Quotes from Benjamin James Sadock

Zolpidem and zaleplon are secreted in breast milk and are therefore contraindicated for use by nursing mothers. The dosage of zolpidem and zaleplon should be reduced in elderly persons and persons with hepatic impairment.

Benzodiazepine withdrawal syndrome consists of anxiety, nervousness, diaphoresis, restlessness, irritability, fatigue, lightheadedness, tremor, insomnia, and weakness (Table 29.9-2). Abrupt discontinuation of benzodiazepines, particularly those with short half-lives, is associated with severe withdrawal symptoms,

which may include depression, paranoia, delirium, and seizures.

Alprazolam seems to be particularly associated with an immediate and severe withdrawal syndrome and should be tapered gradually.

be tapered slowly (25 percent a week); otherwise, recurrence or rebound of symptoms is likely.

The dosage range of carbamazepine used to facilitate withdrawal is 400 to 500 mg a day. Some clinicians report particular difficulty in tapering and discontinuing alprazolam, especially in persons who have been receiving high dosages for long periods. There have been reports of successful discontinuation of alprazolam by switching to clonazepam, which is then gradually withdrawn.

The combination of benzodiazepines and clozapine (Clozaril) has been reported to cause delirium

and should be avoided.

The manufacturer of nefazodone recommends that the dosage of triazolam be lowered by 75 percent and the dosage of alprazolam be lowered by 50 percent when given concomitantly with nefazodone.

may decrease the plasma concentrations of benzodiazepines, and smoking may increase the metabolism of benzodiazepines.

The SSRIs may prolong and exacerbate the severity of zolpidem-induced hallucinations. Deaths have been reported when parental lorazepam is given with parental olanzapine.

An estimated length of therapy should be decided at the beginning of therapy, and the need for continued therapy should be reevaluated at least monthly because of the problems associated with long-term use.

Alprazolam is available in an extended-release form, which reduces the frequency of dosing.