Summary
Objectives
To evaluate the knowledge of specialists on the pharmacological properties and clinical use of benzodiazepines (BDZs) in anxiety.
Methods
A 16-item online questionnaire, produced using the Delphi method, was submitted to a panel of 300 psychiatrists and neurologists.
Results
The specialists showed poor knowledge regarding the pharmacokinetic and pharmacodynamic principles of BDZs, but good knowledge on the mechanisms of interactions of these drugs and their co-administration in polytherapy. Patients receiving prolonged treatment with BDZs can develop “psychological attachment” to the drug. The phase of tapering down the dose of BDZ that is easiest for patients is the initial, intermediate or final phase, but not an undetermined phase. The optimal withdrawal strategy should take 2-4, 4-6 or 8-12 weeks. All patients are at risk of using BDZs poorly, and the doctor must “educate” the patient on correct administration of BDZs. It is prudent to advise patients to not use BDZs during pregnancy and lactation. The ideal pharmacokinetic profile of a BDZ in elderly subjects is one with a short half-life either without active metabolites or with one or more active metabolites, or an intermediate half-life with no active metabolites. Lorazepam has the best risk/benefit ratio for “acute” use in psychomotor agitation in cases of dementia. Treatment with BDZs should be withdrawn gradually when the symptoms requiring treatment disappear, with the awareness that it can be re-introduced if needed. The specialists indicated an even shorter treatment time than the those reported in the prescribing information for BDZs data sheets.
Conclusions
This shows that the use of BDZs is empirical and based only poorly on clinical and pharmacological knowledge about these compounds.