Vorspan Florence, Barré Thomas, Pariente Antoine, Montastruc François, Tournier Marie
AP-HP, hôpital Fernand-Widal, département de psychiatrie et de médecine addictologique, 75010 Paris, France; Faculté de médecine Paris-Diderot, Inserm UMR-S 1144, 75006 Paris, France.
AP-HP, hôpital Fernand-Widal, département de psychiatrie et de médecine addictologique, 75010 Paris, France.
Presse Med. 2018 Oct;47(10):892-898. doi: 10.1016/j.lpm.2018.10.006. Epub 2018 Oct 25.
Benzodiazepines and Z-drugs have pharmacodynamic effects with tolerance that can occur quickly, after one week to one month of treatment and that concerns hypnotic and anxiolytic properties in particular. Old studies showed a real but poor short-term efficacy of benzodiazepines on anxiety and sleep disturbances. Long-term efficacy of benzodiazepines can be confused with the occurrence of rebound effect, discontinuation symptoms or relapse when the treatment is quitted; they contribute to an apparent efficacy, as well as the symptoms removal when treatment is re-initiated. Pharmacologic tolerance exists with respects to efficacy and side effects that decrease over time, in the first weeks of treatment. Its main associated characteristic is the occurrence of a severe withdrawal syndrome when treatment is quitted. To limit long-term treatments, it is relevant to target treatment initiation of benzodiazepines and to restrict indications and treatment duration. Addiction to benzodiazepines is frequent in patients treated for another addiction; it is associated with more frequent complications, in particular overdoses and suicide attempts. The use of benzodiazepines is necessary to prevent complications during alcohol or benzodiazepine withdrawal, but duration of treatment should be limited and dispensing should be supervised in patients with substance use disorders.
苯二氮䓬类药物和Z类药物具有药效学作用，耐受性可在治疗1周后至1个月内迅速出现，尤其涉及催眠和抗焦虑特性。既往研究表明，苯二氮䓬类药物对焦虑和睡眠障碍的短期疗效确实存在，但效果不佳。当停止治疗时，苯二氮䓬类药物的长期疗效可能会与反跳效应、戒断症状或复发的发生相混淆；它们促成了一种明显的疗效，以及重新开始治疗时症状的消除。在治疗的最初几周，就疗效和副作用而言，存在药物耐受性，且耐受性会随着时间推移而降低。其主要相关特征是停止治疗时会出现严重的戒断综合征。为限制长期治疗，确定苯二氮䓬类药物的治疗起始时机、限制适应证和治疗持续时间是有必要的。在因其他成瘾问题接受治疗的患者中，苯二氮䓬类药物成瘾很常见；它与更频繁的并发症相关，尤其是过量用药和自杀企图。在酒精或苯二氮䓬类药物戒断期间，使用苯二氮䓬类药物对于预防并发症是必要的，但对于患有物质使用障碍的患者，治疗持续时间应有限制，且配药应受到监督。
