Drug withdrawal related problem

Sibutramine (Meridia), a weight-loss drug introduced in 1998, inhibits the reuptake of the brain chemicals norepinephrine, dopamine, and serotonin, but does not promote monoamine release like the amphetamines. Yet the drug has been linked to serious side effects, including rapid heart rate, increased blood pressure, heart disease, stroke, seizure, and mental impairments. In March 2002, Italy s Health Ministry announced that it was immediately withdrawing all sibutramine products from the market due to health-related problems. Also, Meridia was the subject of a class action lawsuit filed in the United States. 

Another way to conceptualize drug problems is to examine psychological versus physical dependence on a substance. Psychological dependence is defined by beliefs A person thinks he or she needs the substance in order to cope. Physical dependence, on the other hand, is defined by actual physical changes related to drug use that may result in withdrawal symptoms and tolerance. However, to confuse matters, recreational users also may experience tolerance and withdrawal, so it is important to be careful when using these distinctions to define whether a person has a drug problem. 

My own practice was to refer to agents such as BZ or other related glycolates as similar to belladonna or atropine - belladonnoids if you will. Since the terms atropine and belladonna were also unfamiliar to many volunteers, I said that the effects would vary from person to person, but generally, they would include dryness of the mouth, sleepiness, difficulty in solving problems, and altered perceptions. I assured them that both the nursing staff and I would monitor them closely. I explained that extensive pre-clinical studies in several animal species had revealed no permanent ill effects. I told them we believed the drug to be safe, and would discuss the effects in detail after the test was over. Very few volunteers chose to withdraw after this orientation. 

Sedatives and hypnotics as a group, and BZDs in particular, are frequently implicated in drug-related hospital admissions in the elderly ( 333, 334). This group is at particular risk for abrupt drug discontinuation when hospitalized, with resulting withdrawal symptoms that may be unrecognized as such and attributed to other health problems (313, 335, 336 and 337). BZD hypnotics should not be routinely prescribed in the hospital unless the patient has a demonstrated sleep disorder ( 338). Even then, reassurance that restless sleep is normal in such a situation may obviate the need for a hypnotic ( 330). 

As well as unwanted effects related to direct drug effects, hypnotics, like many other medications, are associated with offset effects, namely withdrawal reactions after discontinuation, abrupt or gradual [4], Numerous terms are used in this context, and include those relating to non-medical use, i.e., abuse and addiction. The purpose of this chapter is to review briefly the clinical problems that can be encountered when discontinuing hypnotic dmgs within the normal therapeutic context. For a review on the abuse and dependence potential of the non-benzodiazepine hypnotics, zolpidem and zopiclone, reference should be made to the paper by Hajak et al. [5],... 

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