Prescrire International - Free Special Edition 2022

ADVERSE EFFECTS

Perioperative benzodiazepines:

COMMON STEM -azam, -azepam, -azolam

NN A drug’s real name

a risk factor for persistent use

A cohort study published in 2021 identified 2.5 million adults in a US health insurance databasewho had undergone surgery between 2009 and 2017 and had not been prescribed a benzodiazepine during the year before their operation (excluding the month before the operation). The most common surgical pro- cedures were cataract surgery, cholecystec- tomy and hysterectomy. The patients’ mean age was 54 years, and 63% of them were women (1). 64 000 (2.6%) of these patients received a benzodiazepine during the perioperative period, and half of them received more than a 10-day supply of the drug. The most com- monly used benzodiazepines were diazepam (32%) and alprazolam (29%). 19.5% of the patients who had been pre- scribed a benzodiazepine around the time of surgery continued taking it afterwards. 56% of these persistent users received another pre- scription for a benzodiazepine between 90days and 180 days after the surgery, and 44% re- ceived two or more prescriptions. The factors shown to be associated with persistent benzodiazepine use in this study were: being 70 years of age or older, female gender, more medical comorbidities, or a history of anxiety, depression, insomnia or substance use disorder. INPRACTICE  Repeated or persistent benzo­ diazepine use is common after occasional use, and the risk of addiction is real. When a benzo­ diazepine is justified, it is important to plan its withdrawal with the patient, as soon as treat- ment is initiated (2). ©Prescrire

According to the nomenclature established by theWorld Health Organization (WHO) to devise international nonproprietary names (INNs), the INNs of psychotropic drugs derived from diazepam , i.e. benzodiazep­ ines, end in -azepam (or -azepate in the case of salts, and -azepoxide in the case of oxides) (1,2). We have identified 13 drugs whose INNs contain this common stem: bromazepam ; chlordiazepoxide (sometimes combined with clidinium , an antimuscarinic); clonazepam ; clorazepate dipotassium ; clotiazepam ; di­ azepam ; ethyl loflazepate ; lorazepam ; lormet­ azepam ; nitrazepam ; nordazepam ; oxazepam ; and prazepam . Some benzodiazepines have an INN which contains another common stem: -azam in the case of clobazam ; and -azolam in the case of alprazolam , estazolam , loprazolam and midazolam (1,2). The benzodiazepines constitute a homo­ geneous group.They all have anticonvulsant, muscle relaxant, sedative, anxiolytic and amnesic effects. Their adverse effect profile mainly includes: drowsiness and difficulty concentrating; memory disturbances; cog­ nitive disorders persisting after withdrawal; confusion, ataxia and falls, especially in elder­ ly patients; reduced efficacy (i.e. tolerance); dependence and withdrawal syndrome; and respiratory depression (3,4). ©Prescrire

▶ Translated from Rev Prescrire December 2021 Volume 41 N° 458 • Page 907

▶ Translated from Rev Prescrire November 2021 Volume 41 N° 457 • Page 825

References 1- World Health Organization “The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceut­ ical substances 2018 (Stem Book 2018)”: 64-65. 2- “Common stems: -azepam, -azam, -azolam” Prescrire Int 2012; 21 (127): 125. 3- “Quelques éléments pour le choix d’une benzodiazépine dans les plaintes de mauvais sommeil” Rev Prescrire 2018; 38 (415): 356-357. 4- “Benzo­ diazépines ou apparentés” Interactions Médicamenteuses Prescrire 2022.

References 1- Wright JD et al. “Association of new perioperative benzodiazepine use with persistent benzo­ diazepine use” JAMA Netw Open 2021; 4 (6): e2112478 + suppl.: 24 pages. 2- Prescrire Rédaction “Réussir l’arrêt d’une benzodiazépine (suite)” Rev Prescrire 2010; 30 (319): 372.

Prescrire Int • March 2022

Prescrire Int • March 2022

Page 12 • Prescrire International Special Edition 2022