Sleep or Drowsy causing Medication

Complications /Information to beware of/General tips:

Be aware of :

• Hypnotic and Anxiolytic (Barbiturates, benzodiazepines and hypnotics) Overdose

• Benzodiazepines are often used with antidepressants as adjunct treatment.
• They are especially useful in the management of acute situational anxiety disorder and adjustment disorder where the duration of pharmacotherapy is anticipated to be 6 weeks or less and for the rapid control of panic attacks.
• Benzodiazepines act quickly but carry the liability of physiologic and psychologic dependence. They can be used as an initial adjunct while SSRIs are titrated to an effective dose, and they can then be tapered over 4-12 weeks while the SSRI is continued.
• This approach can improve short-term tolerability, although it may increase the risk of sedation (drowsiness) and requires warnings not to operate motor vehicles after taking benzodiazepines or if feeling sedated. If possible, long-term prescription of benzodiazepines for chronic anxiety disorders should be avoided.
• Benzodiazepine use has not proved to be effective in the treatment of Post traumatic stress disorder  or Obsessive compulsive disorders.
• The risk of addiction with benzodiazepines should be carefully considered before use in anxiety disorders.
• Benzodiazepine use should be avoided in patients with a prior history of alcohol or other drug abuse.
• Evidence of unauthorized dose escalation or obtaining benzodiazepine prescriptions from multiple sources should be closely monitored.

Medscape

Tapering of medication:

• Recommend that deprescribing (tapering slowly).
• Benzodiazepines be offered to elderly adults (≥ 65 years), regardless of duration of use.
• Deprescribing should be offered to adults aged 18-64 years who have used benzodiazepines for more than 4 weeks.
• These recommendations apply to patients who use these drugs to treat insomnia alone (primary insomnia) or comorbid insomnia where underlying comorbidities are effectively managed.
• This guideline does not apply to those with other sleep disorders (eg, restless leg syndrome) or untreated anxiety, depression, or other physical or mental health conditions that might be causing or aggravating insomnia.
• The guidelines further state that tapering will help reduce withdrawal symptoms, although it may not eliminate them.
• At each step in the taper (approximately every 1-2 weeks), patients should be monitored for severity and frequency of adverse drug withdrawal symptoms, potential benefits, and mood, sleep quality, and changes in sleep.
• This can be done at a scheduled appointment or through a telephone call by a physician, psychologist, pharmacist, or nurse.

Canadian Family Physician

Medscape

• Benzodiazepines are commonly misused by individuals with opioid dependence, with prevalence rates of 45%-70% for patients in opioid maintenance treatment.
• Although benzodiazepines taken alone are relatively safe in case of overdose, the combination of these drugs and opioid analgesics can produce significant respiratory depression and may be fatal.
• Because of these risks, concomitant prescribing of opioids with benzodiazepines should be reserved for use in patients for whom alternative treatment options are inadequate; such patients should be closely monitored.

Medscape

• Physical and psychological dependence, tolerance to and difficulty withdrawing from a benzodiazepine, can occur after less than 14 days’ continuous use.
• Withdrawal symptoms can manifest themselves anytime from a few hours to three weeks after stopping a benzodiazepine, depending on the drug’s half-life.

The Pharmaceutical Journal, PJ, February 2005;()::DOI:10.1211/PJ.2021.1.81445