Anticonvulsant Agents for the Management of Benzodiazepine Dependence

Benzodiazepines (BZDs) are widely available drugs. In the adult population, the prevalence of daily use of anxiolytic drugs is 4%, and the prevalence of daily use of hypnotics is 1.7%, according to a Spanish survey conducted in 2011 [1]. This is due to their anxiolytic, sedative, and hypnotic properties, and also because they have shown to have a broad-spectrum activity, a rapid onset of action, and a wide therapeutic window compared with other anxiolytic medications [2]. However, chronic use of BZDs has revealed that these drugs can lead to tolerance and dependence [3], as indicated by a BZD Withdrawal Syndrome (BWS) following cessation, characterized by nervousness, irritability, sleep disturbances, dizziness, tremor, diaphoresis and diarrhea, which can be complicated with seizures [4]. In addition, they associate a higher risk of impairments in cognition, memory, attention, reaction time and psychomotor function [5,6]. It has been estimated that 30 to 40% of long-term users of BZDs experience difficulties in withdrawing from these drugs [7]. The risk factors for BZD Dependence (BD) and BWS can be classified as those related with the drug properties (short half-life and high-power BZD), those related to the way how the BZD is used (use of high doses of BZDs, during more than 8 months and a rapid rate of taper) and those related to individual characteristics (previous history of drugs or alcohol dependence or abuse; history of a chronic disease; personality, anxiety or mood disorders; insomnia; females; elderly and a high cultural level) [2,8].