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Benzodiazepines: Difference between revisions
>Unity Undo revision 119086 by David Hedlund (talk) Links to 'Barbiturate' page instead of 'Benzodiazepine' |
>NaYeahMate m →Equivalent dosages: Corrected Clonazolam equivalent dosage. |
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At the same time, 117 general practitioners and 50 health authorities were sued by patients to recover damages for the harmful effects of dependence and withdrawal. This led some doctors to require a signed consent form from their patients and to recommend that all patients be adequately warned of the risks of dependence and withdrawal before starting treatment with benzodiazepines.<ref>{{cite journal | author = King MB | title = Is there still a role for benzodiazepines in general practice? | journal = Br J Gen Pract | volume = 42 | issue = 358 | pages = 202–5 | year = 1992 | pmid = 1389432 | pmc = 1372025 }}</ref> The court case against the drug manufacturers never reached a verdict; legal aid had been withdrawn and there were allegations that the consultant psychiatrists, the expert witnesses, had a conflict of interest. This litigation led to changes in the British law, making class action lawsuits more difficult.<ref name="urlHouse of Commons">{{cite web |url=http://www.publications.parliament.uk/pa/cm199899/cmselect/cmhealth/549/99072723.htm |title=Memorandum by Dr Reg Peart |author=Peart R |date=1999-06-01 |work=Minutes of Evidence |publisher=Select Committee on Health, House of Commons, UK Parliament |accessdate=2009-05-27 }}</ref> | At the same time, 117 general practitioners and 50 health authorities were sued by patients to recover damages for the harmful effects of dependence and withdrawal. This led some doctors to require a signed consent form from their patients and to recommend that all patients be adequately warned of the risks of dependence and withdrawal before starting treatment with benzodiazepines.<ref>{{cite journal | author = King MB | title = Is there still a role for benzodiazepines in general practice? | journal = Br J Gen Pract | volume = 42 | issue = 358 | pages = 202–5 | year = 1992 | pmid = 1389432 | pmc = 1372025 }}</ref> The court case against the drug manufacturers never reached a verdict; legal aid had been withdrawn and there were allegations that the consultant psychiatrists, the expert witnesses, had a conflict of interest. This litigation led to changes in the British law, making class action lawsuits more difficult.<ref name="urlHouse of Commons">{{cite web |url=http://www.publications.parliament.uk/pa/cm199899/cmselect/cmhealth/549/99072723.htm |title=Memorandum by Dr Reg Peart |author=Peart R |date=1999-06-01 |work=Minutes of Evidence |publisher=Select Committee on Health, House of Commons, UK Parliament |accessdate=2009-05-27 }}</ref> | ||
Although antidepressants with anxiolytic properties have been introduced, and there is increasing awareness of the adverse effects of benzodiazepines, prescriptions for short-term anxiety relief have not significantly dropped.<ref name=pmid18671662>{{cite journal | author = Lader M | title = Effectiveness of benzodiazepines: do they work or not? | journal = Expert Rev Neurother | volume = 8 | issue = 8 | pages = 1189–91 | year = 2008 | pmid = 18671662 | doi = 10.1586/14737175.8.8.1189 | type = PDF }}</ref> For treatment of insomnia, benzodiazepines are now less popular than nonbenzodiazepines, which include [[zolpidem]], zaleplon and [[zopiclone|eszopiclone]].<ref>{{cite journal | author = Jufe GS | title = [New hypnotics: perspectives from sleep physiology] | journal = Vertex | volume = 18 | issue = 74 | pages = 294–9 | date = Jul–Aug 2007 | pmid = 18265473 }}</ref> Nonbenzodiazepines are molecularly distinct, but nonetheless, they work on the same benzodiazepine receptors and produce similar sedative effects.<ref name=wake>{{cite journal | author = Lemmer B | title = The sleep–wake cycle and sleeping pills | journal = Physiol Behav | volume = 90 | issue = 2–3 | pages = 285–93 | year = 2007 | pmid = 17049955 | doi = 10.1016/j.physbeh.2006.09.006 }}</ref> | Although antidepressants with anxiolytic properties have been introduced, and there is increasing awareness of the adverse effects of benzodiazepines, prescriptions for short-term anxiety relief have not significantly dropped.<ref name="pmid18671662">{{cite journal | author = Lader M | title = Effectiveness of benzodiazepines: do they work or not? | journal = Expert Rev Neurother | volume = 8 | issue = 8 | pages = 1189–91 | year = 2008 | pmid = 18671662 | doi = 10.1586/14737175.8.8.1189 | type = PDF }}</ref> For treatment of insomnia, benzodiazepines are now less popular than nonbenzodiazepines, which include [[zolpidem]], zaleplon and [[zopiclone|eszopiclone]].<ref>{{cite journal | author = Jufe GS | title = [New hypnotics: perspectives from sleep physiology] | journal = Vertex | volume = 18 | issue = 74 | pages = 294–9 | date = Jul–Aug 2007 | pmid = 18265473 }}</ref> Nonbenzodiazepines are molecularly distinct, but nonetheless, they work on the same benzodiazepine receptors and produce similar sedative effects.<ref name="wake">{{cite journal | author = Lemmer B | title = The sleep–wake cycle and sleeping pills | journal = Physiol Behav | volume = 90 | issue = 2–3 | pages = 285–93 | year = 2007 | pmid = 17049955 | doi = 10.1016/j.physbeh.2006.09.006 }}</ref> | ||
==Chemistry== | ==Chemistry== | ||
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* [[Flunitrazolam]] | * [[Flunitrazolam]] | ||
* [[Nitrazolam]] | * [[Nitrazolam]] | ||
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* [[Midazolam]] | * [[Midazolam]] | ||
* [[Loprazolam]] | * [[Loprazolam]] | ||
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The authors of this table specifically state that their equivalents differ from those used by other authors and "are firmly based on clinical experience during switch-over to diazepam at the start of withdrawal programs but may vary between individuals."<ref>BENZODIAZEPINE EQUIVALENCE TABLE | http://www.benzo.org.uk/bzequiv.htm</ref> | The authors of this table specifically state that their equivalents differ from those used by other authors and "are firmly based on clinical experience during switch-over to diazepam at the start of withdrawal programs but may vary between individuals."<ref>BENZODIAZEPINE EQUIVALENCE TABLE | http://www.benzo.org.uk/bzequiv.htm</ref> | ||
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| '''''[[Research chemicals]]''''' || Half-life (Hours)<br>[active metabolite] || Approx. equivalent<br> oral dosage (mg) || Predominant effect <br>(a= [[anxiolytic]],<br> c= [[anticonvulsant]],<br> h= [[hypnotic]]) | | '''''[[Research chemicals]]''''' || Half-life (Hours)<br>[active metabolite] || Approx. equivalent<br> oral dosage (mg) || Predominant effect <br>(a= [[anxiolytic]],<br> c= [[anticonvulsant]],<br> h= [[hypnotic]]) | ||
|- | |- | ||
| '''[[Clonazolam]]''' || ? || 0. | | '''[[Clonazolam]]''' || ? || 0.2 || h | ||
|- | |- | ||
| '''[[Deschloroetizolam]]''' || ~9-20 || 6 || a | | '''[[Deschloroetizolam]]''' || ~9-20 || 6 || a | ||
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