Departamento de Medicina Interna, Dermatología y Psiquiatría. Facultad de Ciencias de la Salud, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain; Consultoría Psiquiátrica SC, Santa Cruz de Tenerife, Spain.
Departamento de Medicina Interna, Dermatología y Psiquiatría. Facultad de Ciencias de la Salud, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain; Sociedad para la Investigación y Asistencia en Salud Mental, Santa Cruz de Tenerife, Spain.
Drug Alcohol Depend. 2020 Jul 1;212:107994. doi: 10.1016/j.drugalcdep.2020.107994. Epub 2020 Apr 25.
Hypnotics (HYP) and benzodiazepines (BZD) are medicines prescribed for the insomnia treatment. Many patients present difficulties in discontinuing the treatment once established. Melatonin (MLT) has been prescribed as a treatment for BZD/HYP detoxification.
The primary objective of this systematic review is to assess the efficacy of MLT and MLT agonists (melatoninergics) in improving the rate of BZD and/or HYP discontinuation among adults with primary insomnia attempting to discontinue BZD and/or HYP. The secondary objective is to evaluate the partial efficacy of melatoninergic drugs in the discontinuation of BZD and/or HYP consumption in subjects that could not stop their consumption.
A search on Web of Science and Scopus was carried out from database inception to July 1st, 2019.
Three hundred and forty-nine articles were identified but only four were included in the final review. Two were cohort prospective, one placebo-control double blind and one double blind placebo-control cross-over designed study. Total withdrawal (TW) ranged from 0% to 25% in the placebo arm and from 64.3% to 77.8% in the MLT arm. In cohort studies TW figures ranged from 30.8% to 65%. Partial withdrawal ranged between 20% and 30.8% of patients that did not achieve TW with reduction figures of diazepam equivalent dose ranging from 25% to 75%.
MLT has a place in the physician armamentarium to treat the suspension/reduction of BZD/HYP consumption in patients with primary insomnia.
催眠药（HYP）和苯二氮䓬类药物（BZD）是用于治疗失眠的药物。许多患者一旦开始治疗，就难以停止。褪黑素（MLT）已被开处方作为 BZD/HYP 解毒的治疗方法。
本系统评价的主要目的是评估 MLT 和 MLT 激动剂（褪黑素能药物）在改善原发性失眠患者试图停止 BZD 和/或 HYP 治疗时 BZD 和/或 HYP 停药率方面的疗效。次要目的是评估褪黑素能药物在无法停止 BZD 和/或 HYP 消费的受试者中停止 BZD 和/或 HYP 消费的部分疗效。
对 Web of Science 和 Scopus 数据库进行了检索，检索时间从数据库建立到 2019 年 7 月 1 日。
共确定了 349 篇文章，但只有 4 篇被纳入最终综述。其中 2 篇为队列前瞻性研究，1 篇为安慰剂对照双盲研究，1 篇为双盲安慰剂交叉设计研究。安慰剂组的总停药（TW）率为 0%至 25%，MLT 组为 64.3%至 77.8%。在队列研究中，TW 率从 30.8%到 65%不等。部分停药率在 20%到 30.8%之间，未能达到 TW 的患者的地西泮等效剂量减少了 25%至 75%。
MLT 在治疗原发性失眠患者 BZD/HYP 消费的暂停/减少方面，是医生治疗手段的一部分。
