Levetiracetam and Midazolam vs Midazolam Alone for First-Line Treatment of Children With Generalized Convulsive Status Epilepticus (Lev-Mid Study): A Randomized Controlled Trial

Background:Benzodiazepines are the first-line anti-seizure medication (ASM) for generalized convulsive status epilepticus (GCSE), but they fail to end seizures in a third of cases. Combining benzodiazepines with another ASM that acts by a different pathway could be a potential strategy for rapid control of GCSE. Objectives: To evaluate the efficacy of adding levetiracetam to midazolam in the initial treatment of pediatric GCSE. Design: Double-blind randomized controlled trial. Setting: Pediatric emergency room at Sohag University Hospital between June, 2021 and August, 2022. Participants: Children aged between 1 month and 16 years with GCSE lasting more than 5 min. Interventions: Intravenous levetiracetam (60 mg/kg over 5 min) and midazolam (Lev-Mid group) or placebo and midazolam (PlaMid group) as first-line anticonvulsive therapy. Outcome measures: Primary: cessation of clinical seizures at 20- min study time point. Secondary: cessation of clinical seizures at 40-min study time point, need for a second midazolam dose, seizure control at 24-hr, need for intubation, and adverse effects. Results: Cessation of clinical seizures at 20-min occurred in 55 children (76%) in Lev-Mid group compared with 50 (69%) in the PlaMid group [RR (95% CI) 1.1 (0.9-1.34); P=0.35]. No significant difference was found between the two groups regarding the need for a second midazolam dose [44.4% vs 55.6%; RR (95% CI) 0.8 (0.58- 1.11); P=0.18] as well as cessation of clinical seizures at 40-min [96% vs 92%; RR (95% CI)1.05 (0.96-1.14); P=0.49] and seizure control at 24-hr [85% vs 76%; RR (95% CI) 1.12 (0.94-1.3); P=0.21]. Intubation was required for three patients in the Lev-Mid group and six patients in the Pla-Mid group [RR (95%CI) 0.5 (0.13- 1.92); P=0.49]. No other adverse effects or mortality were observed during the 24-hour study timeframe. Conclusion: Combined levetiracetam and midazolam for initial management of pediatric GCSE presents no significant advantage over midazolam alone in cessation of clinical seizures at 20-min.

Perfil do consumo dos benzodiazepínicos nos anos de 2019 e 2020 no brasil e regiões / Profile of the benzodiazepines in the years 2019 e 2020 in Brazil and regions / Perfil de consume y hospitalizaciones de los benzodiacepinas en los años 2019 y 2020 enBrasil y regiones

Os benzodiazepínicos estão entre os medicamentos mais prescritos, principalmente em países ocidentais, onde estimativas mostram um consumo anual de 1% a 3% da população.Objetivo:Estudar o perfil do consumo dos benzodiazepínicosnos anos de 2019-2020. Metodologia:Foram estudadas a taxa de desocupação segundo o Instituto Brasileiro de Geografia e Estatística, consumo dos benzodiazepínicosa partir do Sistema Nacional de Gerenciamento de Produtos Controlados da Agencia de Vigilância Sanitáriae quantidade de internações por envenenamento com exposição (acidental ou proposital), auto-intoxicação e efeitos adversos aos anticonvulsivantes, sedativos, hipnóticos, antiparkinsonianos e psicotrópicos segundo o Departamento de Informática do Sistema Único de Saúde no Brasil. Resultados:A região Norte e Nordeste apresentou um aumento na taxa de desocupação. O rendimento nominal mensal domiciliar per capitada população residente nas regiões Norte e Nordeste se manteveabaixo de 01 salário-mínimo nos anos de 2019 e 2020. De 2019 para 2020, o princípio ativo mais utilizado dos benzodiazepínicos industrializados foi o Clonazepam com incremento de 9,81% no Brasil e 22,52% na região Nordeste. Todas as formas farmacêuticas manipuladas apresentaram umaredução no consumo de 2019 para 2020, com exceção da forma em mililitros que apresentou um incremento para o bromazepam (42,1%), clonazepam (8,76%) e diazepam (5,27%). De 2020 em relação a 2019, ocorreu um incrementode 119,05% e 25% nas regiões Nordeste e Centro-Oeste, respectivamente, nasinternações por envenenamento [intoxicação] por exposição, a anticonvulsivantes (antiepilépticos), sedativos, hipnóticos, antiparkinsonianos e psicotrópicos não classificados em outra parte, intenção não determinada. Conclusões:Ocorreu um aumento no consumo de benzodiazepínicosindustrial no ano de 2020 sendo o envenenamento [intoxicação] umadas principais causasde internação. Há necessidade de um controle do consumo e vigilância aos psicotrópicos visto que estes fármacos estão dentre aqueles com risco de internações devido àexposição acidental ou não, autointoxicaçãoou efeitos adversos (AU).

Benzodiazepines are among the most prescribed drugs, especially in Western countrieswhere estimates show an annual consumption of 1% to 3% of the population.Objective: To study the profile of benzodiazepinesconsumptionfrom the National Controlled Products Management System of the Sanitary Surveillance Agencyin the years 2019 and 2020.Methodology:The unemployment rate,according to theBrazilian Institute of Geography and Statistics,benzodiazepines consumptionfrom the National Controlled Products Management System of the Sanitary Surveillance Agency, and the number of hospitalizations due to poisoning with exposure (accidental or intentional), self-intoxication, and adverse effects to anticonvulsants, sedatives, hypnotics, antiparkinsonian drugs and psychotropic drugs according to the Department of Informatics of the Unified Health System in Brazil were studied.Results:The North and Northeast regions showed an increase in the unemployment rate. The nominal monthly household income per capita of the population residing in the North and Northeast regions remained below 01 minimum wage in the years 2019 and 2020. From 2019 to 2020, the most used active substanceof industrialized benzodiazepines was Clonazepam with an increase of 9.81% in Brazil and 22.52% in the Northeast region. All compounded pharmaceutical forms showed a reduction in consumption from 2019 to 2020, with the exception of the form in milliliters which showed an increase for bromazepam (42.1%), clonazepam (8.76%) and diazepam (5.27%). In 2020 compared to 2019, there was an increase of 119.05% and 25% in the Northeast and Midwest regions, respectively, in hospitalizations for poisoning[intoxication] due to exposure toanticonvulsants (antiepileptics), sedatives, hypnotics, antiparkinsonian drugs,and psychotropic drugs not elsewhere classified with intent undetermined.Conclusions:There was an increase in the consumption of industrial benzodiazepines in 2020, with poisoning [intoxication] being one of the main causes of hospitalization. There is a need to control the consumption andincrease the surveillance of psychotropic drugs becausethese drugs are among those that involverisk of hospitalization due to accidental or non-accidental exposure, self-intoxication or adverse effects (AU).

ntroducción: Las benzodiacepinas se encuentran entre los fármacos más recetados, especialmente en los países occidentales, donde se estima que de 1% al 3% de la poblaciónde estos países los consumen. Objetivo: Estudiar el perfil del consumo de benzodiacepinas en los años 2019-2020.Metodología: Se midieron la tasa de desempleo según elInstituto Brasileño de Geografía y Estadística, el consumo de benzodiacepinasdel Sistema Nacional de Gestión de Productos Controlados de la Agencia de Vigilancia Sanitariay el número de hospitalizaciones por intoxicación con exposición (accidental o intencional), además se estudiaron autointoxicaciones y efectos adversos a los anticonvulsivos, sedantes, hipnóticos, drogas contra el mal de Parkinsony psicotrópicossegún elDepartamento de Informática del Sistema Único de Salud de Brasil.Resultados: Las regiones Norte y Nordeste presentaron aumento de la tasa de desempleo. El ingreso nominal mensual de los hogares per cápita de la población residente en las regiones Norte y Nordeste se mantuvo por debajo de 01 salario mínimo en los años 2019-2020. De 2019 a 2020, el principio activo más utilizado de las benzodiacepinas industrializadas fue el clonazepam con un aumento de 9,81% en Brasil y de22,52% en la región Nordeste. Todas las formas farmacéuticas compuestas mostraron una reducción en su consumo de 2019-2020, a excepción de la forma en mililitros que mostró un aumento para bromazepam (42,1%), clonazepam (8,76%) y diazepam (5,27%). En 2020 respecto a 2019, hubo un aumento del 119,05% y 25% en las regiones Noreste y Medio Oeste, respectivamente, en las hospitalizaciones por intoxicación por exposición aanticonvulsivos (antiepilépticos), sedantes, hipnóticos, drogas contra el mal de Parkinsony psicofármacos no clasificados en otra parte conintención indeterminada.Conclusiones: Hubo un aumento en el consumo de benzodiacepinas industriales en 2020, siendo las intoxicaciones una de las principales causas de hospitalización. Existe la necesidad de controlar el consumo y vigilancia de los psicofármacos, ya que estos fármacos se encuentran entre los de riesgo de hospitalización por exposición accidental o no accidental, autointoxicación o efectos adversos (AU).

Recomendaciones y peligros del uso de las benzodiacepinas en los adultos mayores / Recommendations and dangers of the use of benzodiazepines in older adults / Recomendações e perigos da utilização de benzodiazepinas em adultos idosos

Las benzodiazepinas han sido empleadas en la práctica clínica aproximadamente desde la década de los 50, sus principales recomendaciones con importante eficacia son producción de ansiólisis, hipnosis, relajación muscular o como terapia anticonvulsivante, sin embargo, pueden asociarse con algunos riesgos altamente potenciales que pueden influir directamente de forma perjudicial en la calidad de vida de los pacientes geriátricos. Objetivo. Describir las recomendaciones y peligros del uso de benzodiacepinas en los adultos mayores. Metodología. Se realizó una revisión sistemática mediante una búsqueda electrónica en las siguientes bases de datos: "PubMed" y "ScienceDirect", fueron incluidos artículos originales, metaanálisis, ensayos clínicos, entre otros, en idioma inglés y español. Para la recolección de información se tomó en cuenta la temporalidad de los últimos 6 años. Se utilizó palabras clave como: "Aged", "Anciano", "Benzodiacepinas", "Benzodiazepines" "eHealth Strategies", "Safety Management". Según los términos DeCS/MESH. Conclusión. Se identificaron varios usos principales para los benzodiacepinas, los cuales incluyen el tratamiento del insomnio, la depresión, el trastorno de pánico, la ansiedad y la abstinencia por alcoholismo, con una tasa de prevalencia que alcanzó el 83,5%. Se encontró que el uso de benzodiacepinas es más común en pacientes críticos o en aquellos que presentan otras comorbilidades, como demencia (33,5%) o enfermedad de Alzheimer (5%). Entre los principales factores de riesgo relacionados al uso de benzodiacepinas se encuentran las caídas, las cuales presentaron una incidencia que osciló entre el 13% y el 17,5%. Asimismo, se identificó la dependencia y la incontinencia urinaria, ambas con una tasa de prevalencia del 15%.

Benzodiazepines have been used in clinical practice since approximately the 1950s, their main recommendations with important efficacy are to produce anxiolysis, hypnosis, muscle relaxation or as anticonvulsant therapy, however, they can be associated with some highly potential risks that can directly influence in a detrimental way the quality of life of geriatric patients. Objective. To describe the recommendations and hazards of benzodiazepine use in older adults. Methodology. A systematic review was carried out by means of an electronic search in the following databases: "PubMed" and "ScienceDirect", including original articles, meta-analysis, clinical trials, among others, in English and Spanish. For the collection of information, we took into account the temporality of the last 6 years. Keywords such as: "Aged", "Elderly", "Benzodiazepines", "Benzodiazepines", "eHealth Strategies", "Safety Management" were used. According to DeCS/MESH terms. Conclusion. Several main uses for benzodiazepines were identified, which include treatment of insomnia, depression, panic disorder, anxiety, and alcohol withdrawal, with a prevalence rate reaching 83.5%. Benzodiazepine use was found to be more common in critically ill patients or in those with other comorbidities, such as dementia (33.5%) or Alzheimer's disease (5%). Among the main risk factors related to benzodiazepine use were falls, which had an incidence ranging from 13% to 17.5%. Likewise, dependence and urinary incontinence were identified, both with a prevalence rate of 15%.

Os benzodiazepínicos têm sido usados na prática clínica desde aproximadamente a década de 1950, suas principais recomendações com eficácia significativa são para produzir ansiólise, hipnose, relaxamento muscular ou como terapia anticonvulsivante, no entanto, podem estar associados a alguns riscos de alto potencial que podem influenciar diretamente a qualidade de vida de pacientes geriátricos de forma prejudicial. Objetivo. Descrever as recomendações e os riscos do uso de benzodiazepínicos em idosos. Metodologia. Foi realizada uma revisão sistemática por meio de busca eletrônica nas seguintes bases de dados: "PubMed" e "ScienceDirect", incluindo artigos originais, meta-análises, ensaios clínicos, entre outros, em inglês e espanhol. Para a coleta de informações, foi levado em conta o período dos últimos 6 anos. As palavras-chave utilizadas foram: "Aged", "Elderly", "Benzodiazepines", "Benzodiazepines", "eHealth Strategies", "Safety Management". De acordo com os termos do DeCS/MESH. Conclusão. Foram identificados vários usos principais para os benzodiazepínicos, incluindo o tratamento de insônia, depressão, transtorno do pânico, ansiedade e abstinência de álcool, com uma taxa de prevalência de 83,5%. Verificou-se que o uso de benzodiazepínicos é mais comum em pacientes graves ou com outras comorbidades, como demência (33,5%) ou doença de Alzheimer (5%). Entre os principais fatores de risco relacionados ao uso de benzodiazepínicos estavam as quedas, cuja incidência variou de 13% a 17,5%. A dependência e a incontinência urinária também foram identificadas, ambas com uma taxa de prevalência de 15%.

Prescripción de clonazepam tabletas en el municipio Santa Clara

Introducción: Las benzodiazepinas son medicamentos utilizados para el tratamiento de la ansiedad y los trastornos del sueño, así como relajantes musculares y anticonvulsivantes. A pesar de que no se aconseja su uso para tratamientos prolongados, algunos pacientes lo utilizan de forma continuada lo cual se asocia con la dependencia física y síntomas de abstinencia moderada a severa. El clonazepam es uno de las benzodiazepinas con propiedades ansiolíticas y antiepilépticas. Objetivo: Determinar el aumento en la prescripción del medicamento clonazepam de 1mg tabletas en el municipio Santa Clara. Métodos: Se realizó una investigación observacional, retrospectiva, descriptiva y transversal, que se correspondió con un estudio de uso de medicamentos, del tipo prescripción-indicación del medicamento clonazepam de 1mg tabletas, durante el período junio 2021 a junio 2023. El universo lo conformaron 5 819 pacientes que constituían la totalidad de los pacientes de tipo ambulatorio con dicha prescripción al final del estudio. Resultados: En cuanto al sexo, al final del estudio, la distribución mostró un predominio del sexo femenino. Se evidenció un incremento de un 198 % de los pacientes y predominó el grupo de edades de más de 59 años (55,3 %). Conclusiones: Existe una alta tendencia en el uso del clonazepam, sobre todo en personas de la tercera edad, las cuales son las más susceptibles a la aparición de efectos indeseables con consecuencias lamentables.

Introduction: Benzodiazepines are drugs used for anxiety and sleep disorders, as well as muscle relaxants and anticonvulsive. Despite being discouraged in prolonged treatments, some patients have chronic use, which is associated with the development of physical dependence, manifested in moderate to severe withdrawal symptoms. Clonazepam is one such benzodiazepine which has antiepileptic as well as anxiolytic properties. Objective: To determine the increase in prescription of clonazepam 1mg tablets in Santa Clara municipality. Methods: An observational, retrospective, descriptive and cross-sectional investigation was carried out, which corresponded with a medications use study, of prescription-indication type. It was conducted aimed at assessing the prescription of the medication clonazepam 1mg tablets during the period from June 2021 to June 2023. The universe was built by 5819 patients which constituted the totality of ambulatory patients with such prescription at the end of the study. Results: Regarding sex, at the end of the study, the distribution showed a predominance of the female sex. It was evidenced an increase of 198 % of patients and a predominance of patients over 59 years of age (55.33 %). Conclusions: The results showed a high trend in the use of clonazepam, mainly in elderly patients, which are the most susceptible to the appearance of undesirable effects and unfortunate consequences.

Sedative use and incidence of falls and hip fractures among older adults in an outpatient geriatric clinic / Perfil de uso de sedativos e ocorrência de quedas e fratura de fêmur entre idosos em um ambulatório de geriatria

OBJECTIVE: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. METHODS: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine ("z-drugs") intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. RESULTS: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p < 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). CONCLUSIONS: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults

OBJETIVO: Investigar a utilização de sedativos entre idosos atendidos em ambulatório privado de geriatria em Belo Horizonte (MG), bem como sua associação com quedas e fraturas de fêmur. METODOLOGIA: Trata-se de estudo longitudinal, no qual foi descrita a prevalência de uso de benzodiazepínicos e drogas Z entre idosos (60 anos ou mais) e avaliada sua associação com a incidência de queda e fratura (30 dias após consulta inicial) por meio de regressão logística. RESULTADOS: Foram incluídos no estudo 7821 idosos, com maioria feminina (72,50%), idade média de 77,5 anos e Índice de Vulnerabilidade Clínico Funcional (IVCF-20) médio de 16,5 pontos. A prevalência de uso de sedativos em geral foi de 6,19%, sendo 4,48% de benzodiazepínicos e 1,98% de drogas Z. Os medicamentos sedativos mais utilizados foram clonazepam (29,04%), zolpidem (28,65%) e alprazolam (23,44%). Relatou-se queda para 182 idosos (2,33%), com incidência maior entre usuários de sedativos (4,34; p = 0,002; OR = 1,94 ajustada por sexo, idade e IVCF-20) e de benzodiazepínicos (5,14%; p < 0,001; OR = 2,28) do que entre não usuários (2,19%). Identificou-se fratura de fêmur em 33 idosos (0,42%), sendo mais frequente entre usuários de sedativos (1,03%; p = 0,032; OR = 2,57) e de benzodiazepínicos (1,43%; p = 0,003; OR = 3,45) do que entre não usuários (0,38%). CONCLUSÃO: Concluiu-se que a incidência de quedas e fraturas de fêmur em idosos possui associação com o uso de medicamentos sedativos, em especial os benzodiazepínicos

Oral preanesthetic medication in children - comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis

Abstract Background Up to 60% of pediatric surgical patients develop high levels of preoperative anxiety. This study compared the effects of oral combinations of midazolam and ketamine with oral midazolam alone for pediatric preanesthetic medication. Methods The study protocol was registered in PROSPERO as CRD42020172920. A systematic literature search was conducted using Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing oral combinations of midazolam and ketamine with midazolam alone as preanesthetic medication in elective surgical pediatric patients. Meta-analyses included the following outcomes: anxiety and sedation levels, child's behavior during separation from parents, face mask acceptance, and venipuncture. The quality of evidence was assessed using GRADE criteria. Results Twenty studies were included. The following effects (RR (95% CI)) were observed for combinations of ketamine and midazolam relative midazolam alone: anxiolysis (1.2 (0.94-1.52); p= 0.15; I2 = 80%; GRADE = very low); satisfactory sedation (1.2 ( 1.10-1.31); p< 0.001; I2 = 71%; GRADE = very low); behavior during parental separation (1.2 (1.06-1.36); p= 0.003; I2 = 88%; GRADE = very low); facial mask acceptance (1.13 (1.04-1.24); p= 0.007; I2 = 49%; GRADE = very low); behavior during venipuncture (1.32 (1.11-1.57); p= 0.002; I2 = 66%; GRADE = very low). Conclusions While similar probabilities of obtaining anxiolysis were found, adequate sedation, calm behavior during child's separation from parents, low levels of fear during face mask adaptation, and cooperative behavior during peripheral venous cannulation were more likely with midazolam-ketamine combinations.

Prevalence of the Consumption of Tranquilizers without a Medical Prescription and Associated Factors in School-Based Adolescents in Colombia / Prevalencia del consumo de tranquilizantes sin prescripción médica y factores asociados en adolescentes escolarizados de Colombia / Prevalência do uso de tranquilizantes sem prescrição médica e fatores associados em adolescentes em idade escolar na Colômbia

Introduction: Non-prescription tranquilizers are a specific group of benzodiazepines, used as drugs that act on the central nervous system and have an extensive effect in patients with anxiety disorders and problems in sleep stages. Objective: To determine the prevalence of the year and month of consumption of tranquilizers without a medical prescription and the associated factors, in adolescents in school in Colombia. Methods: It is a cross-sec-tional study with an analytical scope. The universe of the study consisted of 3,243,377 students, from grades 7 to 11 (aged between 12 and 18 years), the valid surveys were 80,018. The adolescent who declared having used tranquilizers during the last 30 days and the last 12 months was considered a consumer. All variables were self-re-ported by adolescents. Results: The prevalence of tranquilizer use without medical prescription was 1.02% and 1.97% (month and year, respectively). Adolescents who presented disciplinary problems are the most predisposed to use during the last month with an OR 2.79 (95% CI: 2.20­3.53) and last year an OR of 2.77 (95 % CI: 2.34­3.27). Conclusions: There is a higher prevalence of the consumption of tranquilizers without medical prescription in women between 14 and 17 years of age, from mixed schools and it is associated with academic and disciplinary performance problems, in the last year. In addition, as age increases, the consumption of substances without a medical prescription increases

Introducción: Los tranquilizantes sin prescripción médica son un grupo específico de benzodiacepinas, usados como medicamentos que actúan sobre el sistema nervioso central y cuentan con un extenso efecto en pacientes con trastornos de ansiedad y problemas en las etapas del sueño. Objetivo: Determinar la prevalencia de año y mes de consumo de tranquilizantes sin prescripción médica y los factores asociados en adolescentes escolarizados de Colombia. Métodos: Estudio transversal con alcance analítico. El universo del estudio estuvo constituido por 3 243 377 estudiantes de los gados 7.º a 11.º (con edades entre 12 y 18 años). Las encuestas válidas fueron 80 018. Se consideró consumidor al adolescente que declaró haber consumido tranquilizantes durante los últimos 30 días y los últimos 12 meses. Todas las variables fueron autorreportadas por los adolescentes. Resultados: La prevalencia de consumo de tranquilizantes sin prescripción médica fue del 1,02 % y del 1,97 % (mes y año, respectivamente). Los adolescentes que presentaron problemas disciplinarios son los más predispuestos al consumo durante el último mes con un OR de 2,79 (IC95 %: 2,20-3,53) y último año un OR de 2,77 (IC95 %: 2,34-3,27). Conclusiones: Existe mayor prevalencia de consumo de tranquilizantes sin prescripción médica en mujeres entre los 14 y los 17 años, de colegios mixtos, y se encuentra asociada con problemas de rendimiento académico y disciplinarios, en el último año. Además, a medida que aumenta la edad, se incrementa el consumo de sustancias sin prescripción médica

Introdução: Os tranquilizantes isentos de prescrição são um grupo específico de benzodiazepínicos, usados como medicamentos que atuam no sistema nervoso central e têm um efeito extenso em pa-cientes com transtornos de ansiedade e problemas no estágio do sono. Objetivo: Determinar a prevalência anual e mensal do uso de tranquilizantes sem prescrição médica e os fatores associados em adolescentes em idade escolar na Colômbia. Métodos: Estudo transversal com escopo analítico. O universo do estudo consistiu em 3243377 alunos da 7ª à 11ª série (com idades entre 12 e 18 anos). Foram realizadas 80018 pesquisas válidas. Um adolescente foi considerado usuário, o qual relatou ter usado tranquilizantes nos últimos 30 dias e nos últimos 12 meses. Todas as variáveis foram autorrelatadas pelos adolescentes. Resultados: A prevalência do uso de tranquilizantes sem prescrição médica foi de 1,02% e 1,97% (mês e ano, respectivamente). Os adolescentes com problemas disciplinares apresentaram maior pro-babilidade de uso no último mês, com um OR de 2,79 (IC95%: 2,20-3,53) e no último ano, com um OR de 2,77 (IC95%: 2,34-3,27). Conclusões: Há uma maior prevalência de uso de tranquilizantes sem prescrição médica em mulheres de 14 a 17 anos, de escolas mistas, e isso está associado a problemas de desempenho acadêmico e disciplinar no último ano. Além disso, com o aumento da idade, aumenta o uso de substâncias sem prescrição médica.

Efficacy and Safety of Oral Midazolam Sedation Compared with its Combination with Hydroxyzine Use in Pediatric Dentistry: A Systematic Review

ABSTRACT Objective: To assess the efficacy and safety of the use of midazolam as monotherapy, compared to the associated use of midazolam and hydroxyzine for minimum and moderate sedation of children in dental offices, using data obtained from clinical trials. Material and Methods: A systematic review protocol was developed and registered on PROSPERO (CR42020208633). An electronic search was carried out in Pubmed, Lilacs, Science Direct, Open Gray, Web of Science, and central Cochrane Library. No language restrictions were included. Clinical trials were carried out with children aged 0-12 years, using midazolam as monotherapy compared to the use of midazolam associated with hydroxyzine to verify the effectiveness and safety of oral sedation. The quality of the studies was individually assessed and grouped using the RoB 2 (Revised Cochrane risk-of-bias tool for randomized trials) and GRADE (Grading of Recommendations Assessment, Development and Evaluation) systems, respectively. Results: A total of 749 studies were found. After analyzing the inclusion and removal of duplicates, two studies were analyzed for the quality of evidence. Through this analysis, it was possible to verify the very low level of scientific evidence on the superiority of the efficacy and safety of the combined use of midazolam and hydroxyzine for oral sedation in children in dental offices. Conclusion: The conflicting results and limitations of the studies enabled to establish that there is insufficient evidence to support the use of these drugs combined. There is only evidence for the use of midazolam as monotherapy.

Uso ambulatorio de medicamentos potencialmente inapropiados en adultos mayores usuarios de la RAP Metropolitana de ASSE durante 2019 / Potentially inappropriate medication use in older adults assisted as outpatients in ASSE's Metropolitan RAP (Primary Health Care) during 2019 / Uso ambulatorial de medicamentos potencialmente inapropriados em idosos usuários da RAPE Metropolitana da ASSE durante 2019

Introducción: los adultos mayores son una población de riesgo para el desarrollo de reacciones adversas a los medicamentos. Los medicamentos potencialmente inapropiados son aquellos que representan mayores riesgos que beneficios en este grupo etario. Se cuenta con herramientas de apoyo a la prescripción en geriatría que permiten identificar a estos medicamentos y mediante la aplicación de estudios de utilización de medicamentos, podemos describir o analizar el uso de los mismos en una población. Objetivos: reconocer disponibilidad de medicamentos potencialmente inapropiados para adultos mayores en la RAP metropolitana de ASSE durante 2019 y establecer un diagnóstico de situación de consumo de los mismos durante ese año. Método: se realizó un análisis del vademécum institucional mediante la aplicación de los Criterios de Beers 2019 y dos escalas de riesgo anticolinérgico para identificar medicamentos potencialmente inapropiados. Posteriormente se realizó un estudio de utilización de los medicamentos identificados, mediante datos de dispensación de farmacia entre el 1 de enero y 31 de diciembre de 2019. El consumo se expresó en Dosis Diarias Definidas por cada 1000 adultos mayores-año (DHD). Resultados: se identificaron 16 medicamentos potencialmente inapropiados, de los cuales los más usados fueron clonazepam (DHD 69), quetiapina (65,6), alprazolam (DHD 43,7), flunitrazepam (DHD 42,7) y zolpidem (DHD 36,4). Conclusiones: la aplicación de herramientas explícitas facilita la identificación de medicamentos potencialmente inapropiados para adultos mayores y se evidenció un consumo elevado de los mismos durante el año 2019 a expensas de derivados benzodiazepínicos y quetiapina.

Introduction: older adults are at higher risk for developing adverse drug reactions. Potentially inappropriate medications are drugs that have more risks than benefits in this age group. There are a number of tools to support the prescription of medication in geriatrics that allow the identification of these medications, and by applying studies developed on the use of medications we may describe or analyze their impact on a given population. Objectives: to recognize availability of potentially inappropriate medications in older adults in ASSE's Metropolitan RAP during 2019 and to draw conclusions about the current situation in terms of the consumption of this kind of medications. Method: an institutional analysis of medications available in each healthcare provided was conducted through the application of Beers Criteria 2019, and two anticholinergic risk scales were used to identify potentially inappropriate medications. Subsequently, the use of the medications identified was studied by applying pharmacy dispensing data between January 1 and December 31, 2019. Consumption was expressed in defined daily doses every 1000 adults per year (DHD). Results: 16 potentially inappropriate medications were identified, the most widely used of which were clonazepam (DHD 69), quetiapine (65.6), alprazolam (DHD 43.7), flunitrazepam (DHD 42.7) and zolpidem (DHD 36.4). Conclusions: Applying explicit tools makes it easier to identify potentially inappropriate medications for older adults. An increased consumption of these kinds of drugs was noticed during 2019, as a result of benzodiazepine derivatives and quetiapine.

Introdução: os idosos são uma população de risco para o desenvolvimento de reações adversas a medicamentos. Medicamentos potencialmente inapropriados são aqueles que apresentam maiores riscos do que benefícios nessa faixa etária. Existem ferramentas de apoio à prescrição em geriatria que permitem identificar esses medicamentos e, por meio da aplicação de estudos de utilização de medicamentos, descrever ou analisar seu uso em uma população. Objetivos: reconhecer a disponibilidade de medicamentos potencialmente inapropriados para idosos na RAP metropolitana da ASSE durante o ano de 2019 e estabelecer um diagnóstico de consumo durante esse ano. Método: o formulário institucional foi analisado utilizando os Critérios de Beers 2019 e duas escalas de risco anticolinérgico para identificar medicamentos potencialmente inapropriados. Posteriormente, foi realizado um estudo de consumo dos medicamentos identificados, através dos dados de dispensação da farmácia entre 1 de janeiro e 31 de dezembro de 2019. O consumo foi expresso em Doses Diárias Definidas por 1000 idosos-ano (DHD). Resultados: foram identificados 16 medicamentos potencialmente inapropriados, sendo clonazepam (DHD 69), quetiapina (65,6), alprazolam (DHD 43,7), flunitrazepam (DHD 42,7) e zolpidem (DHD 36,4) os mais utilizados Conclusões: a aplicação de ferramentas explícitas facilita a identificação de medicamentos potencialmente inapropriados para idosos; foi observado um alto consumo dos mesmos em detrimento dos derivados benzodiazepínicos e da quetiapina durante o período do estudo.

Effect of lidocaine on dose-effect relationship of remimazolam combined with alfentanil in inhibiting responses to gastroscope insertion in elderly patients / 中华麻醉学杂志

Objective:To evaluate the effect of lidocaine on the dose-effect relationship of remimazolam combined with alfentanil in inhibiting responses to gastroscope insertion in elderly patients.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱelderly patients of either sex, aged 65-80 yr, with body mass index of 18-28 kg/m 2, undergoing painless gastroscopy under general anesthesia, were divided into 2 groups using a random number table method: remimazolam group (group C) and lidocaine combined with remimazolam group (group L). Alfentanil 6 μg/kg was given at anesthesia induction in all the patients, and then lidocaine 2 mg/kg was intravenously injected in the patients in group L. Modified Dixon′s up-and-down method was used for the study. Remimazolam was intravenously injected at a dose of 0.18 mg/kg in the first patient, and the gastroscope was placed when the eyelash reflex disappeared and the modified observational alertness/sedation assessment score ≤3. Gastroscope insertion response was defined as swallowing, bucking, body movement and other responses affecting the quality of examination during the gastroscope insertion. The dose of remimazolam was increased/decreased by 0.02 mg/kg in the next patient if the gastroscope response was positive or negative, and the process was repeated until 9 turning points occurred. The median effective dose (ED 50) and 95% confidence interval ( CI) of remimazolam were calculated by probit method. Results:The ED 50 (95% CI) of remidazolam in inhibiting responses to gastroscope insertion in elderly patients when combined with alfentanil was 0.158 (0.133-0.183) mg/kg in group C. The ED 50 (95% CI) of remidazolam in inhibiting responses to gastroscope insertion in elderly patients when combined with fentanyl was 0.139 (0.127-0.151) mg/kg in group L. The ED 50 was significantly lower in group L than in group C ( P=0.003). Conclusions:Intravenous lidocaine in combination with alfentanil increases the efficacy of remimazolam for painless gastroscopy in elderly patients.

Effects of remimazolam on gastrointestinal motor function in patients undergoing gastrointestinal endoscopy / 中华麻醉学杂志

Objective:To evaluate the effects of remimazolam on gastrointestinal motor function in the patients undergoing gastrointestinal endoscopy.Methods:A total of 262 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-64 yr, with body mass index of 18-28 kg/m 2, scheduled for elective gastrointestinal endoscopy from May 2022 to August 2022, were divided into 2 groups ( n=131 each) using a random number table method: remimazolam group (group R) and propofol group (group P). The patients in group R received intravenous remimazolam 0.20-0.25 mg/kg, and patients in group P received intravenous propofol 1.5-2.0 mg/kg. The gastrointestinal endoscopy was performed when the patients′ Modified Observer′s Assessment of Alertness/Sedation scores ≤3. During fasting before gastrointestinal preparation, before gastrointestinal endoscopy and while leaving the post-anesthesia care unit (PACU), the concentrations of serum motilin and gastrin were measured by enzyme-linked immunosorbent assay, the intestinal peristalsis rating assessed by the endoscopist during the examination was recorded, the occurrence of hypotension and hypoxemia during the examination and occurrence of abdominal distension, abdominal pain, and nausea and vomiting during stay in PACU were recorded. Results:Compared with group P, the intestinal peristalsis rating was significantly increased, the serum motilin and gastrin concentrations were increased while leaving PACU, the incidence of hypotension and hypoxemia was decreased during the examination, and the incidence of abdominal distention was decreased during stay in PACU in group R ( P<0.05). Conclusions:Remimazolam has a milder inhibitory effect on secretion of gastrointestinal hormones than propofol in the patients undergoing gastrointestinal endoscopy and is helpful for the recovery of gastrointestinal motility.

Effect of gender factor on efficacy of remimazolam combined with alfentanil in patients undergoing gastrointestinal endoscopy / 中华麻醉学杂志

Objective:To evaluate the effect of gender factor on efficacy of remimazolam combined with alfentanil in the patients undergoing gastrointestinal endoscopy.Methods:Two hundred patients, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classificationⅠor Ⅱ, scheduled for elective gastrointestinal endoscopy, were divided into 2 groups ( n=100 each) according to gender: male group (group M) and female group (group F). Remimazolam 0.2-0.3 mg/kg and alfentanil 5-7 μg/kg were intravenously injected, remimazolam 0.5-0.7 mg·kg -1·h -1 was continuously infused during operation to maintain the modified observer′s assessment of alert/sedation score<3 points, and alfentanil 2 μg/kg was administered when necessary. The consumption of remimazolam and alfentanil, examination time, recovery time and time of post-anesthesia care unit stay were recorded. The satisfaction scores of examination physicians and patients were recorded. The occurrence of adverse reactions such as injection pain, intraoperative body movement, respiratory depression, hypotension, bradycardia and hiccups and postoperative dizziness, nausea, vomiting, fatigue, abdominal pain and abdominal distension were recorded. Results:There was no significant difference in the consumption of remimazolam and alfentanil, examination time, recovery time, satisfaction scores of examination physicians and patients between the two groups ( P>0.05). There was no significant difference in the incidence of respiratory depression, hypotension, bradycardia, injection pain, body movement, hiccups, abdominal pain, abdominal distension, and fatigue between the two groups ( P>0.05). Compared with group M, the time of post-anesthesia care unit stay was significantly prolonged, and the incidence of postoperative dizziness, nausea and vomiting was increased in group F ( P<0.05). Conclusions:Remimazolam combined with alfentanil provides better efficacy in male patients than in female patients undergoing gastrointestinal endoscopy.

Uso de benzodiazepinas en el manejo de la Hipertensión Arterial / Use of Benzodiazepines in Hypertension Treatment

RESUMEN La hipertensión arterial es una enfermedad de alta prevalencia mundial y es uno de los principales factores de riesgo cardiovascular. Hoy en día vivimos como sociedad en una época donde predomina el estrés, la depresión y la ansiedad: trastornos que generan una alta descarga simpática, lo cual resulta perjudicial para la salud cardiovascular. Es habitual que como médicos nos encontremos frente a pacientes que en consultorio y/o en salas de emergencias presentan algún grado de ansiedad asociado a registros elevados de presión arterial, y es frecuente que en estos casos el tratamiento elegido para la disminución de la presión arterial sean los ansiolíticos, y específicamente las benzodiazepinas. Actualmente no existen guías que avalen el uso de drogas ansiolíticas para el manejo de la hipertensión arterial, por lo que decidimos realizar una revisión bibliográfica para evaluar las evidencias sobre su indicación en el manejo de la hipertensión arterial.

ABSTRACT Hypertension is a worldwide prevalent disease and one of the main cardiovascular risk factors. Today we live in a society dominated by stress, depression and anxiety, disorders generating a high sympathetic discharge which is damaging for the cardiovascular health. It is usual that as physician we meet patients who in the office and/or emergency departments present some degree of anxiety associated with elevated blood pressure, and in these cases, the treatment chosen to decrease blood pressure is frequently anxiolytics, specially benzodiazepines. As currently no guidelines support the use of anxiolytics for blood pressure management, we decided to carry out a bibliographic review to assess the evidences of their indication to treat hypertension.

Automedicación y riesgo de abuso con benzodiacepinas en pacientes adultos Lima-Perú, 2019 / Self-medication and risk of abuse with benzodiazepines in adults patients Lima-Peru, 2019

RESUMEN: Introducción: Las benzodiacepinas tienen potencial para generar abuso, por lo que, un consumo indiscriminado, a través de la venta sin prescripción y la práctica de automedicación, significaría un alto riesgo, producto de su abuso. Objetivo: Establecer la relación entre la automedicación con benzodiacepinas y el riesgo de abuso en pacientes de un hospital de Lima-Perú. Metodología: Estudio transversal analítico. Se encuestó a 874 participantes, se usó una encuesta para determinar datos demográficos, uso de benzodiacepinas y preguntas de la prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST, por sus siglas en inglés); se obtuvo estadística descriptiva y analítica. Resultados: Hubo más encuestadas del sexo femenino (74,5%), la mediana de edades fue de 52 años (rango intercuartílico: 40-62 años). De los adultos estudiados, 485 fueron considerados como consumidores de benzodiacepinas con receta médica y 389 sin receta médica. Los consumidores con receta médica y sin receta médica que necesitaron tratamiento fueron 129 (26,6%) y 245 (63,0%), respectivamente (p<0.001). Conclusión: Hay una mayor prevalencia de personas que necesitan tratamiento por abuso en consumidores sin receta médica que en el grupo de consumidores con receta médica, por lo que, existe una relación significativa entre la automedicación con benzodiacepinas y el riesgo de abuso; lo que requiere tratamiento en la población estudiada.

ABSTRACT Introduction: Benzodiazepines have the potential to generate abuse, so an indiscriminate consumption, through the sale without prescription and the practice of self-medication, would mean a high risk due to their abuse. Objective: To establish the relationship between self-medication with benzodiazepines and the risk of abuse that requires treatment in adult patients of Hospital San Juan de Lurigancho, 2019. Methodology: It was an observational, correlational descriptive, transversal and prospective study. The sample size was 874 participants (95.0% confidence level; 80% power). Sampling was performed non-randomly. A survey was used to determine demographics, benzodiazepine use, and questions of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Results: Of the study population, the most prevalent demographic data were female sex (74.5%), the median age was 52 years (interquartile range: 40-62 years), the age range 50-59 years (26.43%), married marital status (31.6%), secondary education level (48.4%) and occupation as a housewife (47.3%). Of adults studied, 485 were considered as consumers of benzodiazepines with prescription and 389 consumers without a prescription. Prescription and non-prescription consumers needing treatment were 129 (26.60%) and 245 (62.98%), respectively (p <0.001). Conclusion: There is a higher prevalence of people who need treatment for abuse in consumers without a prescription than in the group of consumers with a prescription so there is a significant relationship between self-medication with benzodiazepines and the risk of abuse that requires treatment in study population.

Uso de benzodiazepinas y fármacos relacionados en el seguro social para adultos mayores de Argentina / Use of benzodiazepines and related drugs in social security for older adults in Argentina

Resumen El uso clínico de las benzodiazepinas (BZD) y fármacos relacionados es un tema controversial, especialmente la prescripción prolongada en adultos mayores, que es contraria a las recomendaciones generales. Nuestro objetivo fue describir el uso de BZD y de los hipnóticos denominados fármacos Z (zolpidem, zopiclona y eszopiclona) en los adultos mayores beneficiarios del Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP-PAMI) de Argentina. Se realizó un estudio de utilización de medicamentos observacional, descriptivo, de corte transversal, a partir de la base de datos de dispensa de medicamentos del Instituto. Se incluyeron los beneficiarios de ambos sexos de 65 años y más. Se calculó para cada fármaco la prevalencia de uso en 2018 y las dosis diarias definidas (DDD) por cada 1000 habitantes/día (DHD). Se inclu yeron 3 864 949 beneficiarios (77.6 % de la población argentina de esa edad, 61.2 % mujeres), con 184 000 nonagenarios y más de 5000 centenarios. El 30.3 % recibió al me nos una dispensa de BZD o fármacos Z durante 2018, con mayor prevalencia de uso en mujeres (35.6%) que en varones (22.0%) y con aumento progresivo hasta los 85-89 años, y descenso posterior. Las BZD más recetadas fueron alprazolam (41.6%) y clonazepam (41.1%), seguidas por lorazepam (9.9%). La dispensa alcanzó 252.7 DHD, representado un promedio de 0.8 DDD por usuario y por día, valor que disminuyó con la edad. La prevalencia de uso encontrada está entre las más elevadas a nivel internacional, justificando la implementación de intervenciones clínicas y de salud pública para mejorar esta situación.

Abstract The clinical use of benzodiazepines (BZD) and related drugs is a controversial issue, especially prolonged prescription in older adults, which is contrary to general recommendations. Our objective was to describe the use of BZD and the hypnotics called Z drugs (zolpidem, zopiclone and eszopiclone) in elderly beneficiaries of the National Institute of Social Services for Retirees and Pensioners (INSSJP-PAMI) of Argentina. An observational, descriptive, cross-sectional drug use study was conducted based on the Institute's drug dispensing database. Beneficiaries of both sexes aged 65 years and over were included. The prevalence of use in 2018 and the defined daily doses (DDD) per 1000 inhabitants / day (DHD) were calculated for each drug. A total of 3 864 949 benefi ciaries were included (77.6% of the Argentine population of that age, 61.2% women), with 184 000 nonagenar ians and more than 5000 centenarians; 30.3% of whom received at least one dispensation of BZD or "Z drugs" during 2018, with a higher prevalence of use in women (35.6%) than in men (22.0%) and with a progressive increase until 85-89 years, with a subsequent decrease. The most prescribed BZDs were alprazolam (41.6%) and clonazepam (41.1%), followed by lorazepam (9.9%). The dispense drugs reached 252.7 DHD, representing an average of 0.8 DDD per user and per day, a value that decreased with age. The prevalence of use found is among the highest at international level, justifying the implementation of clinical and public health interventions to improve this situation.

Descripción de la disponibilidad y normas para el uso de las benzodiacepinas en algunos países de América Latina, 2022 / Description of benzodiazepines availability and regulation in several countries of Latin America, 2022 / Descrição da disponibilidade e regulamentação para o uso de benzodiazepínicos em alguns países da América Latina, 2022

Resumen: Introducción: las benzodiacepinas constituyen un grupo farmacológico de amplia prescripción a nivel mundial desde su aparición en la década de 1960. El objetivo del presente estudio fue identificar la disponibilidad, las modalidades de prescripción y dispensación de benzodiacepinas en diferentes países de América Latina, según reglamentación vigente en cada país participante del estudio. Materiales y métodos: estudio observacional, descriptivo y transversal, realizado con los datos disponibles al año 2022 de todos los países miembros de la Red de Centros de Información de Medicamentos de LatinoAmérica y el Caribe (Red CIMLAC) que fueron parte del estudio. Se utilizaron las bases de datos de las agencias regulatorias, la reglamentación vigente y otros documentos necesarios para obtener la información sobre la dispensación y prescripción en cada país. Resultados: doce de los 20 países de la Red CIMLAC completaron el estudio. El total de benzodiacepinas disponible en cada país varió entre 6 y 12 (media: 9). De ellas, en promedio 5 estaban incluidas en listados de medicamentos esenciales nacionales. La mayoría de los países cuentan con combinaciones a dosis fijas con benzodiacepinas. En todos los países se realiza la prescripción por receta especial. Más de la mitad de los países cuentan con recomendaciones nacionales. Conclusiones: la amplia disponibilidad de benzodiacepinas comercializadas, la existencia de combinaciones a dosis fijas y la falta de recomendaciones nacionales pueden ser factores que contribuyan al uso irracional de este grupo terapéutico.

Summary: Introduction: benzodiazepines constitute a widely prescribed group of drugs around the world, since they appeared in the sixties. This study aims to identify the availability, prescription modalities and dispensing of benzodiazepines in different countries around Latin America, as per the legal provisions in force in each of the countries participating in the study. Method: observational, descriptive, transversal study based on the information available in 2022 about all the member countries of the Network Medicines Information Centers of Latin America and the Caribbean (CIMLAC Network) that were part of the study. The databases of regulatory authorities were used and the legal provisions in force and relevant documents were consulted in order to obtain information on benzodiazepines dispensing and prescription in each country. Results: twelve out of the 20 CIMLAC Network member countries completed the study. The total number of benzodiazepines available in the study ranged from 6 to 12 (mean was 9), and 5 of them on average were included in the national essential medications lists. Most countries have benzodiazepines fixed dose combinations and in all countries a special medical prescription is needed. More than half of the countries have national recommendations. Conclusions: the wide availability of benzodiazepines in the market, the existence of fixed-dose combinations and the lack of national recommendations may constitute factors that contribute to the irrational use of this group of drugs.

Resumo: Introdução: os benzodiazepínicos constituem um grupo farmacológico amplamente prescrito em todo o mundo desde seu surgimento na década de 1960. O objetivo deste estudo foi identificar a disponibilidade, prescrição e modalidades de dispensação de benzodiazepínicos em diferentes países da América Latina, de acordo com as regulamentações vigentes em cada país participante do estudo. Materiais e métodos: estudo observacional, descritivo e transversal, realizado com os dados disponíveis até o ano de 2022 dos países membros da Rede de Centros de Informação sobre Medicamentos da América Latina e do Caribe (Red CIMLAC) que faziam parte do estudo. As bases de dados das agências reguladoras, normas vigentes e outros documentos necessários foram utilizados para obter informações sobre dispensação e prescrição em cada país. Resultados: doze dos 20 países da Rede CIMLAC completaram o estudo. O número total de benzodiazepínicos disponíveis em cada país variou entre 6 e 12 (média: 9). Destes, uma média de 5 foram incluídos nas listas nacionais de medicamentos essenciais. A maioria dos países tem combinações de dose fixa com benzodiazepínicos. Em todos os países é necessário prescrição especial. Mais da metade dos países têm recomendações nacionais. Conclusões: a ampla disponibilidade de benzodiazepínicos comercializados, a existência de combinações em doses fixas e a falta de recomendações nacionais podem ser fatores que contribuem para o uso irracional desse grupo terapêutico.

Segundo estudio de consumo de benzodiazepinas en una población uruguaya (2014-2018): el problema avanza / Second study on the use of benzodiazepines in a Uruguayan population (2014-2018): the problem advances / Segundo estudo de consumo de benzodiazepínicos em uma população uruguaia (2014-2018): o problema avança

Resumen: Introducción: las benzodiazepinas (BZD) constituyen uno de los grupos farmacológicos más prescritos. La forma de uso y el riesgo de aumento de efectos adversos evitables a partir del amplio uso, pueden representar en sí mismos problemas de salud pública. Objetivos: conocer el consumo de BZD en una población uruguaya en el período 2014-2018. Métodos: se realizó un estudio de utilización de medicamentos para evaluar el consumo de BZD por vía oral, a través del dato de dispensación de farmacias de instituciones de salud, mediante la variable DHD (dosis diaria definida/1.000 habitantes/día). Resultados: participaron siete instituciones, representando el 65% de la población uruguaya. Las DHD globales fueron 116,05, 114,36, 117,32, 131,17 y 124,4 DHD para los años 2014, 2015, 2016, 2017 y 2018 respectivamente, con un aumento de 7% en el período. Conclusiones: el consumo de BZD a nivel nacional entre 2014 y 2018 persiste elevado y superior al estudio previo realizado entre 2010 y 2012. Comparado con otros países, los valores para Uruguay se encuentran entre los más altos. Es necesario que todos los actores relevantes de la cadena del medicamento desarrollen estrategias para controlar la situación.

Summary: Introduction: benzodiazepines (BZD) constitute one of the most widely prescribed pharmacological groups. The use modality and the risk of increase of avoidable adverse effects resulting from wide consumption may represent a public health problem in itself. Objectives: to learn about the use of benzodiazepine in a Uruguayan population between 2014 and 2018. Method: a study was conducted on the use of medications to evaluate BZD consumption administered orally, by consulting dispensing of pharmacies in the health institutions, through the DHD variable (daily human doses/1.000 inhabitants/day). Results: 7 institutions participated in the study, representing 65% of the Uruguayan population. Global DHD were 116.05, 114.36, 117.32, 131.17 and 124.4 for 2014, 2015, 2016, 2017 and 2018 respectively, with a 7% increase in the period of study. Conclusions: the use of benzodiazepines was still high at the national level between 2014 and 2018 and greater than the figure found in the previous study, conducted between 2010 and 2012. Compared to other countries, Uruguayan figures are among the highest. All relevant actors in the drug chain need to develop strategies to control the situation.

Resumo: Introdução: os benzodiazepínicos (BZD) constituem um dos grupos farmacológicos mais prescritos. A forma de uso e o risco de aumento dos efeitos adversos evitáveis pelo uso extensivo podem representar, por si só, problemas de saúde pública. Objetivos: conhecer o consumo de BZD em uma população uruguaia no período 2014-2018. Métodos: foi realizado um estudo de uso de medicamentos para avaliar o consumo de BZD por via oral, utilizando dados da dispensação em farmácias de instituições de saúde, utilizando a variável DHD (dose diária definida/1000 habitantes/dia). Resultados: dados de sete instituições foram estudados, representando 65% da população uruguaia. Os DHDs globais foram 116,05, 114,36, 117,32, 131,17 e 124,4 DHDs para os anos de 2014, 2015, 2016, 2017 e 2018 respectivamente, com aumento de 7% no período. Conclusões: o consumo de BZD em nível nacional entre 2014 e 2018 continua alto e é superior aos resultados de um estudo anterior realizado entre 2010 e 2012. Quando comparados com outros países, os valores para o Uruguai estão entre os mais altos. É necessário que todos os atores relevantes da cadeia de medicamentos desenvolvam estratégias para controlar a situação.

Dependence on hypnotics: a comparative study between chronic users of benzodiazepines and Z-drugs

Objective: To evaluate dependence among chronic benzodiazepine and Z-drug users in Brazil. Methods: Chronic users of benzodiazepines (n=94), Z-drugs (n=74), or both (n=11) were recruited from the community, underwent a psychiatric evaluation and completed self-report instruments on hypnotic dependence, insomnia, anxiety, and depression. Users of benzodiazepines and Z-drugs were compared using t-tests, and logistic regression models were employed to explore significant predictors of a dependence diagnosis. Results: There was no difference in the prevalence of dependence among benzodiazepine (77.2%) and Z-drug (69.4%) users. Benzodiazepine users reported increased psychosocial aspects of dependence, anxiety, and depression. Preoccupation with the availability of medication (prevalence ratio [PR] = 2.39 [1.15-5.20]) and insomnia (PR = 1.10 [1.02-1.19]) were associated with a diagnosis of dependence (n=175). Conclusion: The prevalence of dependence was similar among both drug classes. The increased self-reported dependence, anxiety, and depression among benzodiazepine users may be due to behavioral rather than pharmacological aspects of medication use. Behaviors related to hypnotic use were important predictors of dependence.

Prescrição e dispensação de benzodiazepínicos em tempos de pandemia da covid-19 no Brasil / Prescription and Dispensing of Benzodiazepines in Times of the Covid-19 Pandemic in Brazil / Prescripción y Dispensación de Benzodiazepinas en Tiempos de la Pandemia Covid-19 en Brasil

Objetivo: teve como objetivo analisar a prevalência da prescrição e dispensação de benzodiazepínicos nas capitais brasileiras, nos 1°s trimestres de 2020 e 2021, considerando a pandemia da Coronavirus desease-2019 (COVID-19). Método: é um estudo epidemiológico, exploratório, quantitativo, documental e retrospectivo que investigou dados do Sistema Nacional de Gerenciamento de Protocolos Controlados. Utilizou-se da estatística descritiva e testes de associação para as análises dos dados, pelo programa Software Statistical Package for the Social Sciences. Além disso, foi realizado o cálculo da prevalência da dispensação. Resultados:a dispensação de alprazolam e clonazepam tem maior prevalência. A região Sudeste apresenta maior prevalência de dispensação (1° trimestre de 2020 n = 7098,74; 1° trimestre de 2021 n =6849,77), seguida do Sul (1° trimestre de 2020 n = 5939,6; 1° trimestre de 2021 n=5616,16). Conclusão: sendo assim, não houve aumento significativo para dizer que há prescrição e dispensação de benzodiazepínicos entre os anos analisados

Objective: the objective was the prevalence of prescription and dispensing of benzodiazepines in Brazilian capitals, in the first quarters of 2020 and 2021, considering the Coronavirus desease-2019 (COVID-19) pandemic. Methods: this is an epidemiological, exploratory, quantitative, documentary and retrospective study that investigated data from the National Controlled Protocol Management System. Descriptive statistics and association tests were used for data analysis, using the Software Statistical Package for Social Sciences program. In addition, the calculation of the prevalence of dispensation was performed. Results: dispensing of alprazolam and clonazepam is more prevalent. The Southeast region has the highest prevalence of dispensing (1st quarter of 2020 n = 7098.74; 1st quarter of 2021 n = 6849.77), followed by the South (1st quarter of 2020 n = 5939.6; 1st quarter of 2021 of 2021 n =5616.16). Conclusion: therefore, there was no significant increase to say that the prescription and dispensing of benzodiazepines between the years analyzed

Objetivo: el objetivo de este estudio fue analizar la prevalencia de la prescripción y dispensación de benzodiazepinas en capitales brasileñas en el 1er trimestre de 2020 y 2021, considerando la pandemia de Coronavirus desease-2019 (COVID-19). Método: se trata de un estudio epidemiológico, exploratorio, cuantitativo, documental y retrospectivo que investigó datos del Sistema Nacional de Gestión de Protocolos Controlados. Para el análisis de datos se utilizaron estadísticas descriptivas y pruebas de asociación, utilizando el programa Software Statistical Package for Social Sciences. Además, se realizó el cálculo de la prevalencia de dispensación. Resultados: la dispensación de alprazolam y clonazepam es más prevalente. La región Sureste tiene la mayor prevalencia de dispensación (1er trimestre de 2020 n = 7098.74; 1er trimestre de 2021 n = 6849.77), seguida por el Sur (1er trimestre de 2020 n = 5939.6; 1er trimestre de 2021 de 2021 n =5616.16). Conclusión: por lo tanto, no hubo un aumento significativo para decir que la prescripción y dispensación de benzodiazepinas entre los años analizados

Pharmacotherapy used for alcohol and cocaine use disorders in a CAPS-AD of Minas Gerais

Abstract Substance use disorder is one of the major social and public health problems in the world. The present study analyzed the pharmacoepidemiological profile of patients treated at the Psychosocial Treatment Center for Alcohol and Substance Use Disorders (CAPS-AD) for treatment of alcohol use disorders (AUD), cocaine use disorders (CUD) and concomitant alcohol and cocaine use disorders (A-CUD) in the city of Betim-MG. The study used quantitative and descriptive data and was based on the evaluation of medical records of patients attended from January to December 2016. After analyzing 295 medical records, the majority of study participants were male (83.7 %) with an average age of 46.26 for AUD, 28.88 for CUD and 34.29 for A-CUD. The most prescribed drugs for AUD were diazepam (54.1 %), thiamine (37 %), complex B vitamins (29.5 %), and disulfiram (2.7 %); for CUD, diazepam (26.9 %) and haloperidol (23.1 %). It should be noticed that although contraindicated by the guidelines, chlorpromazine (42.3 %, 25.3 %, 20.3 %) was prescribed for CUD, AUD, and A-CUD respectively. Knowing the pharmacoepidemiological profile of CAPS-AD patients is extremely important for making decisions regarding which medicines to make available to the population.