SciELO - Scientific Electronic Library Online

 
vol.48 issue1Treatment; of carotid-cavernous fistula: historical reviewThe practice of neurosomnology author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.48 no.1 São Paulo Mar. 1990

http://dx.doi.org/10.1590/S0004-282X1990000100020 

Benzodiazepínicos padrões de uso, tolerância e dependência

 

Benzodiazepinics: patterns of use. tolerance and dependence

 

 

Márcio Antonini BernikI; Márcia B. de Macedo SoaresII; Cláudio de Novaes SoaresII

IMédico Assistente HC, FMUSP - Trabalho realizado no Ambulatório de Ansiedade do Instituto de Psiquiatria do Hospital das Clinicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP)
IIAcadêmico, FMUSP - Trabalho realizado no Ambulatório de Ansiedade do Instituto de Psiquiatria do Hospital das Clinicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

 

 


RESUMO

Os autores procuram abordar, através de revisão da literatura recente, os principais aspectos a respeito dos benzodiazepínicos (BDZ), uma das drogas largamente utilizadas em todo o mundo como ansiolíticos e hipnóticos. Para isso, sáo apresentados: breve histórico sobre o surgimento das drogas hipnótico-sedativas e ansiolíticas, e como evoluiu seu consumo (e abuso) ao longo dos últimos anos; os principais conceitos aceitos a respeito dos mecanismos de ação dos BDZ; o desenvolvimento de tolerância aos efeitos dos RDZ, abordando inclusive sua tolerância diferencial; por fim, alguns aspectos sobre a sfndrome de abstinência que se segue à retirada abrupta dos BDZ, enfocando a questão da dependência.


SUMMARY

The authors review recent studies on benzodiazepine, the most largely used drug for insomnia and anxiety. In this paper are summarized: the development, patterns of use and abuse, mechanism of action, development of differential tolerance to its many effects, and the phenomena of withdrawal and dependence on the benzodiazepines.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

REFERÊNCIAS

1. Allgulander G - History and current status of sedative-hypnotic drug use and abuse. Acta Psychiat Scand 73:465, 198C.         [ Links ]

2. Ayd FJ Jr - Social issues: misuse and abuse. Psychosomatics 21:21, 1980.         [ Links ]

3. Ayd FJ Jr - Benzodiazepine dependence and withdrawal. MD State Med J 32:22, 1983.         [ Links ]

4. Baldessarini RJ - Chemotherapy in Psychiatry: Principles and Practice. Harvard Univ Press, Cambridge, 1985.         [ Links ]

4a. Braestrup C, Nielsen M, Squires RF - No changes in rat benzodiazepines receptors after withdrawal from continuous treatment with lorazepam and diazepam. Life Sci 24:347, 1979.         [ Links ]

5. Browne TR - Benzodiazepines in human seizure disorders. In Usdin E (ed): Pharmacology of Benzodiazepines. Mac Millan, London, 1982, pg 329.         [ Links ]

6. Busto V, Sellers EM, Naranjo CA, Cappell H, Sanchez-Craig M, Simpkins J - Patterns of benzodiazepine abuse and dependence. Br J Addict 81:87, 1986.         [ Links ]

6a. Chiu TH, Rosenberg HC - Reduced diazepam binding following chronic benzodiazepine treatment. Life Sci 23:1153, 1978.         [ Links ]

7. Busto V, Sellers EM, Naranio CA. Cappell H, Sanchez-Craig M, Sykora K - Withdrawal reaction after lone-term therapeutic use of benzodiazepines. N Engl J Med 315:854, 1986.         [ Links ]

8. Church MW, Johnson LC - Mood and performance of poor sleepers during repeated use of flurazepam. Psychopharmacology 61:309, 1979.         [ Links ]

8a. Committee on the Review of Medicine - Systematic review of the benzodiazepines. Br Med J 1:910, 1980.         [ Links ]

9. Costa E, Guidotti A - Endogenous ligands for benzodiazepines recognition. Biochem Pharmacol 34:3399, 1985.         [ Links ]

10. Diagnostic and Statistical Manual of Mental Disorders. Ed 3. American Psychiatric Assoc Press, Washington, 1980.         [ Links ]

11. Dingemanse J, Breiner DD - Benzodiazepine receptors. Pharmacy Internat 5:33, 1984.         [ Links ]

12. Dundee JW - Abuse of benzodiazepines. Br J Anaesth 55:1, 1983.         [ Links ]

13. File SE - Tolerance to the behavioural actions of benzodiazepines. Neurosci Biobehav Rev 9:113, 1985.         [ Links ]

14. Gallager DW, Tallman JF - Consequences of benzodiazepine receptor occupancy. Neuropharmacology 22:1493, 1983.         [ Links ]

15. Graeff FG - Animal models of aversion. In Simon P, Soubril Ph, Widlocher D (eds): Animal Models of Psychiatric Disorders. Karger, Basel, in press.         [ Links ]

16. Gray JA - Precis of the neuropsychology of anxiety: enquiry into the functions of the septo-hippocampal system. Behav Brain Sci 5:469, 1982.         [ Links ]

17. Greenblatt DJ, Divol M, Abernethy DR, Ochs HR, Shader RI - Clinical pharmacokinetics of the newer benzodiazepines. Clin Pharmacokin 8:233, 1983.         [ Links ]

18. Greenblatt DJ, Shader RI - Long-term administration of benzodiazepines: pharmacokinetic versus pharmacodynamic tolerance. Psychopharmacol Bull 22:416, 1986.         [ Links ]

19. Greenblatt DJ, Shader RI, Harmatz JS, Georgotas A - Self-rated sedation and plasma concentrations of desmethyldiazepam following single doses of clorazepate. Psyehopharmacology 66:289, 1979.         [ Links ]

20. Harvey SC - Hypnotics and sedatives. In Goodman IS, Gilman A (eds): The Pharmacological Basis of Therapeutics. Ed 7. McMillan, New York, 1985.         [ Links ]

21. Heiman EM, Wood G - Patients characteristics and clinician attitudes influencing the prescribing of benzodiazepines. J Clin Psychiat 42:71, 1981.         [ Links ]

22. Hemminki E, Bruun K, Jensen OT - Use of benzodiazepines in nordic countries in the 1960's and 1970's. Br J Addict 78:415, 1983.         [ Links ]

23. Hollister LE - Clinical Pharmacology of Psychotherapeutic Drugs. Ed 2. Churchill Livingstone, Edinburgh, 1983.         [ Links ]

24. Hollister LE, Motzenbecker FP, Degan RO - Withdrawal reaction from chlordiazepoxide («Librium»). Psycopharmacologia 2:63, 1961.         [ Links ]

25. Kales A, Bixler EO, Tan T, Scharf MB, Kales JD - Chronic hypnotic drug use: ineffectiveness drug-withdrawal insomnia, and dependence. J Am Med Assoc 227:513, 1974.         [ Links ]

26. Kales A, Soldatos CR - Rebound insomnia and rebound anxiety: a review. Pharmacology 26:121, 1983.         [ Links ]

27. Kales A, Sharf MB, Kales JD - Rebound insomnia: a new clinical syndrome. Science 201:1039, 1978.         [ Links ]

27a. Karobath M, Placheta P, Lippistch M, Krogsgaard-Larsen P - Characterization of GABA--stimulated benzodiazepine receptor binding in receptors for neurotransmitters and peptide hormones. In Pepeu G, Kuhar MJ, Enna SJ (eds). Raven Press, New York, 1980.         [ Links ]

28. Khan A, Hornblow AR, VValshe JWB - Benzodiazepine dependence: a general practice survey. NZ Med J 94:19, 1981.         [ Links ]

29. Koumjian K - The use of Valium as a form of social control. Soc Sci Med 15E :245, 1981.         [ Links ]

30. Lader M - Benzodiazepine: the opium of the masses. Neuroscience 3:159, 1978.         [ Links ]

31. Lader MH, Higgitt AC - Management of benzodiazepine dependence, update 1986. Br J Addict 81:7, 1986.         [ Links ]

32. Lennane KJ - Treatment of benzodiazepine dependence. Med J Austr 144:594, 1986.         [ Links ]

33. Lippa AS, Coupt J, Greenblatt EN, Klepner CA, Beer B - Benzodiazepine receptors: cellular and behavioral characteristics. Pharmacol Biochem Beh 10:831, 1979.         [ Links ]

34. Loudon JB - Drug treatment. In Kendell RE, Zealley AK (eds): Companion to Psychiatric Studies. Churchill Livingstone, London, 1988, pg 700.         [ Links ]

35. Lucki R, Rickels K, Geller AM - Psychomotor performance following the long term use of benzodiazepines. Psychopharmacol Bull 21:93, 1985.         [ Links ]

36. Marks I - Benzodizepines: Use, Overuse, Misuse, Abuse. MTP Press, Lancaster, 1983.         [ Links ]

37. Mellinger GD, Baiter MB - Prevalence and patterns of use of psychotherapeutic drugs: results from a 1979 national survey of American adults. In Tognoni G, Bellantuono C, Lader M (eds): Epidemiologic Impact of Psychotropic Drugs. Elsevier, Amsterdam, 1981, pg 117.         [ Links ]

38. Mohler H, Okada T - Benzodiazepine receptor: demonstration in the central nervous system. Science 198:849, 1978.         [ Links ]

38a. Murphy SM, Owen RT, Tyrer PJ - Withdrawal symptoms after six weeks treatment with diazepam. Lancet 2:1389, 1984.         [ Links ]

38b. Nutt DJ, Cowen PJ, Franklin M, Murdock P, Gosden B, Fraser S - The effect of diazepam on indices of 5-HT function in man. Pharmacol Biochem Beh 24:1491, 1986.         [ Links ]

39. Petturson H, Shur E, Chockley S, Slade A, Lader MHA - Neuroendrocrine approach to benzodiazepine tolerance and dependence. Br JClin Pharmacol 11:526, 1981.         [ Links ]

40. Piesur-Strehlow B, Strehlow V, Poser W - Mortality of patients dependent on benzodiazepines. Acta Psychiat Scand 73:330, 1986.         [ Links ]

41. Rhodes JC, Houston JB - Antipyrine metabolite kinetics in phenobarbital and B-naph-thoflavone-induced rats. Drug Metab Disp 11:131, 1983.         [ Links ]

42. Rickels K - Treatment of anxiety. First Meeting Internat Society of Investigation on Stress. Munich, 1988.         [ Links ]

43. Rickels K, Case WG, Winokur A, Swenson C - Long-term benzodiazepine therapy and clinical outcome. J Am Med Assoc 250:767, 1983.         [ Links ]

44. Solomon F, White CC, Dorrow DL, Mendelson WB - Sleeping pills, insomnia and medical practice. N Engl J Med 300:803, 1979.         [ Links ]

45. Solomon H, Snyder SH - Opiate and benzodiazepine receptors. Psychosomatics 22:986, 1981.         [ Links ]

46. Squires FR, Benson DJ, Baestrup C, Coupet J, Klepner CA, Myers V, Beer B - Some properties of brain specific benzodiazepines receptors: new evidence for multiple receptors. Pharmacol Biochem Beh 10:825, 1979.         [ Links ]

47. Swanson DA - Benzodiazepines in Psychiatry. S Afr Med J 49:1829, 1975.         [ Links ]

48. Tallman JF, Paul SM, Skolnick R, Gallager DW - Receptors for the age anxiety: pharmacology of the benzodiazepines. Science 207:274, 1980.         [ Links ]

49. Tyrer P - Dependence on benzodiazepines. Br J Psychiat 137:576, 1980.         [ Links ]

50. Tyrer P, Owen R, Dawling S - Gradual withdrawal of diazepam after long term therapy. Lancet 1:1402, 1983.         [ Links ]

51. Tyrer P, Seivenwright N - Identification and management of benzodiazepine dependence. Postgrad Med J 60 (Suppl 2):41, 1984.         [ Links ]

52. Winokur A, Rickels K, Greenblatt DJ, Snyder PJ, Schatz NJ - Withdrawal reactions from long-term, low dosage, administration of diazepam. Arch Gen Psychiat 37:101, 1980.         [ Links ]

 

 

Dr. Márcio A. Bemik - Ambulatório de Ansiedade, Instituto de Psiquiatria - Hospital das Clínicas, FMUSP - Caixa Postal 8091 - 01051 São Paulo SP - Brasil

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License