Is it Safe to Drive a Car when Treated with Anxiolytics? Evidence from onthe- Road Driving Studies During Normal Traffic

Abstract

Background. The majority of those suffering from anxiety or related disorders are outpatients, and presumably involved in daily activities such as driving a car. However, anxiolytic drugs may possess sedative properties that reduce alertness and produce sleepiness. Therefore, it must be questioned whether it is safe to drive a car when treated with these drugs. Methods.A MEDLINE literature search (keywords driving and anxiety) and cross-references identified 14 placebo-controlled, double-blind studies that examined the effects of anxiolytic drugs on driving ability by conducting the on-the-road driving test during normal traffic. Primary parameter of the driving test is the Standard Deviation of Lateral Position (SDLP), the weaving of the car. Data from epidemiological studies was summarized as supportive evidence.Results. After single dose administration of benzodiazepines and related GABAergic compounds (diazepam, lorazepam, alprazolam, oxazepam, alpidem, suriclone, zolpidem) driving performance was significantly impaired. Further, although tolerance develops, driving studies show that the impairing effects of benzodiazepines and related GABAergic compounds may still be present after on week of daily treatment (demonstrated for diazepam, lorazepam, alpidem, suriclone). Driving performance was also significantly impaired after single dose administration of TCAs (imipramine, amitriptyline), but after repeated use of TCAs tolerance developed to the impairing effects on driving ability. In contrast, SSRIs (paroxetine, fluoxetine), venlafaxine, ondansetron) and buspirone produced no significant impairment on the driving test after both acute and repeated administration. These findings were in line with epidemiological evidence.Conclusions. Patients treated with benzodiazepines, GABAergic compounds, or TCAs should be cautioned when driving a car. Driving a car when treated with buspirone, venlafaxine, 5HT-antagonists, and SSRIs seems relatively safe.

Consistency Between the Subjective Perception of Feeling Indisposed, the Decision to Drive and Driving Performance

“…The cognitive, emotional, and even social deterioration linked to psychophysical changes affecting drivers may result in a decrease of safety while driving [1,14]. That is the reason why we suggest that this problem must be especially considered and, consequently, treated as a priority by the Administration and all the agents involved at the intervention level.…”

“…More than 50% of the patients that visit health professionals suffer from anxiety disorders, with part of their treatment being psychoactive medicine consumption [14]. The control and advice from the doctor, the knowledge of the disease and of the effects of the medicines being used, the patient's knowledge of how to act when facing specific side effects, as well as family support and advice, may decrease the patient's risk of being involved in a traffic crash.…”

Zolpidem and zopiclone impair similarly monotonous driving performance after a single nighttime intake in aged subjects

“…Positive correlations were found, but only one was found to be statistically significant (residual blood concentrations of Fln and the SDS changes from placebo). This lack of relationship was probably due to the small number of data available to perform such correlations since a high variability of BACs was described for SDLP values (Verster et al 2005). Moreover, the relationship with alcohol was described with blood concentrations collected shortly after ingestion.…”

Cognitive, psychomotor and actual driving performance in healthy volunteers after immediate and extended release formulations of alprazolam 1 mg

“…SDLP is a measure of road tracking error or 'weaving'. SDLP has proven to be sensitive to the sedative and stimulating effects of various psychoactive drugs such as anxiolytics Verster et al 2005), hypnotics (Vermeeren 2004), antidepressants (Ramaekers 2003), and antihistamines (O'Hanlon and Ramaekers 1995;Verster and Volkerts 2004a).…”