Benzodiazepine gastrointestinal effects

Valproic acid causes hair loss in about 5% of patients, but this effect is reversible. Transient gastrointestinal effects are common, and some mild behavioral effects have been reported. Metabolic effects, including hyperglycemia, hyperglycinuria, and hyperammonemia, have been reported. An increase in body weight also has been noted. Valproic acid is not a CNS depressant, but its administration may lead to increased depression if it is used in combination with phenobarbital, primidone, benzodiazepines, or other CNS depressant agents. 

Less common adverse effects include blurred vision, hallucinations, and paradoxical reactions consisting of excitement, stimulation, and hyperactivity. Also, a variety of gastrointestinal complaints occur, and blood dyscrasias have been reported, but these are rare. Benzodiazepine administration during pregnancy, delivery, or lactation has the potential to have adverse effects on the fetus or newborn. 

There appears to be little difference between benzodiazepines and kava extract in anxiolytic activity. However, kava extracts seem to have fewer side effects. Two studies with more than 3000 patients each found unwanted events in about 2% of patients during treatment with kava extract. The more frequently reported side effects were gastrointestinal complaints, allergic skin reactions, headache, and photosensitivity (Pittler and Ernst, 2000). There have been isolated reports of hepatotoxicity and acute liver failure (Escher et ah, 2001). Kava may potentiate the sedative effects of other medications including barbiturates and benzodiazepines. Kava can also cause behavioral disinhibition in a minority of individuals, including children. The most common problem, which is usually associated with persistent and excessive usage, is a scaly skin rash called kava dermopathy, which is reversible. 

Buspirone causes less psychomotor impairment than benzodiazepines and does not affect driving skills. The drug does not potentiate effects of conventional sedative-hypnotic drugs, ethanol, or tricyclic antidepressants, and elderly patients do not appear to be more sensitive to its actions. Nonspecific chest pain, tachycardia, palpitations, dizziness, nervousness, tinnitus, gastrointestinal distress, and paresthesias and a dose-dependent pupillary constriction may occur. Blood pressure may be significantly elevated in patients receiving MAO inhibitors. 

In most patients, kava s adverse effects are mild at recommended doses. These effects include tingling in the mouth and gastrointestinal upset. Kava does not seem to impair memory or cognitive function to the same degree as benzodiazepines. 

Side effects. Piracetam is well tolerated and there is a low incidence of reported side effects. Those that do occur, at a frequency of less than 10%, include dizziness, insomnia, nausea, gastrointestinal discomfort, weight gain, drowsiness and agitation. Piracetam is indicated only for the treatment of myoclonus, particularly cortical myoclonus. It is used as a second-line drug for patients who are resistant to valproate or the benzodiazepines. 

Adverse effects associated with the use of benzodiazepines include decreased blood pressure, memory impairment, drowsiness, visual disturbances, dizziness, confusion, gastrointestinal disturbances, and urinary retention. 

The safety and efficacy of zolpidem for insomnia is similar to that of the benzodiazepines. As with other sedative medications, treatment optimally should not exceed 4 weeks to minimize tolerance and dependence. Zolpidem is less disruptive of sleep stages than benzodiazepines. The most common adverse effects include drowsiness, amnesia, dizziness, headache, and gastrointestinal complaints. Several cases of brief psychotic reactions have been reported in women. ... 

B. The Movement of Drugs in the Body In order to reach its receptors and bring about a bio-logie effect, a drug molecule (eg, a benzodiazepine sedative) must travel from the site of administration (eg, the gastrointestinal tract) to the site of action (eg, the brain). 

Buspirone, gepirone and ipsapirone, all azapirones have been proven to be effective in generalized anxiety disorders. The compounds maintain the level of efficacy during the period of treatment. The time lag to onset of action is two weeks. The side effects of these drugs (gastrointestinal complaints dizziness and headache) are totally different from those of the benzodiazepines (sedation, memory-loss and withdrawal syndrome). 

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