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[苯二氮䓬类药物副作用的系统评价]

[Systematic review of the side effects of benzodiazepines].

作者信息

Seldenrijk A, Vis R, Henstra M, Ho Pian K, van Grootheest D, Salomons T, Overmeire F, de Boer M, Scheers T, Doornebal-Bakker R, Ruhé H G, Vinkers C H

机构信息

Werkgroep Benzodiazepinen - Generieke module 'Bijwerkingen; preventie, monitoring en behandeling van bijwerkingen bij geneesmiddelen voor psychiatrische aandoeningen'.

出版信息

Ned Tijdschr Geneeskd. 2017;161:D1052.

PMID:29076441
Abstract
  • Benzodiazepines are used frequently, despite the risk of severe side effects.- The Generic module 'Side effects; prevention, monitoring and treatment of side effects of drugs for psychiatric disorders' will be published soon. This contains recommendations for reduction in the risk for falls and fractures, cognitive problems and dependency related to the use of benzodiazepines or Z-drugs (zopiclone, zolpidem).- Prescribing physicians and pharmacists are compulsorily required to provide extensive information to patients on the anticipated effects and side effects of benzodiazepines, and on the limited prescription period.- A lot of information has become available from systematic literature reviews by the Benzodiazepines working group. Different benzodiazepines present similar risks of falls and fractures; higher doses present a higher risk, and Z-drugs are no safer.- In comparison with placebo, benzodiazepines and Z-drugs soon cause cognitive problems, even at low doses and in drugs with a short half-life. There is almost no development of tolerance for these cognitive problems.- Tailored patient education letters for ceasing benzodiazepine use are more effective than the standard letters. Different dose-tapering schemes have comparable success rates (on average 50%). Augmentation with cognitive behavioural therapy is effective for dose reduction.- It is therefore important to carefully consider the use of benzodiazepines before using them.
摘要
  • 尽管存在严重副作用风险,但苯二氮䓬类药物仍被频繁使用。

  • “副作用;精神疾病药物副作用的预防、监测和治疗”通用模块即将发布。其中包含有关降低与使用苯二氮䓬类药物或Z类药物(佐匹克隆、唑吡坦)相关的跌倒、骨折、认知问题和依赖性风险的建议。

  • 开处方的医生和药剂师必须向患者提供有关苯二氮䓬类药物预期效果和副作用以及有限处方期的详细信息。

  • 苯二氮䓬类药物工作组的系统文献综述提供了大量信息。不同的苯二氮䓬类药物存在相似的跌倒和骨折风险;剂量越高风险越高,Z类药物也并不更安全。

  • 与安慰剂相比,苯二氮䓬类药物和Z类药物即使在低剂量和半衰期短的药物中也会很快导致认知问题。对这些认知问题几乎不会产生耐受性。

  • 针对停用苯二氮䓬类药物的个性化患者教育信比标准信件更有效。不同的剂量递减方案成功率相当(平均50%)。采用认知行为疗法辅助减药有效。

  • 因此,在使用苯二氮䓬类药物之前仔细考虑其使用情况很重要。

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