Can Alprazolam, Estazolam and Lorazepam be taken for a long time?
Alprazolam, eszolam, and lorazepam are benzodiazepines, anxiolytics, and have sedative hypnosis, anticonvulsant, antitremor, and central muscle relaxant effects. This class of drugs has the advantages of high selectivity, large safety range, small respiratory depression, does not affect liver enzyme activity, large doses do not cause anesthesia, and long-term application can produce tolerance and dependence but has a relatively low incidence, so it is currently the preferred drug in clinical practice. These 3 drugs belong to the intermediate class (half-life 6~24 hours), mainly used for people who sleep lightly, wake up easily and need to keep their minds clear in the morning.
In terms of safety, when these drugs reach peak plasma drug concentrations, they may cause varying degrees of fatigue, lightheadedness, slow response, motor incoordination, mental and motor dysfunction, thought disturbances, and anterograde amnesia; Cognition appears to be less affected than exercise. All of these effects can greatly impair driving skills and other sports skills, especially when combined with ethanol. When administered immediately before bedtime, the persistence of these effects after the patient wakes up will be harmful, these sequelae effects are clearly dose-related and dangerous, since many people underestimate this potential risk. Although successful medical therapy can reduce daytime sleepiness due to chronic insomnia, sequelae may occur. The severity and incidence of central toxicity usually increases with age.
Other common adverse reactions include weakness, headache, blurred vision, dizziness, nausea and vomiting, epigastric discomfort and diarrhea; A small number of people taking the drug may develop joint pain, chest pain, and incontinence.
These drugs have been reported to cause amnesia, euphoria, restlessness, hallucinations, sleepwalking, sleepwalking, hypomania, and other complex behaviors. Some users have been reported to exhibit bizarre uncontrollable behavior, while others may show hostility and anger. In summary, these reactions are sometimes referred to as desuppression or adverse effects. Use of these drugs is occasionally associated with paranoia, depression, and suicidal thoughts. The incidence of these anomalies or desuppressive reactions is low and appears to be dose-dependent.
Long-term use of these drugs carries a risk of dependence and abuse to a lesser extent than previously used sedatives and other known addictive drugs. Many patients on long-term, stationary medications may develop mild dependence. Withdrawal symptoms may include a short-term worsening of problems that prompted them to take medication (eg, insomnia, anxiety). Restlessness, irritability, sweating, nightmares, tremors, loss of appetite, syncope, or dizziness may also occur, especially if the drug is stopped abruptly. Therefore, when planning to stop treatment, it is prudent to gradually reduce the dose. Despite the above adverse effects, these drugs remain relatively safe. Unless combined with other drugs, even very large doses are rarely fatal. Ethanol is a common contributing factor to these drug-related deaths. In the absence of other central nervous system inhibitors, true coma is rare. Although such drug overdoses rarely cause severe cardiovascular or respiratory depression, therapeutic doses can further aggravate breathing disorders in patients with chronic obstructive pulmonary disease or obstructive sleep apnea.
These drugs can cause a variety of allergies, hepatotoxicity, and hematologic reactions, but the incidence is very low. High-dose use before or during delivery can cause neonatal hypothermia, decreased muscle tone, and mild respiratory depression, and maternal drug abuse can lead to neonatal withdrawal syndrome. Apart from superimposed effects with other sedatives or hypnotics, these drugs rarely have clinically meaningful pharmacodynamic interactions with other drugs. Ethanol both adds their absorption and aggravates its central inhibitory effect, and valproic acid in combination with such drugs may cause confusion.
For patients with chronic insomnia, long-term use of alprazolam, estazolam, lorazepam, with clear dependence and addiction, from the perspective of safety and medication compliance, long-term use is not recommended, it is recommended to use it as short-term as possible, generally not more than 4 weeks, drug intervention within 4 weeks can choose continuous treatment, more than 4 weeks need to be re-evaluated, if necessary, change the intervention plan or use intermittent therapy in a timely manner according to the patient's sleep improvement. Patients with chronic insomnia recommend the preferred non-benzodiazepine (zolpidem, zopiclone, dexzopiclone, etc.) for drug intermittent therapy. At present, only a few drugs, such as zolpidem, dexzopiclone, and rametimemide, have clinical evidence of long-term use, because their potential dependence and addiction are much lower, and they have a better safety profile for long-term use, but they must be taken under the guidance of a doctor.
