Benzodiazepines: a descriptive study of prescription patterns in Tabriz, Iran, 2021-2022

doi:10.21203/rs.3.rs-4509506/v1

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Benzodiazepines: a descriptive study of prescription patterns in Tabriz, Iran, 2021-2022

https://doi.org/10.21203/rs.3.rs-4509506/v1

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Introduction

Benzodiazepines are widely prescribed medications for anxiety, insomnia, and other conditions; they offer therapeutic benefits but also pose risks such as dependence and misuse. This study aimed to analyze the prescribing patterns of benzodiazepines among physicians in Tabriz, Iran, over a one-year period, considering factors such as physician specialty, age, and sex.

Method

A descriptive study was conducted using data extracted from the Social Security Organization in Iran. Benzodiazepine prescriptions in Tabriz from March 2022 to March 2023 were analyzed. Prescription data were categorized by physician specialty, age group, and sex. The statistical analysis was performed using SPSS 2022.

Results

A total of 217,154 benzodiazepine prescriptions were issued by 5,118 physicians to 144,386 individuals during the study period. Alprazolam was the most frequently prescribed benzodiazepine, followed by chlordiazepoxide and clonazepam. The prescription patterns showed that approximately age 40 was the mode, and the patterns were similar for both genders. General practitioners accounted for the highest frequency of prescriptions, followed by psychiatrists, internists, and cardiologists. Long-acting benzodiazepines were predominantly prescribed psychiatrists, who were particularly interested in this topic.

Conclusion

The differences in prescribing patterns among medical specialties highlight the nuanced considerations guiding benzodiazepine use in various clinical contexts. While cardiologists and surgeons prioritize short-acting benzodiazepines for perioperative anxiety management, neurologists and psychiatrists demonstrate a predilection for clonazepam, emphasizing familiarity and perceived efficacy based on clinical experience.

Health sciences/Medical research/Epidemiology

Health sciences/Medical research

Health sciences/Health care

Benzodiazepines

Prescription pattern

Alprazolam

General practitioner

Psychiatrist

Benzodiazepines, a class of medications commonly prescribed for the treatment of conditions such as anxiety and insomnia, work by increasing the effects of the neurotransmitter GABA in the brain and nervous system, resulting in a heightened sense of calm and relaxation throughout the body. While there may be benefits to using benzodiazepines for a short period, there are also risks and limitations linked to their use. In 1960, they made their debut in the US market by introducing chlordiazepoxide as the initial approved compound utilized in clinical settings. The popularity of benzodiazepines grew rapidly as a result of their improved safety record, notably reducing the risk of respiratory depression when compared to older medications like barbiturates. Different types of benzodiazepines, such as alprazolam, midazolam, oxazepam, and triazolam, are accessible. They carry a lower risk of causing daytime drowsiness and tolerance development because they are short-acting. Medium-acting benzodiazepines, like estazolam, lorazepam, quazepam, and temazepam, are frequently recommended for anxiety disorders, panic attacks, or muscle spasms because of their well-rounded effectiveness and side effects. Long-acting benzodiazepines, including chlordiazepoxide, clobazam, clonazepam, clorazepate, diazepam, and flurazepam, exhibit prolonged and steady effects and are frequently utilized in the management of alcohol withdrawal, seizure disorders, or chronic anxiety (4). Benzodiazepine usage presents challenges such as addiction and discontinuation, tolerance and increased dosage, and inappropriate use and exploitation. It is essential to focus on awareness, education, and prevention when dealing with these problems. The proper use of benzodiazepines involves following the prescription precisely and limiting the duration as much as possible. It is imperative to have a doctor's approval before distributing, vending, or consuming them (1). For the prolonged treatment of anxiety and insomnia, alternative therapies such as cognitive behavioral therapy should be taken into account. According to the 2015–2016 National Surveys on Drug Use and Health, 12.5% of adults in the U.S. (approximately 30.5 million people) had used benzodiazepines in the past year, 2.1% approximately 5.1 million people) had misused them at least once, and 0.2% (approximately 0.5 million people) had benzodiazepine use disorders. Among benzodiazepine users, 17.1% had misused them, and 1.5% had benzodiazepine use disorders (5). Benzodiazepine use was associated with emergency room visits, suicidal ideation, the use of various substances and mental disorders. Benzodiazepine misuse and abuse were more prevalent among younger males, black individuals, uninsured individuals, unemployed individuals, and individuals with suicidal thoughts and other substance use problems. Similar trends were observed in benzodiazepine use disorders, where the majority of associations were more robust compared to misuse without use disorders. Variations in benzodiazepine consumption, misuse, and abuse are influenced by various demographic factors like age, sex, and other elements. The frequency of benzodiazepine prescriptions is double for women in comparison to men, with a higher likelihood of chronic usage among older adults. Individuals with other substance use disorders, especially those involving opioids and alcohol, are more likely to misuse or abuse benzodiazepines. Despite the recent spotlight on prescription drug abuse, there are still many unknown aspects regarding benzodiazepine abuse and its consequences. In the realm of prescribing benzodiazepines, several specialists, such as psychiatrists, primary care physicians (PCPs), neurologists, geriatricians, and addiction medicine specialists, stand out due to their frequent use of these medications. The collaboration of healthcare providers is essential in guaranteeing the safe and effective management of patients receiving benzodiazepines from various medical specialties (7). The primary objective of this research was to showcase the specific trend of benzodiazepine prescriptions within the medical community in Tabriz throughout a duration of one year by thoroughly examining the information gathered from social insurance entity.

Study design

Our objective in this observational research was to identify trends in the utilization of benzodiazepines, considering factors like physician age (linked to year of graduation), area of expertise, and gender. The research encompassed individuals who were examined by doctors from various fields of expertise. Initially, the list of benzodiazepines was extracted from psychiatric references such as Kaplan, Sadock, and Oxford. By evaluating the Iranian pharmacopoeia, we identified the roster of medications obtainable in Iran. The drugs analyzed included alprazolam, chlordiazepoxide, clonazepam, diazepam, flurazepam, lorazepam, oxazepam, and zolpidem (8 items).

Data source

The information utilized in this study was initially obtained from the Social Security Organization (Tamin Ejtemaei). The Social Security Organization (SSO) in Iran serves as a social insurance agency that extends coverage to wage earners, salaried workers, and self-employed individuals who choose to participate. The Social Security Organization (SSO) operates as an independent organization that relies entirely on donations, where individuals with insurance cover (making up 7% of the total), companies (contributing between 20–23%), and the government (participating at a rate of 3%) all play a role in its funding. During the period spanning from March of 2022 to March of 2023, we gathered detailed information on prescriptions that included benzodiazepines in the city of Tabriz, situated in the country of Iran.

Data analysis

Following the completion of data collection and the establishment of the variables, we proceeded to examine the data by utilizing the statistical software SPSS 2022. The initial factor that was examined consisted of the particular field of expertise of the medical practitioners who issued the medications. The individuals seeking medical attention were divided into eight distinct categories, including cardiologists, general physicians, neurologists, neurosurgeons, pediatricians, internists, psychiatrists, and surgeons. The next factor taken into consideration was the physicians' age, which was established by examining their national physician number alongside their graduation date. This particular variable was categorized into six distinct groups based on different time periods: prior to 1979, spanning from 1979 to 1987, ranging from 1987 to 1997, covering the period from 1997 to 2007, from 2007 to 2017, and finally, from 2017 to 2022. The subsequent variable that was examined pertained to sex, specifically divided into the classifications of male and female. We analyzed the patterns of benzodiazepine prescriptions without making any modifications, taking into account the mentioned variables.

Frequency and age

Table 1 Displaying benzodiazepine prescription frequency and percentages

	Frequency	Percent
Alprazolam	60802	28.0
Chlordiazepoxide	59270	27.3
Clonazepam	52964	24.4
Diazepam	24206	11.1
Flurazepam	348	.2
Lorazepam	11275	5.2
Oxazepam	3993	1.8
Zolpidem	4296	2.0
Total	217154	100.0

The aggregate number of prescriptions dispensed for all benzodiazepines combined was 217,154. During a twelve-month timeframe, a total of 5,118 distinct medical practitioners administered benzodiazepines to 144,386 unique patients. In our study, the group we aimed to analyze consisted of 920,617 individuals. Among this specific population, a notable proportion of 15.7% had received prescriptions for benzodiazepines. Alprazolam stood out as the most common benzodiazepine, having a grand total of 60,802 prescriptions, which constituted a significant 28% of the overall number of prescriptions dispensed. Chlordiazepoxide was closely associated with 59,270 prescriptions, accounting for approximately 27.3% of the total prescriptions. Approximately 24.4% of the total prescriptions were for Clonazepam, with a total of 52,964 prescriptions. Diazepam was ordered a total of 24,206 instances, representing roughly 11.1% of the complete prescriptions. Flurazepam, lorazepam, oxazepam, and zolpidem had lower prescription frequencies (Table 1).

The mean age of individuals who were prescribed benzodiazepines was found to be approximately 49.05 years old. The utilization trends for benzodiazepines displayed a high degree of uniformity among all age categories. Nonetheless, the way in which diazepam was prescribed showed clear differences compared to other medications. Oral intake was the most commonly prescribed form, with 201,115 prescriptions, accounting for 92.6% of the total. Injections were the second most common form, with 16,039 prescriptions, accounting for 7.4% of the total. Individuals were classified into four different age brackets: Preadolescent, Adolescent, Adult, and Elderly. Adults were found to have the greatest quantity of prescriptions issued for benzodiazepines among all age groups, highlighting their prevalent use of this type of medication. The frequency of diazepam prescriptions among preadolescents was evidently higher than that of other benzodiazepines, while in adults, chlordiazepoxide prescriptions slightly exceeded those of clonazepam and alprazolam. Alprazolam and clonazepam were both more commonly prescribed to elderly patients than chlordiazepoxide (Table 2).

Table 2 Table provides insights into the frequency of benzodiazepine prescriptions among different age groups

Graduation date of physicians

Physicians who completed their medical training prior to 1979 issued a total of 6,458 prescriptions for benzodiazepines, constituting approximately 3% of the overall prescription count. The total percentage of individuals who completed their studies between 1979 and 1987 amounted to 22,403 times, representing 10.3% of the entire group. A total of 44,637 prescription for physicians, accounting for 20.6% of the total, graduated between 1987 and 1997. During the period between 1997 and 2007, the individuals who had graduated had the highest frequency of prescriptions, amounting to 90,734, which represented 41.8% of the total. A total of 30,676 prescriptions were issued for doctors who completed their medical training from 2007 to 2017, representing 14.1% of the overall amount. Between 2017 and 2022, 22,246 individuals graduated from the survey, representing 10.2% of the total. The prescribing trend of benzodiazepines among various physicians remained consistent irrespective of the year they graduated, as illustrated in Fig. 2.

Specialties of physicians

Among all healthcare providers, general practitioners were the most frequent prescribers, making up 44.1% of the entire prescription count, which totaled 95,740 prescriptions. Psychiatrists rank as the second most prolific prescribers, issuing a total of 34,712 prescriptions, representing 16% of the overall amount. Internists and cardiologists accounted for substantial portions of prescriptions, comprising 11.1% (24,195) and 10.4% (22,543) of the total, respectively. Neurologists prescribed benzodiazepines 18,675 times, which accounted for 8.6% of the total. Surgeons prescribed this treatment 14,612 times, accounting for 6.7% of the total. Pediatricians and neurosurgeons had the lowest frequencies, with only 3,624 (1.7%) and 3,053 (1.4%) prescriptions, respectively. Alprazolam, chlordiazepoxide, and clonazepam have been prescribed with increasing frequency by cardiologists. The preference for Chlordiazepoxide was significantly higher among cardiologists who completed their education between 1979-1987, while alprazolam prescriptions began to exceed those of Chlordiazepoxide after 1987. Just as with diazepam and clonazepam, alprazolam and chlordiazepoxide are prescribed by general practitioners almost equally, with the latter being prescribed to a lesser extent. Internists appear to have administered lorazepam at a higher rate compared to cardiologists and general practitioners. Like in the last two specialties, the most commonly prescribed benzodiazepines are alprazolam, chlordiazepoxide, and clonazepam. Neurologists prefer clonazepam to alprazolam and chlordiazepoxide in their prescriptions. Internists have a tendency to issue prescriptions for lorazepam on a more frequent basis compared to general practitioners as well as cardiologists, showcasing a preference for this medication within their practice. Neurosurgeons predominantly utilize chlordiazepoxide in their medical orders. Diazepam was the most frequently prescribed medication by pediatricians. Clonazepam has been prescribed by psychiatrists around two times more often than chlordiazepoxide and three times more often than alprazolam. Psychiatrists have shown a greater tendency to prescribe Lorazepam compared to other medical specialties, demonstrating a higher rate of utilization for this particular medication. Surgeons seem to have used alprazolam more often in their prescriptions, but little difference in the frequency of use of chlordiazepoxide, clonazepam and diazepam was observed (Figure 3).

This article aims to demonstrate how benzodiazepines are prescribed by physicians in Tabriz in 2022. The data were analyzed, and several key points were extracted and discussed as follows:

Benzodiazepines have been prescribed twice as often to women than to men. In England, between January 2017 and December 2021, 2,641,656 women were prescribed benzodiazepines, whereas 1,661,178 men were prescribed these drugs. This finding indicates that women received 59% more benzodiazepine prescriptions than men did during that period. In a study conducted in 2011 in Sparta Province, Turkey, the percentage of patients with benzodiazepine prescriptions was 63.1% for females and 36.9% for males, which closely matched our statistical population. Women tend to seek help for their mental health more than men, which could explain some of the differences in prescription rates (8). Some sociological factors can also result in sex differences in benzodiazepine prescription. Improving prescribing practices requires through research on these sex differences (9). Alprazolam is the most prescribed benzodiazepine, and accounts for 28% of prescriptions. The potency and relatively rapid onset of action of alprazolam make it a popular choice for managing anxiety symptoms. The misuse of alprazolam can lead to addiction, overdose or even death. Abrupt discontinuation of alprazolam after long-term use can result in life-threatening withdrawal symptoms that may persist for 12 months or more. In a study conducted in Switzerland by Xhyljeta Luta et al., the percentage of aged > 65 years treated with alprazolam was 7.8%, which was significantly lower than that in our study population (10). Most likely, in other countries, the prescription of benzodiazepines is based on certain guidelines, but we did not find any specific guidelines regarding the administration of benzodiazepines in our country despite extensive searches. The second most prescribed benzodiazepine is chlordiazepoxide. It is indicated for the short-term treatment of severe and debilitating anxiety or distress, as well as for the treatment of various diseases. Chlordiazepoxide has antimicrobial, anticonvulsant, antianxiety, hypnotic, sedative and skeletal muscle relaxant effects (11). Initially, benzodiazepines (including chlordiazepoxide) were widely accepted, but later faced public opposition and calls for more restrictive guidelines for their use. Chlordiazepoxide is commonly classified as a long-acting benzodiazepine (3). The study conducted by Abdullah Akpinar and colleagues in Isparta, Turkey, established the frequency of benzodiazepine prescriptions for psychiatric conditions. The research revealed that the annual prevalence of benzodiazepine utilization in Isparta Province was comparatively modest in comparison to other areas, with 06% of individuals aged 15 and above having used benzodiazepines at least once. The most commonly prescribed benzodiazepines are alprazolam, clonazepam, and diazepam. General practitioners, psychiatrists, and neurologists are the main prescribers. The percentage of patients treated with chlordiazepoxide in this study was 0.7%, which is much lower than that in our study population (8). Chlordiazepoxide has been prescribed less frequently in elderly (19.7%) patients in comparison to adults (30.5%). Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of chlordiazepoxide in the elderly. However, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness are more likely to occur in the elderly, who are usually more sensitive than younger adults to the effects of chlordiazepoxide. Elderly patients may require a lower dose to help reduce unwanted effects (22). Physicians mostly prescribed long-acting benzodiazepines 60.6% of the time. There is growing interest among physicians in prescribing long-acting benzodiazepines for specific conditions. Long-acting benzodiazepines offer more consistent blood levels over time, which is why they are preferred. Given the extended duration of action of these medications, there is a decreased risk of experiencing rebound symptoms during the intervals between doses. The gradual tapering of benzodiazepines through this approach is commonly favored as it permits a slow alleviation of symptoms without precipitating abrupt withdrawal. For anxiety disorders, the key to the effective and safe use of benzodiazepines is careful selection, managing withdrawal symptoms and preventing relapse through dose reduction combined with psychological interventions (12). Long-acting benzodiazepines are the preferred choice of psychiatrists for their efficacy in treating anxiety disorders. While there is a discussion in support of extended-release benzodiazepines versus immediate-release ones, both types are commonly utilized. The quick alleviation of sudden anxiety manifestations enhances the significance of benzodiazepines in psychiatric treatment. However, diligent monitoring is necessary for extended use because of the varying risks associated with it worldwide. Concerns about prescribing these products have been more pronounced in the UK and Australia, while they have been less significant in France and the US. Ongoing endeavors are being made to enhance the selection of patients who might require long-term benzodiazepines (13). Psychiatrists recognize the need for appropriate prescribing practices in complex clinical landscapes. The interest of psychiatrists in long-acting benzodiazepines can be attributed to several factors. Long-acting benzodiazepines have a lower risk of abuse and dependence than short-acting benzodiazepines. Withdrawal symptoms are associated with a smoother withdrawal process, which is less intense and more manageable. Long-acting benzodiazepines can be beneficial in clinical situations where sustained anxiolytic effects are needed, especially when these drugs are used in combination with other treatments, such as antidepressants (14). Cardiologists and surgeons show greater interest in short-acting benzodiazepines than other physicians. These medications are frequently used for the purpose of controlling preoperative anxiety and promoting sedation prior to medical procedures. They are favored for their rapid onset of effect and brief duration, characteristics that are well-suited for procedures not necessitating extended periods of sedation. Short-acting benzodiazepines in postoperative care can alleviate anxiety and insomnia, with minimal impact on breathing or excessive drowsiness (15). These medications are less likely to build up in the body, particularly in older or organ-compromised patients. Their brief duration allows for precise management of their effects, crucial in fast-changing hospital environments. Although these benzodiazepines carry a higher risk of withdrawal symptoms, these can be effectively controlled in a hospital setting (16). In our study, alprazolam was the predominant psychotropic medication prescribed within our sample. Conversely, a separate study conducted in Costa Rica reported clonazepam as the most commonly prescribed psychotropic drug in their region (17). This discrepancy may be attributed to the prescribing practices of general practitioners in our country who prefer alprazolam to clonazepam. However, psychiatrists and neurologists in our country tend to favor clonazepam as a psychotropic medication. The efficacy of clonazepam in addressing particular types of seizures has led neurologists to favor it as a primary drug in managing epilepsy and seizure disorders (18). Clonazepam is the preferred medication for psychiatrists because of its relatively long duration of action and its efficacy in treating panic disorders and other anxiety-related conditions (19). Clonazepam is generally well-tolerated by patients and has a favorable safety profile, which contributes to its acceptability in both neurological and psychiatric treatments (20). Although all types of benzodiazepines carry the risk of causing dependency and experiencing withdrawal symptoms, clonazepam's extended half-life allows for a more gradual and slow reduction process, which can prove to be advantageous in effectively managing the symptoms associated with withdrawal (21). It is crucial to highlight that the preference for clonazepam can vary depending on the individual patient's needs, the specific condition under treatment, and the clinician's level of experience. Furthermore, careful consideration and monitoring are required during treatment with any benzodiazepine, including clonazepam, due to the potential for tolerance and dependence. Current studies and practical knowledge are guiding the optimal approaches to employing clonazepam in neurological and psychiatric therapy.

Limitations

The limitation we encountered in this study was the fact that despite the extensive searches of similar studies and articles, we could not find congruent results for some of the facts we found in our study. Moreover, the gathered data were raw, and we were unable to calculate the proportion of prescriptions to doctors who prescribed those medications.

The differences in prescribing patterns among medical specialties suggest that there are specific factors influencing the choice of benzodiazepines in different clinical situations. Cardiologists and surgeons may prefer short-acting benzodiazepines for managing perioperative anxiety due to their rapid onset of action and shorter duration, which can be beneficial in the surgical setting. On the other hand, neurologists and psychiatrists may lean toward clonazepam because of its longer duration of action and potential benefits in managing chronic conditions such as epilepsy or anxiety disorders. These preferences may be influenced by the specialties' familiarity with certain benzodiazepines and their perceived efficacy based on clinical experience. For this reason, the attention of educational hospitals, organizations, policy makers and founders of health development programs on this issue seems necessary in terms of developing educational programs for medical students and people working in this field to educate and warn them of various side effects and prescription precautions related to benzodiazepines.

Ethical approval

Approval was obtained from the Medical Ethics Committee of Tabriz University of Medical Science. The procedures used in this study adhered to the tenets of the Declaration of Helsinki.

Statement

Despite the fact that authors made use of advanced large language models (LLMs) like ChatGPT, Copilot (Bing AI) and writing platform (Ludwig. Guru) to help assess linguistic quality and assist in utilization of data analysis software such as Excel and SPSS, it was ultimately the authors who conducted the analysis and interpretation of the results.

Competing interests

The authors have no relevant financial or nonfinancial interests to disclose.

Funding

No funding was received for conducting this study.

Author Contribution

All authors contributed to the study conception and design. Material preparation and data collection was were performed by Ehsan Aghajani and Ali Azimian. Data analysis was performed by Ehsan Aghajani and Mostafa Farahbakhsh. The first draft of the manuscript was written by Ali Fakhari and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Data Availability

The data that support the findings of this study are available from the Social Security Organization (Tamin Ejtemaei), but restrictions apply to the availability of these data, which were used under license for the current study and thus are not publicly available. The data are, however, available from the authors upon reasonable request and with the permission of the Social Security Organization (Tamin Ejtemaei). Kindly reach out to the corresponding author, as indicated on the initial page, in order to obtain access to the data.

Edinoff AN, Nix CA, Hollier J, Sagrera CE, Delacroix BM, Abubakar T, et al. Benzodiazepines: uses, dangers, and clinical considerations. Neurology international. 2021;13(4):594–607.
Baumgartner GR, Rowen RC. Clonidine vs chlordiazepoxide in the management of acute alcohol withdrawal syndrome. Archives of Internal Medicine. 1987;147(7):1223–6.
López-Muñoz F, Álamo C, García-García P. The discovery of chlordiazepoxide and the clinical introduction of benzodiazepines: half a century of anxiolytic drugs. Journal of anxiety disorders. 2011;25(4):554–62.
Burrows GD, Norman TR, Judd FK, Marriott PF. Short-acting versus long-acting benzodiazepines: discontinuation effects in panic disorders. Journal of Psychiatric Research. 1990; 24:65–72.
Schuler MS, Dick AW, Stein BD. Heterogeneity in prescription opioid pain reliever misuse across age groups: 2015–2017 national survey on drug use and health. Journal of General Internal Medicine. 2020; 35:792–9.
Van Der Waals FW, Mohrs J, Foets M. Sex differences among recipients of benzodiazepines in Dutch general practice. British Medical Journal. 1993;307(6900):363–6.
Chou C, McDaniel CC, Abrams JD, Farley JF, Hansen RA. An Examination of Prescribing Responsibilities between Psychiatrists and Primary Care Providers. Psychiatr Q. 2021;92(2):587–600.
Akpinar A, Yaman AR, Karakus K, Atay IM, Demirci K. The frequency of benzodiazepine uses in the Isparta Province. Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology. 2016;26(2):169–74.
Seeman MV. Gender differences in the prescribing of antipsychotic drugs. American Journal of Psychiatry. 2004;161(8):1324–33.
Luta X, Bagnoud C, Lambiris M, Decollogny A, Eggli Y, Le Pogam M-A, et al. Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data. BMJ open. 2020;10(1):e031156.
Baskin SI, Esdale A. Is chlordiazepoxide the rational choice among benzodiazepines? Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 1982;2(2):110–9.
Janhsen K, Roser P, Hoffmann K. The problems of long-term treatment with benzodiazepines and related substances: Prescribing practice, epidemiology, and the treatment of withdrawal. Deutsches Ärzteblatt International. 2015;112(1–2):1.
Llorca PM, Abbar M, Courtet P, Guillaume S, Lancrenon S, Samalin L. Guidelines for the use and management of long-acting injectable antipsychotics in serious mental illness. BMC psychiatry. 2013; 13:1-
Longo LP, Johnson B. Addiction: Part I. Benzodiazepines—side effects, abuse risk and alternatives. American family physician. 2000;61(7):2121–8.
Agarwal SD, Landon BE. Patterns in outpatient benzodiazepine prescribing in the United States. JAMA network open. 2019;2(1):e187399-e.
Bandera R, Bollini P, Garattini S. Long-acting and short-acting benzodiazepines in elderly individuals:kinetic differences and clinical relevance. Current Medical Research and Opinion. 1984;8(sup4):94–97.
Villalobos-Madriz JA, Serrano-Arias B, Arguedas-Chacón S, Zavaleta-Monestel E, Rodríguez-Miranda R, Chaverri-Fernández JM, et al. Prescribing Trends in Psychotropic Medications Among Outpatients of a Latin American Healthcare Setting: A Five-Year Retrospective Study. Cureus. 2023;15(4).
Raggi, A., Mogavero, M. P., DelRosso, L. M., & Ferri, R. (2022, September 16). Clonazepam for the management of sleep disorders. Neurological Sciences.
Otto, M. W., Pollack, M. H., Gould, R. A., Worthington, J. J., McArdle, E. T., Rosenbaum, J. F., & Heimberg, R. G. (2000, July). A Comparison of the Efficacy of Clonazepam and Cognitive-Behavioral Group Therapy for the Treatment of Social Phobia. Journal of Anxiety Disorders, 14(4), 345–358.
Dubovsky, S. L., & Marshall, D. (2022). Benzodiazepines Remain Important Therapeutic Options in Psychiatric Practice. Psychotherapy and Psychosomatics, 91(5), 307–334.
Baldwin, D. S. (2021, October 28). Clinical management of withdrawal from benzodiazepine anxiolytic and hypnotic medications. Addiction, 117(5), 1472–1482.
Mayo Clinic. (n.d.). Chlordiazepoxide Hydrochloride (Oral Route) - Side Effects. Retrieved from https://www.mayoclinic.org/drugs-supplements/chlordiazepoxide-hydrochloride-oral-route/side-effects/drg-20072246?p=1

No competing interests reported.

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Benzodiazepines: a descriptive study of prescription patterns in Tabriz, Iran, 2021-2022

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Abstract

Introduction

Method

Results

Conclusion

Figures

Introduction

Method

Study design

Data source

Data analysis

Results

Frequency and age

Graduation date of physicians

Specialties of physicians

Discussion

Limitations

Conclusion

Declarations

Ethical approval

Statement

Competing interests

Funding

Author Contribution

Data Availability

References

Additional Declarations

Status:

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