Effects of alprazolam and lorazepam on catecholaminergic and cardiovascular activity during supine rest, mental load and orthostatic challenge

Berg, Frans van den; Tulen, Joke H.M.; Boomsma, Frans; Noten, J.B.G.M.; Moleman, P.; Pepplinkhuizen, L.

doi:10.1007/s002130050105

Cited by 20 publications

(8 citation statements)

References 39 publications

(63 reference statements)

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“…A possible hypothesis for this arterial pressure decrease would be the more controlled response of adrenaline and noradrenaline during the stress, confirming the findings of Van den Berg et al [32], who suggested that alprazolam presents specific adrenomedullary suppression activity. These results demonstrate the clinical safety of alprazolam at the dose of 0.5 mg in the preoperative period, besides providing adequate maintenance of the vital signs during the clinical procedures, corroborating with several authors [10,11,13].…”

Section: Discussionsupporting

confidence: 86%

Efficacy assessment of oral and sublingual sedation using alprazolam in implantology surgical procedures

Rosa

Sotto-Maior

Francischone

et al. 2019

RGO, Rev. Gaúch. Odontol.

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Objective: The aim of this study was to evaluate the efficacy of two formulations of alprazolam (ALP) in patients undergoing oral implantology surgical procedures. Methods: A single-blinded randomized clinical study was performed with 52 volunteers (both genders) divided into 2 groups: G1 (n = 26) – oral administration of ALP (0.5 mg) 1h before surgical procedures; and G2 (n = 26) – sublingual administration of ALP (0.5mg) 30 minutes before surgery. Blood pressure (BP) and heart rate (HR) were evaluated. Corah dental anxiety scale (COR), visual analogic scale (VAS), Trieger test (TRI) and the perception questionnaire (PQ) were used to assess the level of anxiety and responses to formulations, respectively. All parameters were evaluated at three times (be-fore, during and postoperative). Results: For BP and HR no statistically significant differences were observed between periods for G1 and G2 (p> 0.05). For COR, most volunteers were classi-fied such as anxious or very anxious. For VAS, decreased anxiety was significant (p< 0.05) and no statistically significant differences between the two groups both in the period “pre” (p= 0.18) and “post” (p= 0.12) were observed. For TRI, there were no significant differences between the periods considering the number of points lost (p> 0.05). The anxiety reduction was significant (p< 0.05) for both formulations. As for PQ, both formulations showed good volunteers’ acceptance (p> 0.05), and they have not reported anterograde amnesia. Conclusion: It was concluded that both formulations were effective for sedation of the evaluated volunteers.

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Section: Discussionsupporting

confidence: 86%

Efficacy assessment of oral and sublingual sedation using alprazolam in implantology surgical procedures

Rosa

Sotto-Maior

Francischone

et al. 2019

RGO, Rev. Gaúch. Odontol.

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“…The treating psychiatrist was instructed to try to maintain the level of medication at the same level, but to adjust levels if deemed clinically necessary. Studies indicate that SSRIs [25] and benzodiazapines [26] do not adversely affect the BP response to orthostasis.…”

Section: Methodsmentioning

confidence: 99%

Mechanisms of Efficacy of CBT for Cambodian Refugees with PTSD: Improvement in Emotion Regulation and Orthostatic Blood Pressure Response

Hinton

Hofmann

Pollack

et al. 2009

CNS Neuroscience & Therapeutics

157

112

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Based on the results of a randomized controlled trial, we examined a model of the mechanisms of efficacy of culturally adapted cognitive-behavior therapy (CBT) for Cambodian refugees with pharmacology-resistant posttraumatic stress disorder (PTSD) and comordid orthostatic panic attacks (PAs). Twelve patients were in the initial treatment condition, 12 in the delayed treatment condition. The patients randomized to CBT had much greater improvement than patients in the waitlist condition on all psychometric measures and on one physiological measure-the systolic blood pressure response to orthostasis (d = 1.31)-as evaluated by repeated-measures MANOVA and planned contrasts. After receiving CBT, the Delayed Treatment Group improved on all measures, including the systolic blood pressure response to orthostasis. The CBT treatment's reduction of PTSD severity was significantly mediated by improvement in orthostatic panic and emotion regulation ability. The current study supports our model of the generation of PTSD in the Cambodian population, and suggests a key role of decreased vagal tone in the generation of orthostatic panic and PTSD in this population. It also suggests that vagal tone is involved in emotion regulation, and that both vagal tone and emotion regulation improve across treatment.

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“…clonidine, guanfacine) [68] Benzodiazepines (e.g. midazolam, alprazolam, lorazepam), especially when given parenterally [69,70] Dopamine agonists (e.g. pramipexole, ropinirole) and levodopa [71,72] Intravascular volume contraction Diuretics (e.g.…”

Section: Drug-drug Interactionsmentioning

confidence: 99%

Antipsychotic Pharmacotherapy and Orthostatic Hypotension

Gugger

2011

CNS Drugs

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Orthostatic hypotension is a common adverse effect of antipsychotics that may delay or prevent titration to a dose necessary to control psychotic symptoms. Complications of orthostatic hypotension include syncope, transient ischaemic attack, stroke, myocardial infarction and death. The risk of orthostatic hypotension associated with antipsychotic therapy is increased in patients with disorders of the autonomic nervous system, fluid imbalance and those taking concomitant drug therapy that affects haemodynamic tone. Prospective monitoring for changes in postural blood pressure is important because patients with psychotic disorders often do not articulate symptoms of orthostasis and the subjective report of dizziness does not correlate well with orthostatic blood pressure changes. Nonpharmacological strategies and patient education, most notably, slowly rising from the supine position, are crucial first steps in the prevention and treatment of both symptomatic and asymptomatic orthostatic hypotension. Pharmacological treatment is only recommended when symptomatic orthostatic hypotension persists despite proper nonpharmacological therapy and there is a compelling indication for antipsychotic treatment. Fludrocortisone is a reasonable first choice for symptomatic orthostatic hypotension. Other agents including desmopressin and midodrine may be considered in patients who do not respond favourably to a trial of fludrocortisone, but safety concerns and lack of evidence limit the utility of these agents.

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Effects of alprazolam and lorazepam on catecholaminergic and cardiovascular activity during supine rest, mental load and orthostatic challenge

Cited by 20 publications

References 39 publications

Efficacy assessment of oral and sublingual sedation using alprazolam in implantology surgical procedures

Efficacy assessment of oral and sublingual sedation using alprazolam in implantology surgical procedures

Mechanisms of Efficacy of CBT for Cambodian Refugees with PTSD: Improvement in Emotion Regulation and Orthostatic Blood Pressure Response

Antipsychotic Pharmacotherapy and Orthostatic Hypotension

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