Sedative, Hypnotic or Anxiolytic-Related Disorders
Pp. 175-187 (13)
Subhash C. Bhatia, Shashi K. Bhatia, Venkata Kolli and Jaya krishna Madabushi
Sedative Hypnotic Agents (SHAs) are prescribed across several medical
disciplines, however, these carry a risk of addiction in small percentage of patients.
SHA use for more than a month can result in tolerance and pharmacological
dependence. This often requires dose escalation during the first 10-12 weeks of
treatment . This pharmacological dependence should be distinguished from SHA use
disorder. In this chapter we discuss the factors associated with risk and risk mitigation
for SHA use disorder. Use of lowest possible effective dose for shorter period of time
with close monitoring a valuable strategy to prevent addiction. Sudden SHA
withdrawal specially from barbiturates may be fatal. We discuss the safe strategy for
acute withdrawal by converting the drug of addiction to equivalent dose of a long halflife
benzodiazepine or barbiturate. Stabilizing on that drug dose and gradually tapering
from that. We also suggest treatment with adjunctive medications for comorbid
psychiatric disorders. We conclude this chapter with a brief discussion of psychosocial
strategies to promote abstinence and recovery.
Barbiturates, Benzodiazepines, Benzodiazepine daily equivalents,
Dependence, Pharmacological dependence, Sedative Hypnotic use disorders,
Department of Psychiatry, Mental Health and Behavioral Sciences, Creighton University; Department VA Nebraska- Western Iowa Health Care System 4101 Woolworth Ave Omaha, NE 68105, USA.