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