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Ask
the Pharmacist By Ron and Marla Chapleau |
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Q) When is it appropriate to take a benzodiazepine? A) Benzodiazepines (lorazepam, oxazepam, temazepam, alprazolam, diazepam, etc.) have been around for a very long time and when used judiciously, can be of great benefit. However, they come with a number of potential adverse effects, including addiction, dependence, withdrawal symptoms, morning hangover, tolerance (ie. loss of effect over time), confusion, depression, rebound anxiety/insomnia, increased fall risk and others . As such, it is important that they be used at the lowest effective dose and for as short a period of time as possible. It is also vital to recognize that the various drugs that make up this class have significant differences between them and therefore which agent to use should be guided by both the condition being treated and the characteristics of the patient. For instance, in treating insomnia which has failed to respond to sleep hygiene techniques and first-line drugs such as zopiclone or trazadone (which show less tolerance and hangover), temazepam would be a good choice due to its intermediate duration of action. This allows it to maintain sleep but minimizes the potential for the dreaded morning hangover-type feeling. In treating anxiety, benzo’s are very effective for short-term use until a preventative agent (such as an anti-depressant) kicks in or when the anxiety happens very infrequently. In general, the best choice for treating anxiety would be medium- to longer-acting agents such as lorazepam, oxazepam or clonazepam.
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Short-acting agents such as alprazolam can cause severe
rebound anxiety and withdrawal making them hard to quit. Older
patients often do better with lorazepam or oxazepam which are less
likely to accumulate in their bodies and therefore pose less risk of
causing falls. For those who are particularly worried about becoming addicted, alprazolam and diazepam should probably be avoided since they are more likely to cause a drug-induced euphoric effect. For people who have been taking these drugs chronically and wish to stop, there are a number of strategies. One is to reduce your dose by 25-per-cent per week for two weeks, then continue to taper it by 10-per-cent per week until off. Suddenly stopping this family of drugs can pose serious health risks. For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination
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