 159(20):2456-60.

24. Cardinali DP, Gvozdenovich E, Kaplan MR, et al. A double-blind controlled study on melatonin efficacy to reduce anxiolytic benzodiazepine use in the elderly. Neuro Endocrinol Lett. 2002 Feb;23(1):55-60.

25. Vissers FH, Knipschild PG, Crebolder HF. Is melatonin helpful in stopping the long-term use of hypnotics? A discontinuation trial. Pharm World Sci. 2007 Dec;29(6):641-6. Epub 2007 Jul 3.

26. Garzon C, Guerrero JM, Aramburu O, et al. Effect of melatonin administration on sleep, behavioral disorders and hypnotic drug discontinuation in the elderly: A randomized, double-blind, placebo-controlled stud. Aging Clin Exp Res. 2009 Feb;21(1):38-42.

27. Baandrup L, Lindschou J, Winkel P, et al. Prolonged-release melatonin versus placebo for benzodiazepine discontinuation in patients with schizophrenia or bipolar disorder: A randomi sed, placebo-controlled, blinded trial. World J Biol Psychiatry. 2016 Oct;17(7):514-24. doi: 10.3109/15622975.2015.1048725. Epub 2015 Jun 18.

28. Peles E, Hetzroni T, Bar-Hamburger R, et al. Melatonin for perceived sleep disturbances associated with benzodiazepine withdrawal among patients in methadone maintenance treatment: A double-blind randomized clinical trial. Addiction. 2007 Dec;102(12):1947-53. Epub 2007 Oct 4.

29. Hadley SJ, Mandel FS, Schweizer E. Switching from long-term benzodiazepine therapy to pregabalin in patients with generalized anxiety disorder: A double-blind, placebo-controlled trial. J Psychopharmacol. 2012 Apr; 26(4):461-70. doi: 10.1177/0269881111405360. Epub 2011 Jun 21.

30. Shevtsova GE, Isaikin AI, Parfenov VA. Cognitive behavioral therapy as a component of interdisciplinary treatment program for postoperative non-oncological pain. Rossiiskii zhurnal boli. 2018;(1):64-9. (In Russ.).


For citation:


Sychev D.A., Zhuchkov A.V., Tereshchenko O.V., Ivashchenko D.V. Tapering (deprescribing) of benzodiazepine tranquilizers. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(1):89-95. (In Russ.) https://doi.org/10.14412/2074-2711-2019-1-89-95

Views: 276


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)