A descriptive analysis of patient's characteristics was performed. The results from both groups were compared to see if there were relevant differences between them for any of the independent variables related to personal or clinical data, comorbidity, benzodiazepine use and reason for prescription. Once the homogeneity of both groups had been confirmed, results were analysed for the populations per protocol and by intention to treat.
Losses — always counted as treatment failures — were limited to two subjects per group, so that results per protocol and by intention to treat were similar. Relative risk RR was calculated at 6 and 12 months of follow up. The absolute risk reduction ARR and the number of subjects that need to be treated to obtain one withdrawal NNT were estimated at 12 months. Although subgroup analysis had not been considered when the study was designed, it was explored post-hoc whether the results differed among subgroups according to relevant variables such as sex, half-life of the benzodiazepine, initial dose and Hamilton Depression Scale.
Withdrawal symptoms were also analysed. A total of patients were included 73 in the intervention group, 66 in the control group. Four were lost to follow up, two per group, because they had moved or could not be contacted. For women, results are 21 and 24 in the population, versus Criteria for depression on the Hamilton Depression Scale were met by No relevant differences were found between both groups in personal or clinical data, comorbidity, type of benzodiazepine nor anxiety or depression scales Table 1.
The main reasons for starting the prescription of benzodiazepines were, in order of frequency, anxiety, insomnia and depressive symptoms. The treatment was started by a family physician in The drugs more frequently prescribed were those with a short-to-intermediate half-life The intervention lasted an average of 2. After 6 months of follow up, 29 patients from the intervention group At 12 months, 33 patients The RR for complete withdrawal at 12 months was 4.
The ARR was 0. A further 16 subjects of the intervention group Results for different subgroups are given in Table 3. Abstinence symptoms in the intervention group included insomnia 15 cases, The results of the present study suggest that a structured intervention consisting of a standardised interview together with a tapering-off process is five times more effective for discontinuing long-term benzodiazepine use than usual practice. There is one success for every three interventions, and the benefit persists for at least 12 months.
No serious adverse effect was detected, neither during the tapering-off process nor in the 12 months of follow up. The more common symptoms of withdrawal were insomnia, anxiety and irritability, but their overall prevalence was not high. Differences in outcome between subsets of patients were found. However, the number of individuals in each of these subsets was too small for the differences to reach statistical significance, especially when considering the case of multiple comparisons eight subgroups where the significance level would be established with Bonferroni's correction.
This study proves the effectiveness of our intervention with a fair degree of accuracy, although the size of the study limited the capacity to estimate relative risks or contrast hypothesis among subgroups of patients. Another possible weakness is that in a study aiming to measure a physician's capacity to influence patient's habits the number of physicians taking part was relatively low.
On the other hand, the patient drop-out rate was low, probably because the intervention was performed personally by the family physician, a fact that may have improved both adherence and follow up. The group of family physicians involved in the trial were interested in benzodiazepine dependence but had no previous specific training in this area.
The study intervention has the value of being feasible in primary care. The training associated with the intervention is simple and it can be readily incorporated into the everyday general practice. Several approaches for discontinuing benzodiazepine use have been tested. In some studies, patients were advised about the need to discontinue the use of benzodiazepines with written information about how to achieve this.
A larger clinical trial, involving a larger sample of family physicians from different settings would increase the external validity of results and allow for exploring efficacy in different subsets of patients for example, according to length of benzodiazepine use, initial dose or type of drug. In conclusion, these results have implications for daily clinical practice, since they show that this intervention is both effective for achieving the withdrawal of long-term benzodiazepine use, and feasible in primary care practice.
Its simplicity and the limited time needed for its application mean that it is a good strategy to discontinue benzodiazepine use and that it can be easily fitted into the daily routine of most physicians. The ethical research committee of Primary Care of Mallorca Island approved the study on 2 June exp: National Center for Biotechnology Information , U. Br J Gen Pract. Palma de Mallorca, Mallorca, Spain. This article has been cited by other articles in PMC.
Abstract Background The long-term use of benzodiazepines is highly prevalent in developed societies and is not devoid of risks. Aim To establish the efficacy of an intervention programme for reducing the chronic use of benzodiazepines. Design of study Randomised, two-arm, parallel, non-blinded controlled trial. Setting Three urban healthcare centres covering a population of 50 inhabitants Mallorca, Spain.
Conclusion Standardised advice given by the family physician, together with a tapering off schedule, is effective for withdrawing patients from long-term benzodiazepine use and is feasible in primary care. Participants Among all patients visiting the collaborating physicians, those aged 14—75 years and who were taking benzodiazepines at least five times a week for over a year, were asked for their consent.
Recruitment and randomisation Physicians identified long-term benzodiazepine users in their practices and asked for their written consent. How this fits in The long-term use of benzodiazepines is highly prevalent in developed societies and is not devoid of risks. Measurements and intervention The type of benzodiazepine, daily dose and duration of use were recorded. Content of the standardised message given on the first and the follow up visits.
Follow up surgery based consultations: Data analysis A descriptive analysis of patient's characteristics was performed. Strengths and limitations of the study This study proves the effectiveness of our intervention with a fair degree of accuracy, although the size of the study limited the capacity to estimate relative risks or contrast hypothesis among subgroups of patients.
Comparisons with existing literature Several approaches for discontinuing benzodiazepine use have been tested. Implications for future research or clinical practice A larger clinical trial, involving a larger sample of family physicians from different settings would increase the external validity of results and allow for exploring efficacy in different subsets of patients for example, according to length of benzodiazepine use, initial dose or type of drug.
Ethics committee The ethical research committee of Primary Care of Mallorca Island approved the study on 2 June exp: Competing interests The authors have stated that there are none. Benzodiazepine consumption in Spain. Eur J Clin Pharmacol. Benzodiazepines and the risk of falling leading to femur fractures. Dosage more important than elimination half-life.
Guidelines for assessing and treating anxiety disorders. National Health Committee; Consensus on drug treatment, definition and diagnosis for insomnia. Treatment for patients with anxiety should be initiated with a dose of 0. Treatment of many panic disorders in patients has required the use of Xanax at doses greater than 4 mg daily. Xanax may interact with alcohol, other medicines that make you sleepy such as cold or allergy medicine, other sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety , birth control pills, cimetidine , cyclosporine , dexamethasone , ergotamine, imatinib, isoniazid, St.
Tell your doctor all medications and supplements you use. Benzodiazepines , such as Xanax, can cause fetal abnormalities and should not be used in pregnancy or in nursing mothers. Xanax is excreted in human milk and can affect nursing infants. Breastfeeding while taking Xanax is not recommended. Our Xanax Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. Get emergency medical help if you have any of these signs of an allergic reaction: Read the entire detailed patient monograph for Xanax Alprazolam. Side effects to XANAX Tablets, if they occur, are generally observed at the beginning of therapy and usually disappear upon continued medication.
In the usual patient, the most frequent side effects are likely to be an extension of the pharmacological activity of alprazolam , eg, drowsiness or lightheadedness. The data cited in the two tables below are estimates of untoward clinical event incidence among patients who participated under the following clinical conditions: These data cannot be used to predict precisely the incidence of untoward events in the course of usual medical practice where patient characteristics, and other factors often differ from those in clinical trials.
These figures cannot be compared with those obtained from other clinical studies involving related drug products and placebo as each group of drug trials are conducted under a different set of conditions. Comparison of the cited figures, however, can provide the prescriber with some basis for estimating the relative contributions of drug and non-drug factors to the untoward event incidence in the population studied. Even this use must be approached cautiously, as a drug may relieve a symptom in one patient but induce it in others.
For example, an anxiolytic drug may relieve dry mouth [a symptom of anxiety] in some subjects but induce it [an untoward event] in others.