Benzodiazepines: Pro and Contra

Abstract

Benzodiazepini se općenito dobro podnose, imaju relativno malo nuspojava, a učinkoviti su u liječenju anksioznih i njima srodnih poremećaja. Učinkoviti su hipnotici, pa se rabe u liječenju poremećaja spavanja. Benzodiazepini su također djelotvorni kao miorelaksansi ili antikonvulzivi, a uvelike se rabe za ublažavanje sindroma alkoholnog sustezanja. Imaju primjenu i kao intravenski anestetici. Farmakokinetske osobine pojedinog benzodiazepina određuju i indikaciju za primjenu. Bez obzira na široku primjenu benzodiazepina, njihova primarna indikacija i nadalje ostaju anksiozni poremećaji, i to ponajprije opći anksiozni poremećaj i panični poremećaj. Ovi lijekovi su relativno netoksični i sigurniji od drugih lijekova sličnog djelovanja, a uzeti u prekomjernoj dozi rijetko dovode do letalnog ishoda. Najčešća nuspojava ovih lijekova je neželjena dnevna sedacija, a najproblematičnija nuspojava je ovisnost, koja se može javiti u mnogih bolesnika tijekom kronične upotrebe. Nelagoda zbog posljedičnog sindroma sustezanja također predstavlja značajnu teškoću. Stoga u primjeni benzodiazepina treba biti vrlo racionalan, tj. treba ih propisivati samo onda kada je to indicirano, davati što je moguće nižu dozu u što kraćem vremenu. Terapija anksioznih stanja ne bi trebala trajati dulje od 4 tjedna u kontinuitetu, a terapija za insomniju treba biti sporadična.Benzodiazepines are generally well tolerated, have relatively few side-effects, and are efficacious in treatment of anxious and related disorders. Because benzodiazepines are effective hypnotics they are used in treatment of sleep disorders. Benzodiazepines are also efficacious as myorelaxant agents or anticonvulsants, and are widely used for diminishing withdrawal syndrome. They are also used as intravenous anesthetics. Pharmacokinetic features of particular benzodiazepine determine their indication for use. Despite wide use of benzodiazepines, their primary indication remains for anxiety disorders in particular generalized anxiety disorder and panic disorder. This medication is relatively nontoxic and safer than other medication of similar effect, and when taken in overdose rarely lethal. The most common side-effect of these medications is unwanted daily sedation, and most problematic side-effect is dependence, which can develop in many patients on chronic treatment. Also another significant problem is the discomfort caused by the withdrawal syndrome. Because of all this the use of benzodiazepines should be very rational, i. e. they should be prescribed only when indicated, the lowest possible dose should be administered for as short time as possible. If possible the therapy of anxious states should not be longer than 4 weeks in continuum, and the therapy for insomnia should be sporadic

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