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Antianxiety
Agents
I. Benzodiazepines
A. Indications.
Benzodiazepines are used for the treatment of
anxiety disorders, insomnia, seizure disorders, and detoxification from alcohol.
They are also effective adjunctive agents for agitated psychotic or depressive
states.
1.
All benzodiazepines induce tolerance and are addictive. Short courses of
treatment should be used whenever possible.
2.
The primary indications for long term treatment are chronic anxiety disorders
such as generalized anxiety disorder and panic disorder.
3.
When benzodiazepines are discontinued, the drug should be tapered slowly. Long
acting agents such as clonazepam and diazepam are preferable for long term
treatment because they cause less withdrawal and require less frequent dosing.
4.
The 3-hydroxy-benzodiazepines (lorazepam, alprazolam, oxazepam) have no active
metabolites and are the agents of choice in patients with impaired liver
function.
5.
Acute agitation usually is treated with lorazepam (Ativan), 2 mg IM because it
is well tolerated and effective in most patients.
B. Side Effects
1. Sedation
is the most common and universal side effect,
and patients should be cautioned about driving after taking benzodiazepines.
Tolerance to sedative effects often occurs during the first few weeks of
treatment.
2. Cognitive Dysfunction.
Anterograde amnesia is common after
benzodiazepine use, especially with high potency agents (alprazolam) or short
acting agents (triazolam).
3. Miscellaneous Side Effects
a.
Benzodiazepines may produce ataxia, slurred speech, and dizziness.
b.
Respiratory depression can occur at high doses, especially in combination with
alcohol or respiratory disorders, such as chronic obstructive pulmonary disease.
c.
Benzodiazepines are contraindicated in pregnancy or lactation.
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Antianxiety Agents
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|
Name |
Trade
Name |
Dose (mg) |
Dose
Equivalence |
Half-Life of
Metabolites
(hours) |
|
Alprazolam |
Xanax |
0.25-2
tid/qid |
0.5 |
6-20 |
|
Chlordiazepoxide |
Librium |
25-50
tid/qid |
10 |
30-100 |
|
Clonazepam |
Klonopin |
0.25-2
bid/tid |
0.25 |
18-50 |
II.
Buspirone
A.
Buspirone is a
nonbenzodiazepine anxiolytic agent of the azaperone class.
B. Indications
1.
Buspirone (BuSpar) is indicated
for anxiety disorders such as generalized anxiety disorder; however it is not
effective for panic disorder.
2.
It may also be an effective
adjunctive agent in the treatment resistant depression. It may be added in a
dosage of 15-60 mg/day if a patient has had a suboptimal response to a 3-6 week
trial of an antidepressant.
C. Dosage
1.
The starting dose is 5 mg two
to three times a day. Gradually increase to a maximum dosage of 60 mg per day
over several weeks.
2.
Many patients respond to a
total dose of 30 - 40 mg per day in two to three divided doses.
3.
At least two weeks are required
before clinical improvement occurs. It is common to see the first signs of
improvement after 3-6 weeks.
D. Side Effects
1.
Buspirone is generally well
tolerated; the most common side effects are nausea, headaches, dizziness, and
insomnia.
2.
Buspirone is not addicting and
has no withdrawal syndrome or tolerance, and it does not produce sedation or
potentiate the effects of alcohol.
Education
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