Benzodiazepines prescription in Dakar: a study about prescribing habits and knowledge in general practitioners, neurologists and psychiatrists

Abstract

Benzodiazepines are relatively well-tolerated medicines but can induce serious problems of addiction and that is why their use is regulated. However, in developing countries like Senegal, these products are used without clear indications on their prescription, their dispensation or their use. This work focuses on the prescription of these medicines with a view to make recommendations for their rational use. Benzodiazepine prescription was studied with psychiatrists or neurologists and generalists in 2003. Specialist doctors work in two Dakar university hospitals and generalists in the 11 health centres in Dakar. We did a survey by direct interview with 29 of 35 specialists and 23 of 25 generalists. All doctors were interviewed in their office. The questionnaire focused on benzodiazepine indications, their pharmacological properties, benzodiazepines prescribed in first intention against a given disease and the level of training in benzodiazepines by doctors. Comparisons between specialists and generalists were made by chi-square test. Benzodiazepines were essentially used for anxiety, insomnia and epilepsy. With these diseases, the most benzodiazepines prescribed are prazepam against anxiety and insomnia and diazepam against epilepsy. About 10% of doctors do not know that there is a limitation for the period of benzodiazepine use. The principal reasons of drugs choice are knowledge of the drugs, habit and low side effects of drugs. All generalists (100%) said that their training on benzodiazepines is poor vs. 62.1% of specialists, and doctors suggest seminars, journals adhesions and conferences to complete their training in this field. There are not many differences between specialists and generalists except the fact that specialists prefer prazepam in first intention in the insomnia treatment where generalists choose bromazepam. In addition, our survey showed that specialists' training in benzodiazepines is better than that of generalists. Overall, benzodiazepine prescription poses problems particularly in training, and national authorities must take urgent measures for rational use of these drugs.

Attitudes to clinical guidelines--do GPs differ from other medical doctors?

“…For each of our suggested statements, there are significantly more GPs than other doctors who agree. This confirms earlier studies that suggest that GPs are less knowledgeable about the latest evidence in the relevant fields and are slower to adopt new therapies 23 24. This seems plausible as it reflects the GPs' working situation covering the whole breadth of clinical fields.…”

Fatores associados ao uso de benzodiazepínicos no serviço municipal de saúde da cidade de Coronel Fabriciano, Minas Gerais, Brasil

“…Porém, na análise multivariada apenas as duas últimas variáveis se mantiveram associadas no modelo. Considera-se o uso por período superior a seis meses injustificado para a grande maioria dos quadros 2,3,5,6,9,12 , com consequên-cias danosos para os usuários, principalmente o risco de dependência 2,15,16 e gastos desnecessários para o município. O fato de o tratamento prolongado estar associado ao uso do Diazepam merece ser cuidadosamente avaliado.…”

“…Diversos estudos 4,5,6,7,8,9,10 já apontaram distorções nas prescrições de benzodiazepínicos, como o tempo de tratamento prolongado, uso equivocado para o alívio de quadros inespecífi-cos, uso por idosos e outras indicações incompatíveis com o perfil farmacológico da classe. Os ARTIGO ARTICLE Firmino KF et al…”

“…As questões relacionadas ao uso excessivo e por vezes injustificado dos benzodiazepínicos são observadas em diversos países, independente do seu grau de desenvolvimento econômico 4,5,6,7,8,9,10 , nos grandes centros urbanos 6,9 e também nas populações rurais 11 . No Brasil, estimase que 1,6% da população adulta seja usuária crônica de benzodiazepínicos 12 .…”

Uma revisão sistemática e metanálise sobre os eventos adversos decorrentes do uso de benzodiazepínicos pos idosos.

“…O crescente e extenso uso inadequado de BDZs é observado tanto em países desenvolvidos quanto em desenvolvimento, por ser uma classe farmacêutica de alto índice terapêutico, boa tolerabilidade e de custo acessível, proporcionando benefícios comprovados e, em contrapartida, desencadeando iatrogenias relevantes (DIÉYE et al, 2006;FURTADO;TEIXEIRA, 2006;GALLEGUILLOS et al, 2003;HUF et al, 2000;KASSAM;PATTEN, 2006;ORLANDI, 2005;ZANDSTRA et al, 2002).…”