Progesterone co-administration in patients discontinuing long-term benzodiazepine therapy: effects on withdrawal severity and taper outcome

Schweizer, Edward E.; Wg, Case; García‐España, Felipe; Dj, Greenblatt; Rickels, Karl

doi:10.1007/bf02246214

Cited by 47 publications

(19 citation statements)

References 24 publications

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“…For patients with BZD dependence, a consensus exists that gradual taper is preferred to abrupt discontinuation (24). Small clinical trials have tested propranolol (25, 26), buspirone (27), and progesterone (28) without any clear evidence of efficacy. Hydroxyzine can reduce anxiety symptoms associated with a BZD taper (29).…”

Section: Introductionmentioning

confidence: 99%

Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Mariani

Malcolm

Mamczur

et al. 2016

The American Journal of Drug and Alcohol Abuse

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Background Benzodiazepine (BZD) use disorders are a common clinical problem among methadone maintenance treatment patients and have adverse effects on clinical outcomes. Objectives To evaluate gabapentin for the outpatient treatment of BZD abuse or dependence in methadone maintenance patients. Methods Participants (n=19) using BZDs at least 4 days per week were enrolled into an eight-week randomized double-blind placebo-controlled outpatient pilot trial. All participants received a manual-guided supportive psychotherapy aimed to promote abstinence. Study medication was titrated over a two-week period to a maximum dose of gabapentin 1200 mg or placebo three times a day. BZD use was assessed using urine toxicology confirmed self-report. BZDs were not provided as part of study participation; participants were provided guidance to gradually reduce BZD intake. Results Sixteen participants had post-randomization data for analysis. Retention at week eight was 50%. The mean dose of gabapentin achieved by titration was 2666 mg/day (SD=±1446). There were no significant between group differences on BZD use outcomes (amount BZD per day (Mann-Whitney U = 27, p = .745), abstinent days per week (U = 28, p = .811)) and CIWA-BZD scale (U = 29.0, p = .913). One participant in the gabapentin group discontinued study medication because of peripheral edema. Two participants in the placebo group requested admission for inpatient detoxification treatment. Conclusion Gabapentin was not found to differ from placebo, although the small sample recruited for this trial may have limited the ability to detect a difference.

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Section: Introductionmentioning

confidence: 99%

Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Mariani

Malcolm

Mamczur

et al. 2016

The American Journal of Drug and Alcohol Abuse

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“…The safety, tolerability and efficacy of micronized progesterone have been demonstrated in multiple studies. Acute effects of micronized progesterone on physiological, performance, and subjective measures have been investigated over a wide dose range, from 200 to 2,000 mg/day in both women and men (Freeman, Rickels, Sondheimer, & Polansky, 1995; Gron, Friess, Herpers, & Rupprecht, 1997; Schweizer, Case, Garcia-Espana, Greenblatt, & Rickels, 1995). Micronized progesterone provides a specific pharmacological tool to investigate the effects of this hormone, devoid of the additional pharmacological effects that synthetic progesterone derivatives have.…”

Section: Clinical Pharmacology Of Progesteronementioning

confidence: 99%

Role of progesterone in nicotine addiction: Evidence from initiation to relapse.

Lynch

Sofuoglu

2010

Experimental and Clinical Psychopharmacology

147

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Nicotine addiction continues to be the main cause of preventable death in developed countries. Women and teen girls appear to be more vulnerable on certain aspects of nicotine addiction compared with men and boys. While the mechanism of gender differences in nicotine addiction is not yet clear, evidence suggests that while estrogen may underlie enhanced vulnerability in females, progesterone may protect females. Thus, progesterone may have therapeutic use for tobacco addiction, especially in female smokers. A greater understanding of the role of progesterone in nicotine addiction is important not only from a treatment standpoint, but also from a prevention standpoint: hormone transition phases, such as those that occur at adolescence, and during pregnancy and following birth, as well as following hormonal manipulation (e.g., using methods of hormonal birth control), may all contribute to changes in vulnerability to nicotine addiction. In this review, we summarize recent evidence from clinical and preclinical studies examining the role of progesterone in nicotine addiction focusing on its role during initiation of use and during later phases of the addiction process as a potential relapse prevention treatment. We conclude with future directions including further examination of progesterone as a potential intervention and treatment of nicotine addiction.

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“…A series of drugs with a wide range of mechanisms have been tested as antiwithdrawal agents with little or no beneÞts, including propranolol (Tyrer et al 1981), clonidine (Goodman et al 1986), progesterone (Schweizer et al 1995), and buspirone (Schweizer and Rickels 1986;Lader and Olajide 1987). The only drug that has demonstrated some beneÞt in a controlled trial was the anticonvulsant carbamazepine (Schweizer et al 1991).…”

Section: Introductionmentioning

confidence: 98%

Trazodone and valproate in patients discontinuing long-term benzodiazepine therapy: effects on withdrawal symptoms and taper outcome

et al. 1999

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Recent uncontrolled research suggested that trazodone and sodium valproate may be helpful in benzodiazepine (BZ) discontinuation. We therefore undertook a double-blind study to assess whether trazodone and valproate, as compared to placebo, would attenuate withdrawal and facilitate discontinuation in BZ-dependent patients with a minimum of 1 year daily BZ use. Seventy-eight patients, taking a mean dose of 19+/-17 mg/day of diazepam (or its equivalent), were stabilized for several weeks on their BZ (16 diazepam, 25 lorazepam, 37 alprazolam) and then for 1-2 weeks, pretreated with trazodone, sodium valproate or placebo before being tapered at 25% per week. All treatments were continued for 5 weeks post-taper. BZ-free status was assessed after 5 and 12 weeks post-taper. Neither trazodone nor valproate had any significant effect on withdrawal severity. Peak physician withdrawal checklist change from baseline to peak severity was 16.4 for trazodone, 18.04 sodium valproate and 18.24 placebo (F = 0.10; NS). Taper success rates were significantly effected by both active agents at the 5-week, but not 12-week, assessment. At 5 weeks post-taper, 79% of sodium valproate and 67% of trazodone, but only 31% of placebo patients were BZ-free (chi2 = 7.34; df 2; P<0.03). Major adverse events for trazodone were sedation and dry mouth, and for valproate, diarrhea, nausea and headaches.

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Progesterone co-administration in patients discontinuing long-term benzodiazepine therapy: effects on withdrawal severity and taper outcome

Cited by 47 publications

References 24 publications

Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Role of progesterone in nicotine addiction: Evidence from initiation to relapse.

Trazodone and valproate in patients discontinuing long-term benzodiazepine therapy: effects on withdrawal symptoms and taper outcome

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