Phenobarbital Versus Clonazepam for Sedative-Hypnotic Taper in Chronic Pain Patients: A Pilot Study

Sullivan, Mark D.; Toshima, Michelle T.; Lynn, Pamela; Roy‐Byrne, Peter

doi:10.3109/10401239309148974

Cited by 16 publications

(3 citation statements)

References 10 publications

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“…Most of the patients underwent an initial BZD tapering before starting PHB treatment. Sullivan et al, examined 19 patients in a small randomised, double-blind controlled trial between clonazepam and PHB for the purpose of sedative-hypnotic tapering [ 15 ]. Clinicians used different doses of PHB or clonazepam based on BZD abuse reported by each patient, finding a superiority of BZD over barbiturates for symptoms of withdrawal but not of recurrent or rebound anxiety.…”

Section: Discussionmentioning

confidence: 99%

Phenobarbital use in benzodiazepine and z-drug detoxification: a single-centre 15-year observational retrospective study in clinical practice

Sartori,

Crescioli,

Brilli

et al. 2022

Intern Emerg Med

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Given the increase in benzodiazepine (BZD) and Z-drug (ZD) use disorder, this study described the use of phenobarbital (PHB) as detoxification in clinical practice. A 15-year observational retrospective study was performed on medical records of BZD-ZD use disorder patients detoxified with PHB at the Toxicology Unit and Poison Centre, Careggi University Hospital, Florence (Italy). A multivariate logistic regression was used to estimate odd ratios (ORs) and related 95% confidence intervals (CI) of “treatment failure” considering demographic and pharmacological characteristics. “Hospitalisation length”, “PHB discharge dose”, and “BZD-ZD free status” at discharge were also calculated. During detoxification, out of 355 patients (57% of men), with a mean age of 42.92 years, only 20 (5.6%) treatment failures were recorded: 19 were discharged against medical advice or due to misbehaviour, and only one for PHB-related non-serious skin rash. Analysis showed a higher probability to be BZD-ZD free at discharge for subjects who reported to be employed (OR 2.29; CI 95% 1.00–5.24), for those who abused oral drops of BZD-ZD (OR 2.16, CI 1.30–3.59), and for those treated with trazodone (OR 2.86, CI 1.14–7.17) during hospital stay. A hospitalisation length of > 7 days was observed for patients with opioid maintenance therapy (OR 2.07, CI 1.20–3.58) for substance use disorder, and for those treated with more than 300 mg/day of PHB equivalents at hospital admission (OR 1.68, CI 1.03–2.72). Our results suggested that PHB can be considered a valuable detoxification option for different types of BZD and ZD use disorder patients.

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Section: Discussionmentioning

confidence: 99%

Phenobarbital use in benzodiazepine and z-drug detoxification: a single-centre 15-year observational retrospective study in clinical practice

Sartori,

Crescioli,

Brilli

et al. 2022

Intern Emerg Med

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“…Benzodiazepines have been used for the detoxification of patients with chronic pain from sedative/hypnotic medications. Benzodiazepines were superior to barbiturates for minimizing symptoms of withdrawal (Sullivan et al, 1993).…”

Section: Benzodiazepinesmentioning

confidence: 99%

Pharmacological treatments for chronic non-malignant pain

Clark

2000

International Review of Psychiatry

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A large body of research now supports the use of traditional psychiatric treatments in the management of chronic pain. Pharmacological treatments have proven effective for many different pain syndromes, especially neuropathic conditions. For any specific disease, no single algorithm can dictate the modalities of treatment to be prescribed. Several classes of medications have proven efficacy for the treatment of neuropathic pain. However, the relief provided by these medications is usually incomplete and difficult to predict in advance. The selection of a particular medication, or combination of medications, will depend on multiple factors. The disease itself may change over time such that the efficacy of a treatment is altered, one treatment may be selected over another based on the response to previous treatments, and the patient's psychiatric co-morbidity, temperament, coping skills, and life story cannot be neglected.

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“…There is a consensus about gradual rather than abrupt tapering BZDs as a first step for BZD discontinuation [10,11]. Other extended traditional strategy has been switching from short half-life BZD to long half-life BZD before gradual taper, with different results as for support [12,13]. A great variety of agents have been used as adjuvant medication in BWS with varying degrees of success.…”

Section: Introductionmentioning

confidence: 99%

Anticonvulsant Agents for the Management of Benzodiazepine Dependence

Marín-Mayor¹,

López‐Muñoz²,

Rubio³

2014

AAD

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IntroductionChronic use of Benzodiazepines (BZDs) can lead to tolerance and dependence, as indicated by a BZD Withdrawal Syndrome (BWS). In general, it is preferred a gradual than an abrupt tapering of BZDs as a first step in the treatment of BZD Dependence (BD). In addition, a great variety of agents have been used as adjuvant medication for BD. Recently, research has focused in the use of Anticonvulsant (AC) drugs. The aim of this article is to review the use of AC in the management of BWS and BD. MethodsMEDLINE and the Cochrane were searched, selecting studies from 1980 until 2014, in which a pharmacological intervention with classic and new AC was made for discontinuing long-term BZD use. ResultsIn regard to classic AC, there were identified 10 studies related to carbamazepine and 4 studies related to valproate. On one hand, whereas there is a great body of research involving carbamazepine and there is a consensus about its efficacy for discontinuing long-term BZD use, especially in terms of improving drug-free outcomes, there have been brought inconclusive results in regard to valproate. On the other hand, studies identified of the new AC are as follows: 2 for gabapentin, 2 for oxcarbazepine, 2 for pregabalin, 1 for tigabine and 2 for topiramate. With the exception of pregabalin, only small studies and cases report have been conducted for most of the new AC. Pregabalin has demonstrated to be effective in the treatment of BD and BWS, exerting its beneficial action by reducing the severity of withdrawal and anxiety symptoms. ConclusionTo date, among AC agents, only carbamazepine and pregabalin can be considered as augmentation alternatives for the treatment of long-term BZD use. Further randomized, double-blind, placebo-controlled studies are necessary to increase the knowledge to support the use of AC for the treatment of BD and BWS.

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Phenobarbital Versus Clonazepam for Sedative-Hypnotic Taper in Chronic Pain Patients: A Pilot Study

Cited by 16 publications

References 10 publications

Phenobarbital use in benzodiazepine and z-drug detoxification: a single-centre 15-year observational retrospective study in clinical practice

Phenobarbital use in benzodiazepine and z-drug detoxification: a single-centre 15-year observational retrospective study in clinical practice

Pharmacological treatments for chronic non-malignant pain

Anticonvulsant Agents for the Management of Benzodiazepine Dependence

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