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Psychiatria Polska Jun 2022Alcohol addiction is one of the most common health problems. Long-term consumption of high doses of ethanol leads to numerous adaptive changes in the central and...
Pharmacotherapy of alcohol withdrawal syndromes - Recommendations of the Polish Psychiatric Association and the Pharmacotherapy Section of the Polish Society for Addiction Research.
Alcohol addiction is one of the most common health problems. Long-term consumption of high doses of ethanol leads to numerous adaptive changes in the central and peripheral nervous systems, most notably a decrease in the activity of inhibitory GABAergic pathways and an increase in the activity of excitatory glutamatergic pathways. Up to half of patients may develop alcohol withdrawal syndrome (AWS) when they stop drinking alcohol. This article contains the recommendations of the Polish Psychiatric Association and the Pharmacotherapy Section of the Polish Society for Addiction Research for the pharmaco�therapy of AWS. This paper presents the aetiopathogenesis, neurotransmitter and receptor mechanisms, symptoms and diagnostic criteria of AWS, medications used in the treatment of alcohol withdrawal syndromes, management of uncomplicated and complicated alcohol withdrawal syndromes, and discusses the management of special populations. First‑line drugs in the management of AWS are benzodiazepines (BDZ). Most studies have not shown a su�periority of any BDZ in the treatment of AWS. The decision to choose a formulation should be based on its pharmacokinetic properties, comorbidities, and the patient's current condi�tion. The most commonly used BDZs are diazepam, lorazepam, oxazepam, and clorazepate.
Topics: Humans; Substance Withdrawal Syndrome; Alcoholism; Poland; Benzodiazepines; Ethanol
PubMed: 36342978
DOI: 10.12740/PP/OnlineFirst/149321 -
Journal of Clinical and Experimental... 2022Alcohol withdrawal syndrome (AWS) is a common condition that is seen in treatment-seeking patients with Alcohol use disorder (AUD) and alcoholic liver disease (ALD).... (Review)
Review
Alcohol withdrawal syndrome (AWS) is a common condition that is seen in treatment-seeking patients with Alcohol use disorder (AUD) and alcoholic liver disease (ALD). AWS, which typically starts within 4-6 h of the last alcohol use, can range from mild symptoms such as insomnia, tremors, and autonomic hyperactivity to more severe symptoms such as seizures and delirium tremens. Clinical Institute Withdrawal Assessment Scale-Alcohol Revised (CIWA-Ar) is the most commonly used scale to assess AWS in clinical practice. The presence of moderate withdrawal as indicated by a score of more than 8 is an indication for pharmacotherapy. Lorazepam and oxazepam are preferred agents for the management of AWS in the setting of ALD. In severe ALD, benzodiazepines should be used cautiously with monitoring due to the risk of excessive sedation or precipitating hepatic encephalopathy.
PubMed: 36340306
DOI: 10.1016/j.jceh.2022.03.003 -
Pakistan Journal of Medical Sciences 2022To explore the effect of grouping motivational interviewing on psychological craving of patients with alcohol dependence in the rehabilitation.
OBJECTIVE
To explore the effect of grouping motivational interviewing on psychological craving of patients with alcohol dependence in the rehabilitation.
METHODS
In this prospective study one hundred patients with convalescent alcohol dependence admitted to Hebei Province Veterans Hospital from October 2017 to June 2019 were randomly divided into two groups, the experimental group and the control group, 50 cases in each. The experimental group was administrated oxazepam as a replacement therapy and the motivational interviewing. The control group was administrated oxazepam as a replacement therapy and routine health education. Both groups continued treatment for three months. Curative effect was assessed before treatment, and two weeks, four weeks and three months after treatment by using Penn Alcohol Craving Scale (PACS), Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA).
RESULTS
PACS, HAMD and HAMA in the experimental group were significantly lower than those in the control group (P < 0.05).
CONCLUSION
Grouping motivational interviewing can effectively reduce the degree of psychological dependence on alcohol and improve the symptoms of anxiety and depression in patients with alcohol dependence during rehabilitation period.
PubMed: 36246683
DOI: 10.12669/pjms.38.7.4741 -
Advanced Biomedical Research 2022This study aimed to compare the efficacy of gabapentin and oxazepam on sleep quality, the severity of anxiety, and pain level in patients admitted to the coronary care...
Comparison the Effects of Gabapentin and Oxazepam on Sleep Quality, Anxiety, and Pain in Unstable Angina Patients Admitted to Coronary Care Unit of Hazrat Rasool Akram Hospital.
BACKGROUND
This study aimed to compare the efficacy of gabapentin and oxazepam on sleep quality, the severity of anxiety, and pain level in patients admitted to the coronary care unit (CCU).
MATERIALS AND METHODS
This double-blind randomized clinical trial was done on the patients with unstable angina (UA) admitted to the CCU of Hazrat Rasool Akram Hospital in Tehran. A total of 56 patients were entered the study and randomly divided into two groups of 26. The first group was given a gabapentin capsule at a dose of 300-1200 mg/day, and the second group was given 10-20 mg of oxazepam tablets per day until hospitalization in the CCU. On the first and 4 days of hospitalization, Groningen sleep quality score (GSQS), Beck Anxiety Inventory, and severity of pain experienced by Visual Analogue Scale were recorded, and the mean frequency of chest pains was calculated in 24 h during the first 4 days. The amount of drug (morphine) prescription in CCU also compared between the two groups.
RESULTS
There was no significant difference in GSQS scores between both groups. The mean score of Beck's anxiety scale did not differ significantly between the two groups. However, the incidence of chest pain was significantly lower in the gabapentin-receiving group than in the oxazepam-receiving group (<0.001). The days that the patients experienced chest pain were significantly less in the gabapentin-receiving group than in the oxazepam-receiving group (<0.001).
CONCLUSION
The results of our study showed that gabapentin compared to oxazepam could significantly reduce chest pain in patients with UA.
PubMed: 36124023
DOI: 10.4103/abr.abr_154_20 -
Evidence-based Complementary and... 2022To explore the efficacy of risperidone orally disintegrating tablets combined with oxazepam in the treatment of schizophrenia.
OBJECTIVE
To explore the efficacy of risperidone orally disintegrating tablets combined with oxazepam in the treatment of schizophrenia.
METHODS
From May 2019 to May 2021, 60 patients with schizophrenia treated in our hospital were recruited and assigned into an observation group (risperidone orally disintegrating tablets combined with oxazepam treatment) and a control group (alprazolam combined with chlorpromazine treatment) according to the random number table method. The positive and negative symptom score (PANSS), quality of life score (QOL-75), ability of daily living score (ADL), clinical efficacy, incidence of adverse reactions, and disease recurrence were compared between the two groups before and after treatment.
RESULTS
The PANSS scores were similar in the two groups before treatment ( > 0.05). The two groups presented a declining trend in PANSS score after treatment, whereas a remarkable lower score in the observation group was observed ( < 0.05). The QOL scores of the two groups of patients before treatment was not significantly different ( > 0.05). Both groups witnessed improvements one month and three months after treatment, with considerable improvements being obtained in the observation group (all < 0.05). The two groups did not differ in ADL scores before treatment ( > 0.05). At 1 month and 3 months after treatment, the ADL scores of the two groups were improved, with a higher score in the observation group ( < 0.05). The observation group had a markedly higher total effective rate as compared to the control group ( = 5.455, =0.020). Adverse reaction occurred in both groups, with milder results in the observation group. The recurrence rate of the two groups was not statistically different one month after treatment ( > 0.05), while two and three months after treatment, they were lower than those of the control group (all < 0.05).
CONCLUSION
Risperidone orally disintegrating tablets combined with oxazepam shows potential in the treatment of schizophrenia by relieving patients' mental symptoms, improving quality of life and activities of daily living, and minimizing the incidence of adverse reactions.
PubMed: 35990853
DOI: 10.1155/2022/2344946 -
Journal of Chromatography. A Aug 2022This paper systematically investigated and reported for the first time the identification and quantification of co-eluting impurities as low as 0.05 area% by PDA with...
Liquid chromatography coupled with photodiode array and a multivariate curve resolution - Alternating least square algorithm for identification and quantification of co-eluting impurities in pharmaceutical analysis.
This paper systematically investigated and reported for the first time the identification and quantification of co-eluting impurities as low as 0.05 area% by PDA with i-PDeA II deconvolution software in the LabSolutions Chromatographic Data System (CDS) using an integrated multivariate curve resolution-alternating least squares (MCR-ALS) algorithm with a bidirectional exponentially modified Gaussian (BEMG) model function. The algorithm was able to consistently identify 0.05% impurities when co-eluting with the main component (Rs ≥ 0.8) as well as when co-eluting with another impurity (Rs ≥ 0.5). In the case of two co-eluting impurities from 0.05% to 1% (Rs ≥ 0.5), the quantification error ranged from +10.6% to -16.7%. In the case of an impurity co-eluting with the main component (Rs ≥ 0.8), the quantification error was 4.4-8.9% for 1% impurity and 109-184% for 0.05% impurity. The precision was excellent for the range of 0.05-1.0% impurities with the RSD being 1.4-3.0% for 1% impurity and 4.0-8.7% for 0.05% impurity. The identification rate and quantitation accuracy were not affected by the spectral similarity of the molecules, as comparable results were obtained by analyzing two molecules with low similarity (4,4-difluorobenzophenone and valerophenone) and two molecules with high similarity (diazepam and oxazepam) based on simulated data. This peak resolution by MCR-ALS approach provides fast and robust identification and quantification of co-eluting impurities even when method development efforts do not provide complete separation of the target peaks, and could therefore find a wide range of applications in pharmaceutical and other types of analyses.
Topics: Algorithms; Chromatography, High Pressure Liquid; Chromatography, Liquid; Least-Squares Analysis; Multivariate Analysis; Pharmaceutical Preparations; Software
PubMed: 35914409
DOI: 10.1016/j.chroma.2022.463364 -
Case Reports in Otolaryngology 2022Disturbed pitch perception is a rare but well-known side effect of the antiepileptic drug carbamazepine and its derivates. A patient is presented who used three...
Disturbed Pitch Perception during Antidepressant Therapy of a Combination of Lithium, Nortriptyline, and Oxazepam: A Rare Unexpected and Undesirable Side Effect for a Violinist.
Disturbed pitch perception is a rare but well-known side effect of the antiepileptic drug carbamazepine and its derivates. A patient is presented who used three antidepressants because of depression. After recovering, the medication was continued, but as a violinist, the patient was told that his intonation was too low with the consequence that he was not allowed to participate in the orchestra where he had been for years. After phasing out the medications, his pitch perception returned to normal. This observation is unique as no other examples of this side effect are found in the literature in relation to antidepressants.
PubMed: 35911473
DOI: 10.1155/2022/4494284 -
Ugeskrift For Laeger Jun 2022In this case report we describe a life-threatening episode of delirium in a 51-year-old man. The condition was triggered by an abrupt withdrawal of benzodiazepines. The...
In this case report we describe a life-threatening episode of delirium in a 51-year-old man. The condition was triggered by an abrupt withdrawal of benzodiazepines. The patient had been taking multiple sedatives for several years but a large proportion of the drugs were not available in Denmark. His general practitioner substituted and prescribed oxazepam and zolpidem for ten days. Afterwards the patient did not have access to benzodiazepines and developed a severe benzodiazepine withdrawal delirium. He was treated with diazepam and olanzapine with gradual dose reduction.
Topics: Alcohol Withdrawal Delirium; Benzodiazepines; Delirium; Diazepam; Humans; Male; Middle Aged; Oxazepam; Substance Withdrawal Syndrome
PubMed: 35703059
DOI: No ID Found -
Journal of Analytical Toxicology Oct 2022A rapid, simple extraction method followed by qualitative screening using liquid chromatography-tandem mass spectrometry (LC-MS-MS) for drugs in oral fluid is presented....
A rapid, simple extraction method followed by qualitative screening using liquid chromatography-tandem mass spectrometry (LC-MS-MS) for drugs in oral fluid is presented. The decision points were selected to be at, or lower, than those recommended as Tier I compounds by the National Safety Council's Alcohol, Drugs and Impairment Division for toxicological investigation of driving under the influence of drug (DUID) cases and were also at, or lower, than those recommended by Substance Abuse and Mental Health Service Administration and the Department of Transportation for Federal workplace drug testing programs. The method included 30 drugs: delta-9-tetrahydrocannabinol, amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxyamphetamine, cocaine, benzoylecgonine, carisoprodol, meprobamate, zolpidem, alprazolam, clonazepam, 7-aminoclonazepam, diazepam, nordiazepam, lorazepam, oxazepam, temazepam, codeine, morphine, 6-acetylmorphine, buprenorphine, fentanyl, hydrocodone, hydromorphone, oxycodone, oxymorphone, methadone, tramadol and phencyclidine. Phencyclidine was included because it is in the Federal workplace program even though it is considered a Tier II drug for DUID cases. A liquid-liquid extraction method using isopropanol, hexane and ethyl acetate to extract drugs from the oral fluid-buffer mix collected in a Quantisal™ device, followed by LC-MS-MS screening, was developed and validated according to ANSI/ASB 2019 Standard Practices for Method Validation in Forensic Toxicology. Interference studies, limit of detection, precision at the decision point, ionization suppression/enhancement and processed sample stability were determined for each drug. The method was successfully applied to proficiency specimens and routine samples received in the laboratory.
Topics: 2-Propanol; 3,4-Methylenedioxyamphetamine; Alprazolam; Amphetamines; Buprenorphine; Carisoprodol; Clonazepam; Cocaine; Codeine; Dronabinol; Fentanyl; Hexanes; Hydrocodone; Hydromorphone; Lorazepam; Meprobamate; Methadone; Methamphetamine; Morphine Derivatives; N-Methyl-3,4-methylenedioxyamphetamine; Nordazepam; Oxazepam; Oxycodone; Oxymorphone; Pharmaceutical Preparations; Phencyclidine; Tandem Mass Spectrometry; Temazepam; Tramadol; Zolpidem
PubMed: 35640884
DOI: 10.1093/jat/bkac031 -
The Science of the Total Environment Aug 2022Soil Aquifer Treatment (SAT) can provide supplementary treatment of trace organic compounds (TrOCs) such as pharmaceutical and industrial compounds present in Secondary...
Soil Aquifer Treatment (SAT) can provide supplementary treatment of trace organic compounds (TrOCs) such as pharmaceutical and industrial compounds present in Secondary Treated Wastewater (STWW). Concern on presence of unregulated TrOCs in natural systems has raised recently as well as the interest in SAT systems for remediation. The present study quantifies, at the field scale over35 m of lateral groundwater flow, the effectiveness of the Agon-Coutainville SAT system (Manche, Normandy, France) for TrOCs removal by sorption and biodegradation through monitoring of seven TrOCs (oxazepam, carbamazepine, benzotriazole, tolyltriazole, caffein, paracetamol, ibuprofen) and major inorganic compounds as intrinsic tracers in STWW and groundwater during a 34-day STWW infiltration experiment during operational use of the SAT. Cationic exchanges and mixing between groundwater and STWW during the experiment were highlighted by major ions and geochemical simulations. Due to the low thickness of the unsaturated zone, a 1D analytical solution of the advection-dispersion equation (ADE) was applied on chloride data. Chloride was used as conservative intrinsic tracer to calibrate the horizontal flow and transport parameters such as the aquifer dispersion coefficient (D) and the average pore water velocity (ν) allowing estimation of the groundwater residence time. Transport and attenuation of the TrOCs were simulated assuming first-order degradation constant (μ) and linear retardation coefficient (R), calibrated to simulate the observed temporal changes in the breakthrough of TrOCs. Sorption was found to play a role in the transport of TrOCs, notably for oxazepam with a higher linear retardation coefficient value of 2.2, whereas no significant differences of retardation were observed for carbamazepine, tolyltriazole, benzotriazole (1.37, 1.35, 1.36 respectively). Estimated first order degradation rate constants, between 0.03d for carbamazepine and 0.09d for tolyltriazole, were generally high compared to the literature, possibly due to favourable redox conditions and important microbial activities within the system. This study provides evidence of the efficiency of the Agon-Coutainville SAT system for the removal of TrOCs.
Topics: Carbamazepine; Chlorides; Felodipine; Groundwater; Organic Chemicals; Oxazepam; Soil; Wastewater; Water Pollutants, Chemical
PubMed: 35513148
DOI: 10.1016/j.scitotenv.2022.155643