Drugs of Abuse: Benzodiazepines
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Diazepam - Alcohol Withdrawal
Diazepam - alcohol withdrawal Why have I been prescribed diazepam? If a person stops drinking alcohol after a time of drinking too much they can experience withdrawal effects. These include “the shakes”, sweating, having fits, seeing things which are not there (hallucinations) and feeling anxious and low in mood. They can feel wound up and find it difficult to sleep. These withdrawal effects can be very uncomfortable and in extreme cases can be dangerous if they persist into “DTs” (delirium tremens). Diazepam is used to help reduce these withdrawal symptoms. It relieves anxiety and tension and aids sleep. Diazepam can also prevent fits. It controls the withdrawal symptoms until the body is free of alcohol and has settled down. This usually takes three to seven days from the time you stop drinking. What exactly is diazepam? Diazepam is a benzodiazepine. This group of medicines is also called anxiolytics or minor tranquillisers. Diazepam has many uses. It can be used to reduce symptoms of anxiety and insomnia, as well as to help people come off alcohol. Diazepam should only be prescribed and taken as a short course. Is diazepam safe to take? Diazepam is safe to take for a short period of time, but it doesn’t suit everyone. Below are a few conditions where diazepam may be less suitable. If any of these apply to you please tell your doctor or key-worker. If you have depression or a mental illness If you have lung disease or breathing problems, or suffer from liver or kidney trouble If you take any other medicines or drugs, including those on prescription and bought from a chemist If you take illicit drugs bought “on the street” If you are pregnant or breast-feeding What is the usual dose of diazepam? The dose of diazepam will usually be started at 10-20mg four times a day. -
What Is Diazepam?
Diazepam (Di-a-ze-pam) Valium™ Patient Name: ___________________________________ Date: _____________________________________________ Doctor Name: ___________________________________ Emergency Number: ________________________________ Pharmacy: _____________________________________ Number: __________________________________________ What is Diazepam? • Diazepam is a medicine approved by the Food and Drug Administration to treat all types of seizures, including absence, myoclonic, atonic (drop attacks), partial seizures and seizures associated with Lennox-Gastaut syndrome. • It is most often used together with another antiepileptic drug. It is also used in emergency situations involving seizures. It may also be used for other conditions as well as seizures, such as anxiety. • The drug is quickly absorbed after taking it by mouth and it reaches its highest amount in the body in 1-2 hours. A rectal form of the medicine called diastat is also available. Important questions to ask your doctor: • Why am I being given this medicine? _________________________________________________________________ • What amount should I be taking? ____________________________________________________________________ What does this drug look like and how should I take it? There are several brands and generic forms of the medicine. The brand name Valium is shown below at the 0.5 mg pill, the 1 mg pill and the 2 mg pill and the generic form lorazepam at 1 mg pill is also shown. 10 mg diazepam 10 mg diazepam 2 mg diazepam 10 mg diazepam 5 mg diazepam 2 mg diazepam 5 mg diazepam 2 mg diazepam 10 mg Valium 5 mg Valium 2 mg Valium © 2010 epilepsy.com A service of the Epilepsy Foundation Diazepam (Di-a-ze-pam) Valium™ Frequently Asked Questions: How do I take Diazepam? To use the tablet form: chew tablets and swallow or swallow the tablet whole. -
Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW
Guideline Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW Summary To provide the most up-to-date knowledge and current level of best practice for the treatment of withdrawal from alcohol and other drugs such as heroin, and other opioids, benzodiazepines, cannabis and psychostimulants. Document type Guideline Document number GL2008_011 Publication date 04 July 2008 Author branch Centre for Alcohol and Other Drugs Branch contact (02) 9424 5938 Review date 18 April 2018 Policy manual Not applicable File number 04/2766 Previous reference N/A Status Active Functional group Clinical/Patient Services - Pharmaceutical, Medical Treatment Population Health - Pharmaceutical Applies to Area Health Services/Chief Executive Governed Statutory Health Corporation, Board Governed Statutory Health Corporations, Affiliated Health Organisations, Affiliated Health Organisations - Declared Distributed to Public Health System, Ministry of Health, Public Hospitals Audience All groups of health care workers;particularly prescribers of opioid treatments Secretary, NSW Health Guideline Ministry of Health, NSW 73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 Telephone (02) 9391 9000 Fax (02) 9391 9101 http://www.health.nsw.gov.au/policies/ space space Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW space Document Number GL2008_011 Publication date 04-Jul-2008 Functional Sub group Clinical/ Patient Services - Pharmaceutical Clinical/ Patient Services - Medical Treatment Population Health - Pharmaceutical -
Understanding Benzodiazephine Use, Abuse, and Detection
Siemens Healthcare Diagnostics, the leading clinical diagnostics company, is committed to providing clinicians with the vital information they need for the accurate diagnosis, treatment and monitoring of patients. Our comprehensive portfolio of performance-driven systems, unmatched menu offering and IT solutions, in conjunction with highly responsive service, is designed to streamline workflow, enhance operational efficiency and support improved patient care. Syva, EMIT, EMIT II, EMIT d.a.u., and all associated marks are trademarks of General Siemens Healthcare Diagnostics Inc. All Drugs other trademarks and brands are the Global Division property of their respective owners. of Abuse Siemens Healthcare Product availability may vary from Diagnostics Inc. country to country and is subject 1717 Deerfield Road to varying regulatory requirements. Deerfield, IL 60015-0778 Please contact your local USA representative for availability. www.siemens.com/diagnostics Siemens Global Headquarters Global Siemens Healthcare Headquarters Siemens AG Understanding Wittelsbacherplatz 2 Siemens AG 80333 Muenchen Healthcare Sector Germany Henkestrasse 127 Benzodiazephine Use, 91052 Erlangen Germany Abuse, and Detection Telephone: +49 9131 84 - 0 www.siemens.com/healthcare www.usa.siemens.com/diagnostics Answers for life. Order No. A91DX-0701526-UC1-4A00 | Printed in USA | © 2009 Siemens Healthcare Diagnostics Inc. Syva has been R1 R2 a leading developer N and manufacturer of AB R3 X N drugs-of-abuse tests R4 for more than 30 years. R2 C Now part of Siemens Healthcare ® Diagnostics, Syva boasts a long and Benzodiazepines have as their basic chemical structure successful track record in drugs-of-abuse a benzene ring fused to a seven-membered diazepine ring. testing, and leads the industry in the All important benzodiazepines contain a 5-aryl substituent ring (ring C) and a 1,4–diazepine ring. -
Risk Based Requirements for Medicines Handling
Risk based requirements for medicines handling Including requirements for Schedule 4 Restricted medicines Contents 1. Introduction 2 2. Summary of roles and responsibilities 3 3. Schedule 4 Restricted medicines 4 4. Medicines acquisition 4 5. Storage of medicines, including control of access to storage 4 5.1. Staff access to medicines storage areas 5 5.2. Storage of S4R medicines 5 5.3. Storage of S4R medicines for medical emergencies 6 5.4. Access to storage for S4R and S8 medicines 6 5.5. Pharmacy Department access, including after hours 7 5.6. After-hours access to S8 medicines in the Pharmacy Department 7 5.7. Storage of nitrous oxide 8 5.8. Management of patients’ own medicines 8 6. Distribution of medicines 9 6.1. Distribution outside Pharmacy Department operating hours 10 6.2. Distribution of S4R and S8 medicines 10 7. Administration of medicines to patients 11 7.1. Self-administration of scheduled medicines by patients 11 7.2. Administration of S8 medicines 11 8. Supply of medicines to patients 12 8.1. Supply of scheduled medicines to patients by health professionals other than pharmacists 12 9. Record keeping 13 9.1. General record keeping requirements for S4R medicines 13 9.2. Management of the distribution and archiving of S8 registers 14 9.3. Inventories of S4R medicines 14 9.4. Inventories of S8 medicines 15 10. Destruction and discards of S4R and S8 medicines 15 11. Management of oral liquid S4R and S8 medicines 16 12. Cannabis based products 17 13. Management of opioid pharmacotherapy 18 14. -
Benzodiazepines
Benzodiazepines Using benzodiazepines in Children and Adolescents Overview Benzodiazepines are group of medications used to treat several different conditions. Some examples of these medications include: lorazepam (Ativan®); clonazepam (Rivotril®); alprazolam (Xanax®) and oxazepam (Serax®). Other benzodiazepine medications are available, but are less commonly used in children and adolescents. What are benzodiazepines used for? Benzodiazepines may be used for the following conditions: • anxiety disorders: generalized anxiety disorder; social anxiety disorder; post-traumatic stress disorder (PTSD); panic attacks/disorder; excessive anxiety prior to surgery • sleep disorders: trouble sleeping (insomnia); waking up suddenly with great fear (night terrors); sleepwalking • seizure disorders (epilepsy) • alcohol withdrawal • treatment of periods of extreme slowing or excessive purposeless motor activity (catatonia) Your doctor may be using this medication for another reason. If you are unclear why this medication is being prescribed, please ask your doctor. How do benzodiazepines work? Benzodiazepines works by affecting the activity of the brain chemical (neurotransmitter) called GABA. By enhancing the action of GABA, benzodiazepines have a calming effect on parts of the brain that are too excitable. This in turn helps to manage anxiety, insomnia, and seizure disorders. How well do benzodiazepines work in children and adolescents? When used to treat anxiety disorders, benzodiazepines decrease symptoms such as nervousness, fear, and excessive worrying. Benzodiazepines may also help with the physical symptoms of anxiety, including fast or strong heart beat, trouble breathing, dizziness, shakiness, sweating, and restlessness. Typically, benzodiazepines are prescribed to manage anxiety symptoms that are uncomfortable, frightening or interfere with daily activities for a short period of time before conventional anti-anxiety treatments like cognitive-behavioural therapy or anti-anxiety takes effect. -
XANAX® Alprazolam Tablets, USP
XANAX® alprazolam tablets, USP CIV WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death [see Warnings, Drug Interactions]. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation. DESCRIPTION XANAX Tablets contain alprazolam which is a triazolo analog of the 1,4 benzodiazepine class of central nervous system-active compounds. The chemical name of alprazolam is 8-Chloro-1-methyl-6-phenyl-4H-s-triazolo [4,3-α] [1,4] benzodiazepine. The structural formula is represented to the right: Alprazolam is a white crystalline powder, which is soluble in methanol or ethanol but which has no appreciable solubility in water at physiological pH. Each XANAX Tablet, for oral administration, contains 0.25, 0.5, 1 or 2 mg of alprazolam. XANAX Tablets, 2 mg, are multi-scored and may be divided as shown below: 1 Reference ID: 4029640 Inactive ingredients: Cellulose, corn starch, docusate sodium, lactose, magnesium stearate, silicon dioxide and sodium benzoate. In addition, the 0.5 mg tablet contains FD&C Yellow No. 6 and the 1 mg tablet contains FD&C Blue No. 2. CLINICAL PHARMACOLOGY Pharmacodynamics CNS agents of the 1,4 benzodiazepine class presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system. Their exact mechanism of action is unknown. Clinically, all benzodiazepines cause a dose-related central nervous system depressant activity varying from mild impairment of task performance to hypnosis. -
Analytical Methods for Determination of Benzodiazepines. a Short Review
Cent. Eur. J. Chem. • 12(10) • 2014 • 994-1007 DOI: 10.2478/s11532-014-0551-1 Central European Journal of Chemistry Analytical methods for determination of benzodiazepines. A short review Review Article Paulina Szatkowska1, Marcin Koba1*, Piotr Kośliński1, Jacek Wandas1, Tomasz Bączek2,3 1Department of Toxicology, Faculty of Pharmacy, Collegium Medicum of Nicolaus Copernicus University, 85-089 Bydgoszcz, Poland 2Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, 80-416 Gdańsk, Poland 3Institute of Health Sciences, Division of Human Anatomy and Physiology, Pomeranian University of Słupsk, 76-200 Słupsk, Poland Received 16 July 2013; Accepted 6 February 2014 Abstract: Benzodiazepines (BDZs) are generally commonly used as anxiolytic and/or hypnotic drugs as a ligand of the GABAA-benzodiazepine receptor. Moreover, some of benzodiazepines are widely used as an anti-depressive and sedative drugs, and also as anti-epileptic drugs and in some cases can be useful as an adjunct treatment in refractory epilepsies or anti-alcoholic therapy. High-performance liquid chromatography (HPLC) methods, thin-layer chromatography (TLC) methods, gas chromatography (GC) methods, capillary electrophoresis (CE) methods and some of spectrophotometric and spectrofluorometric methods were developed and have been extensively applied to the analysis of number of benzodiazepine derivative drugs (BDZs) providing reliable and accurate results. The available chemical methods for the determination of BDZs in biological materials and pharmaceutical formulations are reviewed in this work. Keywords: Analytical methods • Benzodiazepines • Drugs analysis • Pharmaceutical formulations © Versita Sp. z o.o. 1. Introduction and long). For this reason, an application of these drugs became broader allowing their utility to a larger extent, Benzodiazepines have been first introduced into medical and at the same time, problems related to drug abuse practice in the 60s of the last century. -
The Misuse of Benzodiazepines Among High-Risk Opioid Users in Europe
EMBARGO — 7 JUNE 7. 6. 2018 UPDATED 11:30 Central European Time/CET (10:30 Western European Time/WET/Lisbon) Proof - 28 May 2018 not for circulation PERSPECTIVES ON DRUGS The misuse of benzodiazepines among high-risk opioid users in Europe Benzodiazepines are a widely prescribed I Introduction group of medicines with a range of clinical uses that include treating Benzodiazepines have a range of clinical uses and are among the most commonly prescribed medicines globally. anxiety, insomnia and managing alcohol They are useful in the short-term treatment of anxiety and withdrawal. This group of medicines is insomnia, and in managing alcohol withdrawal (Medicines often misused by high-risk opioid users, and Healthcare Products Regulatory Agency, 2015). Like all medicines, benzodiazepines can produce side effects. They and this is associated with considerable may also be misused, which we define as use without a morbidity and mortality. This paper prescription from a medical practitioner or, if prescribed, when describes the impact of benzodiazepines they are used outside accepted medical practice or guidelines. misuse on the health and treatment of While the misuse of benzodiazepines has been identified high-risk opioid users. as a concern for large groups in the general population, for example, among elderly people and women, this analysis focuses specifically on misuse among high-risk opioid users (1), a group of people among whom these medicines have been linked with severe treatment challenges and implicated in considerable numbers of drug-related deaths. It is important to stress that much benzodiazepine prescribing to high-risk drug users is done with legitimate therapeutic aims in mind. -
Hsrs Alcohol and Other Drug Abuse Module
WORKER ID (Field 1) OPTIONAL DEFINITION: The primary worker assigned to the client, or the person designated by the agency as having overall responsibility for the client or case. This is the person who will get information back about the client if any is requested. You may use a provider ID if you have delegated overall responsibility to a provider and you want them to get back all information about this client. PURPOSE: For local use to connect reports to specific case managers. MA NUMBER (Field 2) REQUIRED IF MEDICAL ASSISTANCE RECIPIENT CODES: Enter the client’s 10 digit MA Number. PURPOSE: For comparison with other databases (Medical Assistance; DWD employment data; Crime Information Bureau, etc.) CLIENT ID (Field 3) REQUIRED, COMPUTER GENERATED DEFINITION: An identifier that is computer generated for each individual reported on HSRS. Full legal name, birthdate, and sex are used to produce a 14 character ID which bears no resemblance to the client’s name. ENTER: May be left blank if name, birthdate, and sex are reported. OR Enter the 14 character HSRS client identification number. The ID will be generated and returned to you on the terminal screen. Copy it down or print the screen. Once the ID number is generated, use it on all future input. PURPOSE: To maintain client confidentiality while allowing reports to be produced on individual clients for audit purposes; to produce reports on multiple services to the same individual; to produce client number listings for recidivist clients. AODA - 1 NAME - LAST, FIRST, MIDDLE, SUFFIX (Fields 4a-d) REQUIRED TO GENERATE ID (THEN OPTIONAL) DEFINITION: The full legal name of the client. -
124.210 Schedule IV — Substances Included. 1
1 CONTROLLED SUBSTANCES, §124.210 124.210 Schedule IV — substances included. 1. Schedule IV shall consist of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this section. 2. Narcotic drugs. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below: a. Not more than one milligram of difenoxin and not less than twenty-five micrograms of atropine sulfate per dosage unit. b. Dextropropoxyphene (alpha-(+)-4-dimethylamino-1,2-diphenyl-3-methyl-2- propionoxybutane). c. 2-[(dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol, its salts, optical and geometric isomers and salts of these isomers (including tramadol). 3. Depressants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances, including its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation: a. Alprazolam. b. Barbital. c. Bromazepam. d. Camazepam. e. Carisoprodol. f. Chloral betaine. g. Chloral hydrate. h. Chlordiazepoxide. i. Clobazam. j. Clonazepam. k. Clorazepate. l. Clotiazepam. m. Cloxazolam. n. Delorazepam. o. Diazepam. p. Dichloralphenazone. q. Estazolam. r. Ethchlorvynol. s. Ethinamate. t. Ethyl Loflazepate. u. Fludiazepam. v. Flunitrazepam. w. Flurazepam. x. Halazepam. y. Haloxazolam. z. Ketazolam. aa. Loprazolam. ab. Lorazepam. ac. Lormetazepam. ad. Mebutamate. ae. Medazepam. af. Meprobamate. ag. Methohexital. ah. Methylphenobarbital (mephobarbital). -
S1 Table. List of Medications Analyzed in Present Study Drug
S1 Table. List of medications analyzed in present study Drug class Drugs Propofol, ketamine, etomidate, Barbiturate (1) (thiopental) Benzodiazepines (28) (midazolam, lorazepam, clonazepam, diazepam, chlordiazepoxide, oxazepam, potassium Sedatives clorazepate, bromazepam, clobazam, alprazolam, pinazepam, (32 drugs) nordazepam, fludiazepam, ethyl loflazepate, etizolam, clotiazepam, tofisopam, flurazepam, flunitrazepam, estazolam, triazolam, lormetazepam, temazepam, brotizolam, quazepam, loprazolam, zopiclone, zolpidem) Fentanyl, alfentanil, sufentanil, remifentanil, morphine, Opioid analgesics hydromorphone, nicomorphine, oxycodone, tramadol, (10 drugs) pethidine Acetaminophen, Non-steroidal anti-inflammatory drugs (36) (celecoxib, polmacoxib, etoricoxib, nimesulide, aceclofenac, acemetacin, amfenac, cinnoxicam, dexibuprofen, diclofenac, emorfazone, Non-opioid analgesics etodolac, fenoprofen, flufenamic acid, flurbiprofen, ibuprofen, (44 drugs) ketoprofen, ketorolac, lornoxicam, loxoprofen, mefenamiate, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, pranoprofen, proglumetacin, sulindac, talniflumate, tenoxicam, tiaprofenic acid, zaltoprofen, morniflumate, pelubiprofen, indomethacin), Anticonvulsants (7) (gabapentin, pregabalin, lamotrigine, levetiracetam, carbamazepine, valproic acid, lacosamide) Vecuronium, rocuronium bromide, cisatracurium, atracurium, Neuromuscular hexafluronium, pipecuronium bromide, doxacurium chloride, blocking agents fazadinium bromide, mivacurium chloride, (12 drugs) pancuronium, gallamine, succinylcholine