Dependence on benzodiazepines

In subjects with sedative-hypnotic dependence who underwent detoxification in an addictions treatment unit, a significant association was not found between abstinence rate and either gender or psychiatric status (Charney et al. 2000). Patients dependent on benzodiazepines reported decreased anxiety during follow-up, even though their use of these agents had decreased. 

Physical dependence on benzodiazepines Flumazenil is known to precipitate withdrawal seizures in patients who are physically dependent on benzodiazepines, even if such dependence was established in a relatively few days of high-dose sedation in ICU environments. The risk of either seizures or resedation in such cases is high and patients have experienced seizures before regaining consciousness. Use flumazenil in such settings with extreme caution, because use of flumazenil in this situation has not been studied and no information as to dose and rate of titration is available. 

Dependence on benzodiazepines, as evidenced by a withdrawal syndrome, can develop to large doses of drugs. Mild dependence is produced at therapeutic doses. 

Griffiths, R.R., Sannerud, Ch.A. Abuse of and dependence on benzodiazepines and other anxiolytic sedative drugs. In Meltzer, H.Y. (ed.) Psychopharmacology the Third Generation of Progress. Raven, New York. 1987, pp. 1535-1541. 

Physical dependence on benzodiazepines is recognized as a major problem, and occurs after relatively short periods of treatment (50,51), particularly in patients with a history of benzodiazepine or alcohol problems. Abrupt withdrawal can cause severe anxiety, perceptual changes, convulsions, or delirium. It can masquerade as a return of the original symptoms in a more severe form (rebound), or present with additional features (SEDA-17,42 11). Up to 90% of regular benzodiazepine users have adverse symptoms on withdrawal. The differences between rebound, withdrawal syndrome, and recurrence have been reviewed in detail (3). 

The likelihood and possible severity of dependence on benzodiazepines has been discussed (50). 

Pelissolo A, Bisserbe JC. Dependance aux benzodiazepines. Aspects clinique et biologiques. [Dependence on benzodiazepines. Clinical and biological aspects.] Encephale 1994 20(2) 147-57. 

Flumazenil may induce seizures, particularly in patients tolerant to or dependent on benzodiazepines, or who have overdosed on cyclic antidepressants, received recent/repeated doses of parenteral benzodiazepines, or have jerking or convulsion during overdose... 

Patients dependent on benzodiazepines or receiving benzodiazepines to suppress seizures in cyclic antidepressant overdose should receive the minimally effective dose of flumazenil... 

The issues of abuse of and dependence on benzodiazepines have been controversial. Benzodiazepines do turn up on the street but far less frequently than barbiturates or Quaaludes did in their day. In general the potential for abuse of benzodiazepines is considered to be fairly moderate in comparison with most other depressants (Cappell, Sellers, Busto, 1986). There are still reports of abuse and dependence, and they appear to be most common in individuals who abuse other drugs (King, 1994). The... 

Ashton. H. (1989) Risks of dependence on benzodiazepine drugs a major... 

The half-life of elimination (fj ) of benzodiazepines is a special pharmacokinetic parameter. It clearly divides them into three groups (a) long half-life 48 h and above (b) medium, 24-48 h and (c) short, less than 24 h [69], We note also that clinical pharmacologists have recently hnked the development of dependence on benzodiazepines to f,/2 [70], The half-life of ehmination is closely related through the clearance (Cl) to other pharmacokinetic parameters such as the distribution volume V and the bioavailability F). 

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