Benzodiazepines in epilepsy: pharmacology and pharmacokinetics

@article{Riss2008BenzodiazepinesIE,
  title={Benzodiazepines in epilepsy: pharmacology and pharmacokinetics},
  author={Jennifer R. Riss and James C. Cloyd and John R. Gates and Stephen D. Collins},
  journal={Acta Neurologica Scandinavica},
  year={2008},
  volume={118}
}
Benzodiazepines (BZDs) remain important agents in the management of epilepsy. They are drugs of first choice for status epilepticus and seizures associated with post‐anoxic insult and are also frequently used in the treatment of febrile, acute repetitive and alcohol withdrawal seizures. Clinical advantages of these drugs include rapid onset of action, high efficacy rates and minimal toxicity. Benzodiazepines are used in a variety of clinical situations because they have a broad spectrum of… 
View on Wiley
ncbi.nlm.nih.gov
414 Citations
Highly Influential Citations
19
Background Citations
160
Methods Citations
8
Results Citations
2

414 Citations

Clinically Significant Interactions with Benzodiazepines
TLDR
This chapter will review the varied kinetics of available benzodiazepines and discuss the metabolic pathways leading to excretion of these medications and identify the clinical monitoring that is required for individuals being prescribed benzdiazepines including respiratory depression, sedation, and withdrawal.
Reduced efficacy and risk of seizure aggravation when cannabidiol is used without clobazam
Single dose efficacy evaluation of two partial benzodiazepine receptor agonists in photosensitive epilepsy patients: A placebo-controlled pilot study
Antiepileptic drugs
TLDR
This article addresses AEDs individually, focusing on key pharmacokinetic characteristics, indications, and modes of use, and Rational AED combinations should avoid Aeds with unfavorable pharmacokinetics interactions or pharmacodynamic interactions related to mechanism of action.
Antiepileptic-drugs
TLDR
Knowledge of AED pharmacokinetics, efficacy, and tolerability profiles facilitates the choice of appropriate AED therapy for patients with epilepsy, and Rational AED combinations should avoid AEDs with unfavorable pharmacokinetic interactions or pharmacodynamic interactions related to mechanism of action.
Benzodiazepines for prolonged seizures
  • Mark S. Anderson
  • Biology, Medicine
    Archives of Disease in Childhood: Education & Practice Edition
  • 2010
TLDR
Diazepam, lorazepam and midazolam, the drugs most widely used to stop prolonged seizures, are members of the benzodiazepine family, a class of psychoactive drugs with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties.
Steering the pharmacological treatment along different metabolic pathways in response to outlying complicated benzodiazepine withdrawal – a case study
TLDR
Lorazepam, short-acting but bypassing the accelerated metabolic pathway, at sufficient doses provided the satiation necessary to stabilize the patient, and the breakthrough occurred when lorZepam was used instead of previously administered substitute BZDs.
Clonazepam: Indications, Side Effects, and Potential for Nonmedical Use.
TLDR
There is a need to find safer therapeutic alternatives for treating seizures and anxiety disorders and greater awareness of its frequent nonmedical use is also needed to achieve safer overall use of this medication.
Levetiracetam: a review of its use in epilepsy.
TLDR
Oral levetiracetam provided seizure control relative to placebo as adjunctive therapy in patients with idiopathic generalized epilepsy with myoclonic seizures or GTC seizures and showed improvements in measures of health-related quality of life relative to those receiving placebo.
New approach for detoxification of patients dependent on benzodiazepines and Z-drugs for reduction of psychogenic complications.
TLDR
Individually prepared pharmaceutics with different and precise diazepam contents can be used for comfortable detoxification and also may eliminate psychogenic stress during switching, tapering, and the withdrawal period.
...
...

References

SHOWING 1-10 OF 243 REFERENCES
Guidelines for the clinical use of benzodiazepines: pharmacokinetics, dependency, rebound and withdrawal. Canadian Society for Clinical Pharmacology.
  • J. Nelson, G. Chouinard
  • Medicine, Psychology
    The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique
  • 1999
Principles of benzodiazepine selection are outlined for various psychiatric indications and diverse populations (the elderly, and drug and alcohol abusers). Benzodiazepines are still among the most…
Pharmacokinetic Optimisation of Benzodiazepine Therapy for Acute Seizures
TLDR
Although diazepam was initially chosen for the management of refractory status epilepticus, the longer duration of action of lorazepam and clonazep am may favour the use of these 2 drugs, and double-blind evaluations are necessary to determine which drug is best.
Benzodiazepines in the treatment of epilepsy in people with intellectual disability.
TLDR
Despite the limitations of BZDs in the prophylactic treatment of epilepsies, these drugs play a prominent role in clinical practice in the emergency management of acute seizures and status epilepticus.
Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound.
  • G. Chouinard
  • Psychology, Medicine
    The Journal of clinical psychiatry
  • 2004
TLDR
Although as a class benzodiazepines act rapidly and are well tolerated, their use presents clinical issues such as dependence, rebound anxiety, memory impairment, and discontinuation syndrome.
Pharmacokinetic optimization of benzodiazepine therapy for acute seizures. Focus on delivery routes.
TLDR
Although diazepam was initially chosen for the management of refractory status epilepticus, the longer duration of action of lorazepam and clonazep am may favour the use of these 2 drugs, and double-blind evaluations are necessary to determine which drug is best.
Guidelines for the rational use of benzodiazepines. When and what to use.
TLDR
Indications for benzodiazepines include acute stress reactions, episodic anxiety, fluctuations in generalised anxiety, and as initial treatment for severe panic and agoraphobia, and occasionally in acute psychoses.
Pharmacokinetics of benzodiazepines. Short-acting versus long-acting.
TLDR
A review is given of the pharmacokinetics of the major benzodiazepines presently available and suggests that compounds with long elimination half-lives of parent drug or active metabolites are of advantage in anticonvulsant and anti-anxiety treatment.
Benzodiazepines: some aspects of their clinical pharmacology.
TLDR
There are differences among benzodiazepines in patterns of absorption, distribution, and elimination by the human body, which may lead to apparent differences in clinical action.
The Use of Clobazam, Midazolam, and Nitrazepam in Epilepsy
Summary: The benzodiazepines clobazam (CLB), midazolam (MDL), and nitrazepam (NZP) all have proven efficacy in epilepsy management, but their differences in physical properties, pharmacokinetic…
The Importance of Drug Interactions in Epilepsy Therapy
TLDR
Physicians prescribing AEDs to patients with epilepsy must, therefore, be aware of the potential for drug interactions and the effects (pharmacokinetic and pharmacodynamic) that can occur both during combination therapy and on drug discontinuation.
...
...