BZD and dementia

[lobelsteve]

http://www.psychiatryadvisor.com/al...1&spJobID=640409648&spReportId=NjQwNDA5NjQ4S0

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[101N]

1. http://www.ncbi.nlm.nih.gov/pubmed/26123874
2. http://www.ncbi.nlm.nih.gov/pubmed/23045258
To say nothing of their inherent addictive properties and the added risk of over dose death when
prescribed with opioids. And if they claim none of these work, it's completely appropriate to cycle back through them all as nocebo effects are common in CNP patients.

TIP 54 SAMHSA: BENZODIAZEPINE ALTERNATIVES


The consensus panel recommends that clinicians treat comorbid anxiety and insomnia with antidepressants or anticonvulsants. Some antidepressants (e.g., trazodone, mirtazapine, amitriptyline, doxepin) may be useful sleep aids. Benzodiazepine weaning can be done in consultation with a psychiatrist or SUD treatment provider (see Center for Substance Abuse Treatment [CSAT], 2006).


The anxiety that is often comorbid with CNCP can often be managed satisfactorily
with adjuvants prescribed for the pain syndrome. Several anticonvulsants that are used
for CNCP are strongly anxiolytic. In a review, Van Ameringen and colleagues (2004) found that the strongest evidence was for pregabalin (for social phobia and generalized anxiety disorder), gabapentin (for social phobia), lamotrigine (for PTSD), and valproic acid (for panic disorder). In addition, many antidepressants are effective for chronic pain and may be used to treat comorbid anxiety and depression, and both duloxetine and venlafaxine have been approved by the Food and Drug Administration for treatment of generalized anxiety disorder. Most tricyclic antidepressants are anxiolytic. Trazodone has also been found to be anxiolytic and is often used as a sedative in patients for whom benzodiazepine-like agents are undesirable. Treating comorbidities with medications that also alleviate pain can reduce polypharmacy, drug interactions,


Alternatives to Benzodiazepines for Sleep

Trazodone: 50mg – 100mg po QHS

Mirtazapine: 15mg po QHS

Amitriptyline: 10mg po QHS

Doxepin: 10mg – 25mg po QHS

Cyclobenzaprine: 10mg po QHS

Benadryl: 50mg po QHS

Melatonin: 5mg po QHS



Alternatives to Benzodiazepines for Anxiety

Pregabalin: (Social Phobia and Generalized Anxiety) Escalating dose over 8wks to 450mg po QD.

Gabapentin: (Social Phobia) Escalating dose over 8wks to 2700mg po QD.

Lomotrigine: (PTSD) Escalating dose over 8wks to 500mg po QD

Valproic Acid: (Panic Disorder) 500mg to 2000mg Escalating dose over 8wks.

Buspirone: (Generalized Anxiety) 7.5mg po BID increase by 5mg Q 3D, to 15mg po BID. Maximum daily dose 60mg.



Alternatives to Benzodiazepines for Panick Atacks

Acute : Propranolol 10mg can repeat x 1

Prophylaxis: Propranolol 10mg po TID. and

 

[jettavr6]

Careful with Lamictal - Steven Johnsons syndrome risk; Depakote - monitor WBC's and LFT's.

Buspirone is an excellent option -- go more aggressive--- 15 bid then to tid--- then to 30mg twice daily.

 

[clubdeac]

You dose the antiepileptics once daily ?

Pregabalin: (Social Phobia and Generalized Anxiety) Escalating dose over 8wks to 450mg po QD.

Gabapentin: (Social Phobia) Escalating dose over 8wks to 2700mg po QD.

Lomotrigine: (PTSD) Escalating dose over 8wks to 500mg po QD