Benzodiazepines contraindications

Benzodiazepines are used commonly in SAD however, there are limited data supporting their use. Clonazepam has been effective for social anxiety, fear, and phobic avoidance, and it reduced social and work disability during acute treatment.58 Long-term treatment is not desirable for many SAD patients owing to the risk of withdrawal and difficulty with discontinuation, cognitive side effects, and lack of effect on depressive symptoms. Benzodiazepines may be useful for acute relief of physiologic symptoms of anxiety when used concomitantly with antidepressants or psychotherapy. Benzodiazepines are contraindicated in SAD patients with alcohol or substance abuse or history of such. 

High-potency benzodiazepines (e.g., clonazepam and lorazepam) are common alternatives to or in combination with antipsychotics for acute mania, agitation, anxiety, panic, and insomnia or in those who cannot take mood stabilizers. Lorazepam IM may be used for acute agitation. A relative contraindication for long-term benzodiazepines is a history of drug or alcohol abuse or dependency. 

There have been no formal studies of the toxicity of passionflower, but adverse effects have not been reported. There is one report of a case of inflammatory vasculitis associated with a preparation of passionflower (Smith et al. 1993). Like other herbs in this category, its putative benzodiazepine action contraindicates its combined use with other CNS depressants. 

Contraindication are myasthenia gravis, chronic obstructive pulmonary disease and severe hepatic disease. Both in the elderly and in children paradoxical reactions were described. In the elderly the use of benzodiazepines is strongly correlated with falls and hip fractures. 

Patients in whom haloperidol is contraindicated can be treated by intramuscular injection of benzodiazepines, but these can cause respiratory depression or respiratory arrest if given in too high a dose, are contra-indicated in patients with preexisting respiratory depression, and have no specific anti-psychotic effect. 

Contraindications Narrow-angle glaucoma, significant hepatic disease, hypersensitivity to benzodiazepines... 

Contraindications Anticholinergic signs (such as mydriasis, dry mucosa, and hypo-peristalsis), arrhythmias, cardiovascular collapse, history of hypersensitivity to benzodiazepines, patients with signs of serious cyclic antidepressant overdose (such as motor abnormalities), patients who have been given a benzodiazepine for control of a potentially life-threatening condition (such as control of status epilepticus or increased intracranial pressure ICP )... 

Contraindications Acute alcohol intoxication, acute angle-closure glaucoma, hypersensitivity to other benzodiazepines... 

Contraindications Angle-closure glaucoma CNS depression hypersensitivity to other benzodiazepines severe, uncontrolled pain sleep apnea... 

Specific factors to consider are both psychiatric and physical contraindications. For example, bupropion is contraindicated in a depressed patient with a history of seizures due to the increased risk of recurrence while on this agent. Conversely, it may be an appropriate choice for a bipolar disorder with intermittent depressive episodes that is otherwise under good control with standard mood stabilizers. This consideration is based on the limited data suggesting that bupropion is less likely to induce a manic switch in comparison with standard heterocyclic antidepressants. Another example is the avoidance of benzodiazepines for the treatment of panic disorder in a patient with a history of alcohol or sedative-hypnotic abuse due to the increased risk of misuse or dependency. In this situation, a selective serotonin reuptake inhibitor (SSRI) may be more appropriate. 

Barbiturates may precipitate episodes of acute intermittent porphyria (AIP) and their use is contraindicated in patients who are predisposed to this condition. Some animal models indicate that ketamine, etomidate, and the benzodiazepines may be porphyrinogenic and propofol is considered to be the intravenous anaesthetic of choice in AlP-prone patients. 

Ketamine has been traditionally contraindicated in patients with increased ICP or reduced cerebral compliance because it increases CMR02, CBF and ICP. These deleterious effects can be antagonised by the concomitant administration of propofol, or thiopentone, and benzodiazepines. Furthermore, ketamine is an antagonist at the NMDA receptor. Nevertheless, ketamine can adversely affect neurological outcome in the presence of brain ischaemia. 

Only phenobarbital strongly induces the synthesis of the hepatic cytochrome P-450 drug metabolizing system. Phenobarbital is contraindicated in the treatment of acute intermittent porphyria. Buspirone lacks the anticonvulsant and muscle-relaxant properties of the benzodiazepines and causes only minimal sedation, v ... 

Benzodiazepines are secreted into the milk in relatively small amounts (28). During lactation, longer-acting agents are relatively contraindicated, particularly with continued administration beyond 3-5 days, owing to the likelihood of infant sedation (122,124). Short-acting benzodiazepines and zopiclone are probably safe, especially if restricted to single doses or for short courses of therapy (28,125). Zopiclone and midazolam, for example, become undetectable in breast milk 4—5 hours after a dose (126). 

Patients receiving intravenous benzodiazepines must be monitored for respiratory depression, which may demand artificial ventilation during intensive treatment. Diazepam may cause more respiratory depression than lorazepam at equieffective dosages (SEDA-20, 59) and is contraindicated in neonates for this reason and because it produces unacceptably prolonged sedation (9). 

Most anticonvulsants are excreted in the breast milk in limited amounts, and their use is not generally a contraindication to breastfeeding. Barbiturates, ethosuximide, lamotrigine, and to a lesser extent carbamazepine and benzodiazepines can reach appreciable serum concentrations in breast-fed infants, who should be carefully observed. 

Drug treatment of anticholinergic delirium is typically not recommended, although benzodiazepines can be used to treat severe agitation. Neuroleptics, with their anticholinergic properties, are relatively contraindicated. 

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