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Benzodiazepine Equivalents

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1. Benzodiazepine Equivalents

Benzodiazepine Equivalents Benzodiazepine Equivalents Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Benzodiazepine Equivalents (...) Benzodiazepine Equivalents Aka: Benzodiazepine Equivalents , Barbiturate Equivalents , Sedative Equivalents From Related Chapters II. Indications Sedative withdrawal III. Preparations: Benzodiazepines Equivalents ( ) 0.5 mg is equivalent to 10 mg = Dose x20 Phenobarbital = Dose x30 ( , Limbitrol) 25 mg is equivalent to 10 mg = Dose x0.4 Phenobarbital = Dose x1.2 ( ) 0.5 mg is equivalent to 10 mg = Dose x20 Phenobarbital = Dose x7.5 ( ) 15-30 mg is equivalent to 10 mg = Dose x0.33 Phenobarbital = Dose x2.0

2018 FP Notebook

2. Opioids Used in Conjunction With Benzodiazepines Produce Worse Outcomes in Patients Experiencing Chronic Pain Compared To Sole Opioid Use

Opioids Used in Conjunction With Benzodiazepines Produce Worse Outcomes in Patients Experiencing Chronic Pain Compared To Sole Opioid Use UTCAT3169, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Opioids Used in Conjunction With Benzodiazepines Produce Worse Outcomes in Patients Experiencing Chronic Pain Compared To Sole Opioid Use Clinical Question For a patient experiencing chronic pain, will the use (...) of benzodiazepines with opioids, compared to opioids alone, produce better outcomes? Clinical Bottom Line For patients with chronic pain, the use of opioids in conjunction with benzodiazepines produces worse outcomes than opioids alone. This is supported by a cross-sectional study where it was noted that the combination of opioids and benzodiazepines correlated with poor mood and decreased patient function. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient

2017 UTHSCSA Dental School CAT Library

3. Safety of benzodiazepines and opioids in interstitial lung disease: a national prospective study

Safety of benzodiazepines and opioids in interstitial lung disease: a national prospective study Safety concerns are a barrier to prescribing benzodiazepines (BDZs) and opioids in interstitial lung disease (ILD). We therefore examined the association of BDZs and opioids on risk of admission to hospital and death.We conducted a population-based longitudinal cohort study of fibrotic ILD patients starting long-term oxygen therapy in Sweden between October 2005 and December 2014. Effects of BDZs (...) ). Opioids showed no association with increased admission. Neither low-dose opioids (≤30 mg·day-1 oral morphine equivalent) (SHR 1.18, 95% CI 0.96-1.45) nor high-dose opioids (>30 mg·day-1 oral morphine equivalent) (SHR 1.11, 95% CI 0.89-1.39) showed association with increased mortality.This first ever study to examine associations between BDZ and opioid use and harm in ILD supports the use of opioids and low-dose BDZs in severely ill patients with respiratory compromise.Copyright ©ERS 2018.

2019 EvidenceUpdates

4. Receipt of Overlapping Opioid and Benzodiazepine Prescriptions Among Veterans Dually Enrolled in Medicare Part D and the Department of Veterans Affairs: A Cross-sectional Study. (PubMed)

of overlap with a daily opioid dose >120 morphine milligram equivalents). Augmented inverse probability weighting regression was used to compare these measures by prescription drug source: VA only, Medicare only, or VA and Medicare (dual use).Of 368 891 eligible veterans, 18.3% received prescriptions from the VA only, 30.3% from Medicare only, and 51.4% from both VA and Medicare. The proportion with PQA opioid-benzodiazepine overlap was larger for the dual-use group than the VA-only group (23.1% vs. 17.3 (...) Receipt of Overlapping Opioid and Benzodiazepine Prescriptions Among Veterans Dually Enrolled in Medicare Part D and the Department of Veterans Affairs: A Cross-sectional Study. Overlapping use of opioids and benzodiazepines is associated with increased risk for overdose. Veterans receiving medications concurrently from the U.S. Department of Veterans Affairs (VA) and Medicare may be at higher risk for such overlap.To assess the association between dual use of VA and Medicare drug benefits

2018 Annals of Internal Medicine

5. Narcotics, Benzodiazepines, Stimulants, and Gabapentin: Policies, Initiatives, and Practices Across Canada, 2014

Narcotics, Benzodiazepines, Stimulants, and Gabapentin: Policies, Initiatives, and Practices Across Canada, 2014 Narcotics, Benzodiazepines, Stimulants, and Gabapentin: Policies, Initiatives, and Practices Across Canada, 2014 | CADTH.ca Find the information you need Narcotics, Benzodiazepines, Stimulants, and Gabapentin: Policies, Initiatives, and Practices Across Canada, 2014 Narcotics, Benzodiazepines, Stimulants, and Gabapentin: Policies, Initiatives, and Practices Across Canada, 2014 (...) , as well as place a significant burden on our health, social services, and public safety systems.” 1 The purpose of this Environmental Scan is to provide an overview of policies, practices, and initiatives which the publicly funded drug programs, colleges of physicians and surgeons, and colleges of pharmacy are implementing across Canada to address the misuse, abuse, and diversion of prescription narcotics (opioids), benzodiazepines, stimulants, and gabapentin. This information may assist drug policy

2015 Canadian Agency for Drugs and Technologies in Health - Environmental Scanning

6. Benzodiazepine and Z-Drug Safety

At risk of drug interaction with other medications. o At risk of permanent cognitive impairment when using high doses of benzodiazepines (e.g., diazepam 30 mg or equivalent) on a regular basis. Table 1. Common indications for benzodiazepines (BZDs) and Z-drugs See Appendix 1 for full prescribing information. Indication BZDs Z-drugs Considerations Insomnia Temazepam 1 Zolpidem Eszopiclone Zaleplon • Both are effective in the relief of short-term (1–2 weeks continuous) but not long-term insomnia (...) Benzodiazepine and Z-Drug Safety © 2014 Kaiser Foundation Health Plan of Washington. All rights reserved. 1 Benzodiazepine and Z-Drug Safety Guideline Expectations for KFHPWA Providers 2 Background 2 Prescribing 3 Management of Patients on Chronic Benzodiazepines or Z-Drugs 6 Tapering and Discontinuation 9 Treatment of Withdrawal Symptoms 12 Referral Criteria 13 Evidence Summary 14 References 17 Guideline Development Process and Team 18 Appendix 1 Table A. Long-acting benzodiazepine comparison

2014 Kaiser Permanente Clinical Guidelines

7. Patterns of Prescription Opioid Use in Women With Endometriosis: Evaluating Prolonged Use, Daily Dose, and Concomitant Use With Benzodiazepines. (PubMed)

18-49 years were compared with women in the control group matched on age, region, race, insurance payer, and plan type. Key outcomes included: filled prescription for an opioid, multiple opioid prescriptions, number of days' supply, daily dose (morphine milligram equivalents), and concomitant opioid and benzodiazepine prescriptions. Cohorts were descriptively analyzed using t- and χ statistics and multivariable regression analyses yielded adjusted relative risk (RR) ratios and 95% CI.The study (...) milligram equivalents or more (24,544 [45.6%] vs 10,463 [9.7%]; adjusted RR ratio 4.07; 3.98-4.16) or 100 morphine milligram equivalents or more (8,013 [14.9%] vs 3,582 [3.3%]; adjusted RR ratio 3.56; 3.43-3.70). Women in the case group were more likely to have concomitant opioid and benzodiazepine prescriptions (5,453 [10.1%] vs 3,711 [3.5%]; adjusted RR ratio 1.95; 1.88-2.03) and to have used these drugs concurrently for at least 30 days (1,596 [3.0%] vs 1,265 [1.2%]; adjusted RR ratio 1.43; 1.34-1.52

2019 Obstetrics and Gynecology

8. Patterns of Prescription Opioid Use in Women With Endometriosis: Evaluating Prolonged Use, Daily Dose, and Concomitant Use With Benzodiazepines. (PubMed)

18-49 years were compared with women in the control group matched on age, region, race, insurance payer, and plan type. Key outcomes included: filled prescription for an opioid, multiple opioid prescriptions, number of days' supply, daily dose (morphine milligram equivalents), and concomitant opioid and benzodiazepine prescriptions. Cohorts were descriptively analyzed using t- and χ statistics and multivariable regression analyses yielded adjusted relative risk (RR) ratios and 95% CI.The study (...) milligram equivalents or more (24,544 [45.6%] vs 10,463 [9.7%]; adjusted RR ratio 4.07; 3.98-4.16) or 100 morphine milligram equivalents or more (8,013 [14.9%] vs 3,582 [3.3%]; adjusted RR ratio 3.56; 3.43-3.70). Women in the case group were more likely to have concomitant opioid and benzodiazepine prescriptions (5,453 [10.1%] vs 3,711 [3.5%]; adjusted RR ratio 1.95; 1.88-2.03) and to have used these drugs concurrently for at least 30 days (1,596 [3.0%] vs 1,265 [1.2%]; adjusted RR ratio 1.43; 1.34-1.52

2019 Obstetrics and Gynecology

9. Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study. (PubMed)

users who concurrently used benzodiazepine receptor modulators with an average of 98 days (SD=114, 95% CI 97 to 99) of total cumulative concurrency and a median of 37 days (IQR 10 to 171). The average longest duration of consecutive days of concurrency was 45 (SD=60, 95% CI 44.6 to 45.4) with a median of 24 days (IQR 8 to 59). Concurrency was more prevalent in females, patients using an average daily oral morphine equivalent >90 mg, opioid dependence therapy patients, chronic opioid users, patients (...) Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study. The objective of this study is to characterise concurrent use of benzodiazepine receptor modulators and opioids among prescription opioid users in Alberta in 2017.A population based retrospective study.Alberta, Canada, in the year 2017.All individuals in Alberta, Canada, with at least one dispensation record from a community pharmacy for an opioid in the year 2017

2019 BMJ open

10. Concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives among patients with cancer referred to an outpatient palliative care clinic. (PubMed)

Concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives among patients with cancer referred to an outpatient palliative care clinic. The concurrent use of opioids with benzodiazepines (BZD) or nonbenzodiazepine sedatives (S) recently was found to be associated with an increased risk of overdose death compared with the use of opioids alone. In the current study, the authors examined the frequency and trend of concurrent opioid/BZD-S use and its associated risk factors among (...) ). The morphine equivalent daily dose was significantly higher in concurrent opioid/BZD-S group (median of 67.5 mg/day [interquartile range (IQR), 30-135 mg/day] vs 60 mg/day [IQR, 30-105 mg/day]; P = .034). Multivariate analysis demonstrated that anxiety (P ≤ .0001), white race (P = .0092), and poor Eastern Cooperative Oncology Group performance status (P = .0017) were significantly associated with concurrent use.The concurrent use of opioids with BZD-S has declined but continues to be frequent among

2019 Cancer

11. Strategies for discontinuing benzodiazepines

, agitation or delirium as one of 5 key things to avoid in elderly patients. 5 When a benzodiazepine is prescribed to an elderly patient, health care providers should be alert Table 1. Hypnotics: equivalent doses to 5 mg Diazepam. Active substance Brand name (in Spain) Elimination half-life (h) Approximate dose (mg) Short half-life ( 24 h) Flurazepam Dormodor® 24 – 100 15 Quazepam Quiedorm® 40 – 55 10 Table 2. Anxiolytics: equivalent doses to 5 mg Diazepam. Active substance Brand name (in Spain (...) an initial reduction of the total daily dose by 10-25%, depending on the degree of dependence. The reduced dose is maintained for 2-3 weeks, before considering further dose reductions. Dose reduction can be accomplished with the original benzodiazepine, or after switching to an equivalent dose of diazepam, to take advantage of its long elimination half-life (1-3 days) and the even longer t½ elimination of its active metabolite nordiazepam risk of falls and hip fracture benzodiazepines also increase

2015 Drug and Therapeutics Bulletin of Navarre (Spain)

12. Reducing Inappropriate Benzodiazepine Use Among Older Adults

. It does NOT suggest patients to stop on their own, but rather suggests they speak with their provider. Behavioral: Educational Material Educational material is in the form of a brochure Outcome Measures Go to Primary Outcome Measures : Change in avg. daily dose of benzodiazepine prescribed in lorazepam-equivalent mg [ Time Frame: 3 months ] Compare the average daily dose during month 3 to the baseline average daily dose Change in avg. daily dose of benzodiazepine prescribed in lorazepam-equivalent mg (...) Reducing Inappropriate Benzodiazepine Use Among Older Adults Reducing Inappropriate Benzodiazepine Use Among Older Adults - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Reducing Inappropriate

2018 Clinical Trials

13. Don’t miss this adverse drug reaction when tapering benzodiazepines

Don’t miss this adverse drug reaction when tapering benzodiazepines Don’t miss this adverse drug reaction when tapering benzodiazepines Don’t miss this adverse drug reaction when tapering benzodiazepines | | November 27, 2018 14K Shares “Alice Woods” is dying of metastatic breast cancer, but she cares little for awareness efforts like pink ribbons and catchy hashtags like #stage4needsmore. You see, Alice has due to an adverse effect from discontinuing Klonopin — a condition that has caused her (...) in the case of withdrawal from drugs such as benzodiazepines. Alice called her doctor’s office at the onset of symptoms and was told it could not be related to Klonopin because the drug was “out of her system.” Instead, she was presumed to be mentally ill and was admitted multiple times to psychiatric facilities over the next year. She was given trials of different psychiatric drugs, none of which stopped her relentless need to move. On one particular occasion, she recalls the nurses threatening to tie

2018 KevinMD blog

14. Correlates of Benzodiazepine Use and Adverse Outcomes Among Patients with Chronic Pain Prescribed Long-term Opioid Therapy. (PubMed)

, overall comorbidity score, and opioid morphine equivalent dose.Twenty-five percent (N = 127) of participants had co-occurring benzodiazepine and opioid prescriptions in the prior year. Odds of receiving a benzodiazepine prescription were significantly higher among patients with the following psychiatric diagnoses: anxiety disorder (adjusted odds ratio [AOR] = 4.71, 95% confidence interval [CI] = 2.67-8.32, P < 0.001), post-traumatic stress disorder (AOR = 2.24, 95% CI = 1.14-4.38, P = 0.019 (...) Correlates of Benzodiazepine Use and Adverse Outcomes Among Patients with Chronic Pain Prescribed Long-term Opioid Therapy. To examine the correlates and odds of receiving overlapping benzodiazepine and opioid prescriptions and whether co-prescription was associated with greater odds of falling or visiting the emergency department.Cross-sectional study.A large private integrated health system and a Veterans Health Administration integrated health system.Five hundred seventeen adults

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2018 Pain Medicine

15. RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities. (PubMed)

equivalent doses/day/resident; proportions of residents for whom drug was ceased or the dose reduced; prevalence of antidepressant and prn (as required) psychotropic prescribing (to detect any substitution practice).During the 6-month intervention, the proportion of residents prescribed antipsychotics declined by 13% (from 21.6% [95% CI, 20.4-22.9%] to 18.9% [95% CI, 17.7-20.1%]), and that of residents regularly prescribed benzodiazepines by 21% (from 22.2% [95% CI, 21.0-23.5%] to 17.6% [95% CI, 16.5 (...) -18.7]; each, P < 0.001). Mean chlorpromazine equivalent dose declined from 22.9 mg/resident/day (95% CI, 19.8-26.0) to 20.2 mg/resident/day (95% CI, 17.5-22.9; P < 0.001); mean diazepam equivalent dose declined from 1.4 mg/resident/day (95% CI, 1.3-1.5) to 1.1 mg/resident/day (95% CI, 0.9-1.2; P < 0.001). For 39% of residents prescribed antipsychotics and benzodiazepines at baseline, these agents had been ceased or their doses reduced by 6 months. There was no substitution by sedating

2018 Medical Journal of Australia

16. Preoperative Smoking and Narcotic, Benzodiazepine, and Tramadol Use are Risk Factors for Narcotic Use After Hip and Knee Arthroplasty. (PubMed)

18 years or older with osteoarthritis of the hip or knee who presented over a 1-year period and underwent total knee arthroplasty or total hip arthroplasty were included. The Arkansas prescription monitoring program was then used to determine recent narcotic and benzodiazepine prescriptions filled within 3 months of surgery, and this was converted into morphine milligram equivalents (MME).One hundred seventy-nine patients met the inclusion criteria. When compared with patients who did not take (...) Preoperative Smoking and Narcotic, Benzodiazepine, and Tramadol Use are Risk Factors for Narcotic Use After Hip and Knee Arthroplasty. The use of narcotics has been found to be a modifiable risk factor for success of arthroplasty. We sought to determine the risk factors leading to increased narcotic use after total hip arthroplasty and total knee arthroplasty.A retrospective chart review was performed on new patients presenting to an orthopedic reconstructive-service clinic. New patients aged

2018 Journal of Arthroplasty

17. Safety of benzodiazepines and opioids in interstitial lung disease: A national prospective study. (PubMed)

Safety of benzodiazepines and opioids in interstitial lung disease: A national prospective study. Safety concerns are a barrier to prescribing benzodiazepines (BDZs) and opioids in interstitial lung disease (ILD). We therefore examined the association of BDZs and opioids on risk of admission to hospital and death.We conducted a population-based longitudinal cohort study of fibrotic ILD patients starting long-term oxygen therapy in Sweden between October 2005 and December 2014. Effects of BDZs (...) ). Opioids showed no association with increased admission. Neither low-dose opioids (≤30 mg·day-1 oral morphine equivalent) (SHR 1.18, 95% CI 0.96-1.45) nor high-dose opioids (>30 mg·day-1 oral morphine equivalent) (SHR 1.11, 95% CI 0.89-1.39) showed association with increased mortality.This first ever study to examine associations between BDZ and opioid use and harm in ILD supports the use of opioids and low-dose BDZs in severely ill patients with respiratory compromise.Copyright ©ERS 2018.

2018 European Respiratory Journal

18. Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis

or short consultation with a general practitioner regarding long-term use, adverse effects and advice on withdrawal. Long-term use was defined as three months or more. The primary outcome of interest was withdrawal from use of benzodiazepine. A secondary outcome was general health status. All the included studies were conducted in UK general practice. Follow-up was reported as six months. Benzodiazepine dosage was expressed as diazepam equivalents of either 5mg or 10mg. Interventions included (...) Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis Mugunthan K, McGuire T, Glasziou P CRD summary The review concluded that a brief primary care intervention for long-term users

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2011 DARE.

19. A Clinical Trial for Examining the Therapeutic Equivalence Between Fluticasone Propionate 100 mcg and Salmeterol 50 mcg Inhalation Powder/Respirent Pharmaceuticals vs. ADVAIR DISKUS® 100/50 mcg Inhalation Powder/GSK in Patients With Asthma

A Clinical Trial for Examining the Therapeutic Equivalence Between Fluticasone Propionate 100 mcg and Salmeterol 50 mcg Inhalation Powder/Respirent Pharmaceuticals vs. ADVAIR DISKUS® 100/50 mcg Inhalation Powder/GSK in Patients With Asthma A Clinical Trial for Examining the Therapeutic Equivalence Between Fluticasone Propionate 100 mcg and Salmeterol 50 mcg Inhalation Powder/Respirent Pharmaceuticals vs. ADVAIR DISKUS® 100/50 mcg Inhalation Powder/GSK in Patients With Asthma - Full Text View (...) - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. A Clinical Trial for Examining the Therapeutic Equivalence Between Fluticasone Propionate 100 mcg and Salmeterol 50 mcg Inhalation Powder/Respirent Pharmaceuticals vs. ADVAIR DISKUS® 100/50 mcg

2018 Clinical Trials

20. Therapeutic Equivalence of Two Formulations of Fluticasone Propionate and Salmeterol Inhalation Powder in Subjects With Asthma

Therapeutic Equivalence of Two Formulations of Fluticasone Propionate and Salmeterol Inhalation Powder in Subjects With Asthma Therapeutic Equivalence of Two Formulations of Fluticasone Propionate and Salmeterol Inhalation Powder in Subjects With Asthma - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached (...) the maximum number of saved studies (100). Please remove one or more studies before adding more. Therapeutic Equivalence of Two Formulations of Fluticasone Propionate and Salmeterol Inhalation Powder in Subjects With Asthma The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our

2018 Clinical Trials

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