A retrospective review on benzodiazepine use: A case study from a chronic dispensary unit

Abstract

Background. Benzodiazepines (BZDs) are highly effective hypnotic and anxiolytic agents and among the most frequently used drugs in the world, but there are significant disadvantages associated with their use. Identifying possible irrational BZD prescribing is important to ensure safe and effective use of these agents. No studies have been conducted in other African countries, and this is the only study in the Western Cape (WC) Province of South Africa (SA), highlighting the paucity of local research. Objectives. To identify the most commonly prescribed BZDs at a chronic dispensary unit (CDU) in the WC and describe the indications, co-prescribing patterns and patient factors in different areas of the WC. Methods. A retrospective, quantitative study was carried out using prescription data from a CDU in the Western Cape Department of Health, SA. Data for January 2017 were analysed. Associations between BZD therapeutic indications and co-prescribing patterns were assessed, together with demographic data. Data were coded and descriptive and inferential analysis was done using Stata version 14. Results. A total of 1 396 prescriptions met the inclusion criteria and were analysed. Overall, clonazepam was the most frequently prescribed BZD (n=691 prescriptions, 49.5%), followed by diazepam (n=298, 21.4%), lorazepam (n=222, 15.9%) and oxazepam (n=185, 13.3%). The most common therapeutic indication for BZDs was epilepsy (n=294, 21.1%), followed by depression (n=166, 11.9%) and depression with concomitant anxiety (n=79, 5.7%). The most common concomitant drug class associated with BZD use was antiepileptics (n=1 581), followed by other BZDs (n=706) and analgesics and antipyretics (n=665). Female patients were more likely than males to be prescribed BZDs (p<0.001), and the mean (standard deviation) age of BZD users was 51.3 (19.5) years. Conclusions. BZDs were most commonly prescribed to female patients and middle-aged adults. Clonazepam was the most frequently prescribed BZD, indicating a preference for long-acting BZDs. Epilepsy was the most common therapeutic indication and antiepileptics were the most common concomitant drug class prescribed, implying that BZDs have a primary role in the management of epileptic conditions in the public healthcare sector. Future studies should include the private sector, as regulations in the public sector greatly influence the patterns of BZD use.

Long-term benzodiazepine prescriptions in community psychiatry clinics

“…42 However, these control measures have not been entirely effective. 21 Benzodiazepines are divided into four groups based on their elimination half-life. They include ultra-short acting (midazolam, triazolam), short-acting (oxazepam, temazepam), intermediate-acting (alprazolam, bromazepam, lorazepam), and long-acting (clonazepam, diazepam, nitrazepam).…”

“…Generally, in the South African public healthcare sector, clinicians’ choice depends on what is available on the country’s essential medicine list and in the central pharmacy stocks at the time of prescribing. 21 , 44 During this study, the benzodiazepines available on the essential medicine list were diazepam, lorazepam, oxazepam, and clonazepam. However, as there are no limitations in the South African private health sector; there is a preference for intermediate-acting benzodiazepines such as alprazolam and bromazepam.…”

“…Despite not being recommended as first-line treatment by all guidelines, 1 , 2 , 4 , 17 benzodiazepines in actual clinical practice tend to be prescribed for a broad range of psychiatric conditions, including anxiety, mood, psychotic, personality, and sleep disorders, 10 , 18 , 19 , 20 and in patients with comorbid medical illnesses. 19 , 20 , 21 , 22 They are also frequently prescribed for older patients, 23 , 24 , 25 , 26 females, 27 , 28 , 29 patients with lower education and socioeconomic status, 24 and those with perceived low levels of support. 24 , 30 Although the guidelines recommend that benzodiazepines be prescribed for short periods of 2 weeks initially and then reviewed, several studies have reported a high rate of prescribing benzodiazepines for long-term periods.…”

O Uso De Benzodiazepínicos Em Idosos E O Risco De Dependência: Uma Revisão Integrativa

“…Outro risco é a tolerância, que pode ser desenvolvida com repetidas doses, resultando em um aumento do uso para adquirir o resultado clínico inicial. A suspensão do uso de BZD de forma abrupta pode implicar em uma síndrome de abstinência, caracterizada por sintomas semelhantes aos anteriormente tratados, causando ansiedade, irritabilidade e distúrbios no sono (SINGH;OOSTHUIZEN, 2019).…”

Análise do perfil de utilização de medicamentos ansiolíticos em uma unidade da Farmácia da Família no Sudoeste Baiano

“…pacientes deste estudo, representando 85,71% das notificações de receitas B1, seguido por 17,58% de indicações do Diazepam.Entretanto, não ocorreu a dispensação de 16,49% dessas prescrições por motivos diversos, como rasuras, ausência do carimbo do prescritor, concentração errada do fármaco, dosagem não pertencente à Relação Municipal de Medicamentos Essenciais (REMUME), Cartão Nacional de Saúde (CNS) não pertencente ao município e nova prescrição antes do prazo previsto para o término da última medicação dispensada (menos de 60 dias). Os pacientes foram orientados quanto às irregularidades para que Estudos sobre a utilização desses medicamentos em outros países apresentam resultados equivalentes, com destaque para a indicação do Clonazepam, seguido pelo Diazepam e Lorazepam, na segunda e/ou terceira posições(Alpízar et al, 2020;Singh & Oosthuizen, 2019).Similarmente, os autores Alvim et al (2017), Gonçalves (2019), Moreira e Borja (2018) e Schallemberger e Colet (2016) compartilham esses mesmos resultados, evidenciando que, no Brasil, o Clonazepam e o Diazepam estão nas primeiras…”