Mechanisms of drug-induced driving impairment: a dimensional approach

Riedel, Wim J.; Vermeeren, A.; Boxtel, M.P.J. van; Vuurman, E.F.P.M.; Verhey, F.R.J.; Jolles, J.; Ramaekers, Johannes G.

doi:10.1002/(sici)1099-1077(1998110)13:2+<s49::aid-hup49>3.3.co;2-t

Cited by 2 publications

(2 citation statements)

References 36 publications

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“…Driving a motor vehicle is a complex task encompassing psychomotor capability, physical space awareness, reaction times, and other areas of human physiology. The psychopharmacological mechanisms that underlie driving impairment from Z-drugs clearly involve GABA-ergic effects, though other neurotransmitter pathways are important in wakefulness and attention [62]. The impairment of driving ability from medications has been studied for over 30 years with the "on-the-road driving test" being validated as the gold standard for such a purpose [62,63].…”

Section: Driving Impairmentmentioning

confidence: 99%

In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

2013

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Despite their improved pharmacokinetic profile, the Z-drugs, zolpidem, zopiclone, and zaleplon, have a spectrum of adverse effects comparable to benzodiazepines. This review focuses on the impairment from Z-drugs on cognition, behavior, psychomotor performance, and driving ability. Z-drugs are short-acting GABA agonists that reduce sleep latency without disturbing sleep architecture. Bizarre behavioral effects have prompted warnings on the prescription, dispensation, and use of Z-drugs. Psychomotor impairment, falls, and hip fractures are more likely to occur with Z-drugs that have longer half-lives, that are taken at higher-than-recommended doses and when mixed with other psychoactive substances including alcohol. Zopiclone and higher doses of zolpidem are more likely to cause anterograde amnesia than zaleplon. Z-drugs, especially zolpidem, are associated with complex behaviors such as sleepwalking, sleep-driving, and hallucinations. Patients taking zopiclone and zolpidem have an increased risk of motor vehicle collisions, over double that of unexposed drivers. Driving impairment occurs with zopiclone and higher doses of zolpidem but is unlikely to occur after 4 h post-zaleplon administration. The residual effect of Z-drugs on next-day cognitive and psychomotor performance has significant impact on lifestyle, safety, and occupational considerations, including motor vehicle and machine operation. The risk-benefit analysis of Z-drugs in the treatment of insomnia, particularly in the elderly, may not favor treatment due to the increased risks of falls and motor vehicle collisions. Prescribers should warn patients taking Z-drugs of minimum time thresholds before they operate machinery or drive motor vehicles.

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Section: Driving Impairmentmentioning

confidence: 99%

In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

2013

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“…One aspect of relevance is that, in the sample of the mentioned study [1], both the cases (78%) and controls (76%) were taking ‘sedating drugs’ quite frequently. Many of these drugs (benzodiazepines, barbiturates, classic antidepressants and antipsychotic drugs) have shown a clear deteriorating effect on psychomotor performance [6] and appropriate warnings appear in the summary of product characteristics and package inserts. They are frequently rated as category III (likely to produce severe effects) or II (likely to produce minor or moderate effects).…”

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confidence: 99%

Warfarin, medicinal drugs and road traffic accidents

Álvarez

2006

Brit J Clinical Pharma

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Delaney et al . [1] have recently reported that warfarin use has not been linked to an increase in road traffic accidents as previously reported [2].The finding of no increase in the risk of motor vehicle accidents following warfarin use is reasonable, as there is no evidence that this medicinal drug impairs psychomotor performance. Furthermore, in the summary of product characteristics and package insert within the European Union (EU) it is not mentioned that this drug impairs driving performance, as the authors also indicated for Canada [1]. Within the EU, according to the existing rules, information about the effect of medicinal drugs on driving and the use of machinery should be included in the summary of product characteristics and package insert [3, 4]. Furthermore, a classification regarding the effects of drugs on driving performance has been proposed [5]. Spain introduced a three-level categorization system after Belgium, and warfarin was rated as a non-impairing medicinal drug of driving performance.One aspect of relevance is that, in the sample of the mentioned study [1], both the cases (78%) and controls (76%) were taking 'sedating drugs' quite frequently. Many of these drugs (benzodiazepines, barbiturates, classic antidepressants and antipsychotic drugs) have shown a clear deteriorating effect on psychomotor performance [6] and appropriate warnings appear in the summary of product characteristics and package inserts. They are frequently rated as category III (likely to produce severe effects) or II (likely to produce minor or moderate effects). Nevertheless, the new antidepressants (selective serotonin reuptake inhibitors and antipsychotic drugs) have a less impairing effect on driving performance and are classified as low impairing drugs. What is of relevance is that in clinical practice, when prescribing to a driver (the majority of the population in Western countries), appropriate drug selection and information regarding driving should be provided. An additional aspect to be considered, as mentioned by the authors [1], as well as in previous studies [5], is the possibility of interaction between the prescribed drugs, as well as with alcohol.Regarding the study design, the authors noticed [1] that they were not able to control by exposure (distance driven), which is a key issue. The question has also recently been raised that those drivers who drove less distance are more frequently involved in road accidents in any age group [7]. Alcohol consumption is another confusing factor for which results has not been controlled. Alcohol consumption varies according to age, decreasing as age increases but still frequent in older people [8]. This may be of relevance, as many of the subjects in the study were taking 'sedating drugs'.Within the EU policy of reducing road traffic accidents, the target is a 50% reduction between 2000 and 2010. To achieve this, the action programme is making continuing efforts 'to combat the scourge of drinkdriving and find solutions to the issue of the use of drugs and medicine...

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Mechanisms of drug-induced driving impairment: a dimensional approach

Cited by 2 publications

References 36 publications

In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

Warfarin, medicinal drugs and road traffic accidents

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