Benzodiazepines neuroleptic drugs

In accordance with the structure of the BBB as a double Upid bilayer, classical neuroactive drugs such as benzodiazepines, neuroleptics and tricyclic antidepressive agents, are all small lipophilic molecules. These small molecular weight neuropharmaceuticals were selected by a trial and error approach because their structural characteristics allow for diffusion-mediated,... 

It is not clear that so-called antipsychotic drugs are superior to other types of drugs with sedative effects but different mechanisms of action. Lithium, benzodiazepines and opium have been shown to be comparable to neuroleptics in the treatment of psychotic states in some studies. The ability of the neuroleptic drugs to reduce the most characteristic symptoms of psychosis such as hallucinations, delusions and thought disorder have often been interpreted as evidence of their specifically antipsychotic or antischizophrenic action (The National Institute of Mental Health Psychopharmacology Service Center Collaborative Study... 

There is little evidence that lithium is superior to other drugs with sedative actions for the treatment of acute mania. Benzodiazepines, neuroleptics and anticonvulsants have all been tried in mania and none have been found to be inferior to lithium. Two small studies of clonazepam in mania found it was superior to lithium (Chouinard 1988 Chouinard, Young, Annable 1983). All new- and old-generation neuroleptics have been found to be more effective than placebo (Perlis et al. 2006). Comparisons of lithium with the sedative anticonvulsants carbamazepine and sodium valproate show similar effects (Bowden et al. 1994 Freeman et al. 1992 Lerer et al. 1987 Small et al. 1991). 

Female orgasm is inhibited by some central depressant and psychotropic drugs, including neuroleptic drugs, antidepressants, and anxiolytic benzodiazepines (204). 

Neuroleptic drugs can potentiate the sedative effects of benzodiazepines pharmacodynamically. 

In a brief review, emphasis has been placed on pharmacokinetic interactions between neuroleptic drugs and benzodiazepines, as much information on their metabolic pathways is emerging (629). Thus, CYP3A4, which plays a dominant role in the metabolism of benzodiazepines, also contributes to the metabolism of clozapine, haloper-idol, and quetiapine, and plasma neuroleptic drug concentrations can rise. 

The potentiation of sedative effects from benzodiazepines when combined with centrally acting drugs with antihistamine properties (for example first-generation antihistamines, tricyclic antidepressants, and neuroleptic drugs) can pose problems (143). Antihistamines that do not have central actions do not interact with benzodiazepines as in the case of mizolastine and lorazepam (144), ebastine and diazepam (145), and terfenadine and diazepam (143). 

Because of the frequency of co-administration of benzodiazepines with neuroleptic drugs, it is important to consider possible adverse effects that can result from such combinations. In a brief review, emphasis has been placed on pharmacokinetic interactions between neuroleptic drugs and benzodiazepines, as much information on their metabolic pathways is emerging (166). Thus, the enzyme CYP3A4, which plays a dominant role in the metabolism of benzodiazepines, also contributes to the metabolism of clozapine, haloperidol, and quetiapine, and neuroleptic drug plasma concentrations can rise. Intramuscular levomepromazine in combination with an intravenous benzodiazepine has been said to increase the risk of airways obstruction, on the basis of five cases of respiratory impairment the doses of levomepromazine were higher in the five cases that had accompanying airways obstruction than in another 95 patients who did not (167). 

Other drug classes for which RRA have been reported include benzodiazepines, neuroleptics, and tricyclic antidepressants. Many of the drugs in these classes are not asymmetric and information on enantioselectivity is sparse. Barnett and Nahovski (59) give references to these assays. 

A 56-year-old woman with previous affective disorder had an episode of mania while taking ginseng (8). She was treated with neuroleptic drugs and benzodiazepines and ginseng was withdrawn. She made a rapid full recovery. 

Two series of 39 and 78 deaths attributed to buprenorphine have respectively been reported in Strasbourg and 13 other French forensic centers between 1996 and 2000 (14). The risks incurred by the misuse of buprenorphine seem to arise through a combination of (a) the concomitant use of other psychotropic drugs (especially benzodiazepines and neuroleptic drugs) and (b) the improper use of tablets for intravenous administration and/or massive oral doses. The total recorded number of buprenorphine-... 

Various somatic complaints have been reported in patients in whom neuroleptic drugs are abruptly withdrawn (SEDA-20, 44). The incidence of these complaints varies widely in different reports, from 0 to 75%. Common complaints include headache, vomiting, nausea, diarrhea, insomnia, abdominal pain, rhinorrhea, and muscle aches. On rare occasions, the symptoms resemble those of benzodiazepine withdrawal (appetite change, dizziness, tremulousness, numbness, nightmares, a bad taste in the mouth, fever, sweating, vertigo, tachycardia, and anxiety), but it is possible that in some of the reported cases there was actually benzodiazepine withdrawal. Some of these symptoms may also have been linked to... 

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