Fernandes Milene, Neves Inês, Oliveira Joana, Santos Osvaldo, Aguiar Pedro, Atalaia Paula, Matos Fátima, Freitas Maria Carina, Alvim António, Maria Vasco
Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina-Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal.
ACES Almada Seixal, Administração Regional de Saúde de Lisboa e Vale do Tejo, Largo Professor Arnaldo Sampaio, Lisboa 1549-010, Portugal.
Fam Pract. 2022 Mar 24;39(2):241-248. doi: 10.1093/fampra/cmab143.
Chronic benzodiazepine use is a challenge in primary care practice. Protocols to support safe discontinuation are still needed, especially in countries with high utilization rates.
To evaluate the feasibility, effectiveness, and safety of a benzodiazepine discontinuation protocol in primary care setting.
Nonrandomized, single-arm interventional study, at primary care units. Family physicians (FPs) recruited patients (18-85 years-old) with benzodiazepine dependence and chronic daily use ≥3 months. Patients with daily dosages ≥30 mg diazepam-equivalent, taking zolpidem, with a history of other substance abuse or major psychiatric disease were excluded. After the switch to diazepam, the dosage was gradually tapered according to a standardized protocol. Primary endpoint was the percentage of patients who stopped benzodiazepine at the intervention last visit. Dosage reduction, withdrawal symptoms, patients' and FPs' satisfaction with the protocol were evaluated.
From 66 enrolled patients (74% female; 66.7% aged >64 years; median time of benzodiazepine use was 120 months), 2 withdrew due to medical reasons and 3 presented protocol deviations. Overall, 59.4% of participants successfully stopped benzodiazepine (60.7% when excluding protocol deviations). Men had higher probability of success (relative risk = 0.51, P = 0.001). A total of 31 patients reported at least 1 withdrawal symptom, most frequently insomnia and anxiety. Most of participating FP considered the clinical protocol useful and feasible in daily practice. Among patients completing the protocol, 77% were satisfied. For the patients who reduced dosage, 85% kept without benzodiazepines after 12 months.
The discontinuation protocol with standardized dosage reduction was feasible at primary care and showed long-term effectiveness.
长期使用苯二氮䓬类药物是基层医疗实践中的一项挑战。仍需要支持安全停药的方案，尤其是在使用率高的国家。
评估基层医疗环境中苯二氮䓬类药物停药方案的可行性、有效性和安全性。
在基层医疗单位进行非随机、单臂干预研究。家庭医生招募了年龄在18 - 85岁、对苯二氮䓬类药物有依赖性且每日慢性使用≥3个月的患者。排除每日剂量≥30毫克地西泮等效剂量、服用唑吡坦、有其他物质滥用史或严重精神疾病史的患者。在换用地西泮后，根据标准化方案逐渐减少剂量。主要终点是在干预末次访视时停用苯二氮䓬类药物的患者百分比。评估了剂量减少情况、戒断症状、患者和家庭医生对该方案的满意度。
在66名入组患者中（74%为女性；66.7%年龄>64岁；苯二氮䓬类药物使用的中位时间为120个月），2例因医疗原因退出，3例出现方案偏离。总体而言，59.4%的参与者成功停用苯二氮䓬类药物（排除方案偏离时为60.7%）。男性成功的可能性更高（相对风险 = 0.51，P = 0.001）。共有31名患者报告至少出现1种戒断症状，最常见的是失眠和焦虑。大多数参与的家庭医生认为该临床方案在日常实践中有用且可行。在完成方案的患者中，77%表示满意。对于减少剂量的患者，85%在12个月后不再使用苯二氮䓬类药物。
标准化减量的停药方案在基层医疗中可行且显示出长期有效性。
