What are barbiturates and how do they work. What conditions are barbiturates used to treat. What are the main types of barbiturates available. What are the potential side effects and risks of barbiturate use. How do barbiturates compare to other sedatives.

What Are Barbiturates and How Do They Work?

Barbiturates are a class of central nervous system (CNS) depressant drugs that were widely used in the mid-20th century to treat anxiety, insomnia, and seizure disorders. They work by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. This results in a sedative and calming effect on the body and mind.

The mechanism of action of barbiturates involves:

• Binding to GABA receptors in the brain
• Increasing chloride ion flow into neurons
• Hyperpolarizing neurons and reducing their excitability
• Depressing the central nervous system overall

This CNS depression leads to effects like drowsiness, relaxation, reduced anxiety, and at higher doses, anesthesia. However, the potent effects of barbiturates also come with significant risks of side effects, dependence, and overdose.

Historical and Current Medical Uses of Barbiturates

Barbiturates were first synthesized in the late 19th century and became widely prescribed in the 1960s and 1970s. Their use has declined significantly since then due to safety concerns, but they still have some limited medical applications today.

Past Uses of Barbiturates

Historically, barbiturates were commonly prescribed for:

• Anxiety disorders
• Insomnia and sleep problems
• Epilepsy and seizure control
• Anesthesia induction
• Acute alcohol withdrawal

Current Medical Uses

Today, barbiturates have largely been replaced by safer alternatives like benzodiazepines. However, they are still used in some specific situations:

• Treatment of severe, intractable insomnia
• Control of seizures unresponsive to other medications
• Induction of anesthesia before surgery
• Emergency treatment of acute migraines (in combination with other drugs)
• Rarely, for anxiety when other treatments have failed

Why are barbiturates rarely prescribed now? The main reasons are:

1. High risk of dependence and addiction
2. Dangerous side effects and narrow therapeutic window
3. Potentially fatal overdoses
4. Development of safer alternatives like benzodiazepines

Common Types of Barbiturates

Barbiturates are classified based on their duration of action. The main types include:

Ultra Short-Acting Barbiturates

These have a rapid onset and short duration, lasting only a few minutes. They are primarily used for anesthesia induction. Examples include:

• Thiopental (Pentothal)
• Methohexital (Brevital)

Short-Acting and Intermediate-Acting Barbiturates

These barbiturates have effects lasting several hours and are sometimes used for severe insomnia or seizures. Examples include:

• Secobarbital (Seconal)
• Pentobarbital (Nembutal)
• Butabarbital (Butisol)

Long-Acting Barbiturates

These can have effects lasting 24 hours or more and are occasionally used for seizure control. The main example is:

• Phenobarbital

How do different barbiturates compare in terms of onset and duration? Ultra short-acting barbiturates like thiopental take effect within seconds and wear off in minutes. Short-acting ones like secobarbital start working in about 15-40 minutes and last 3-6 hours. Long-acting phenobarbital can take an hour to start working but lasts 1-2 days.

Side Effects and Risks of Barbiturate Use

While barbiturates can be effective for their intended uses, they come with a range of potential side effects and significant risks, especially with long-term use or misuse.

Common Side Effects

Even at therapeutic doses, barbiturates can cause:

• Drowsiness and fatigue
• Dizziness and confusion
• Impaired coordination and balance
• Slurred speech
• Nausea and vomiting
• Headache
• Mood changes, including depression or irritability

Serious Risks and Complications

More severe risks associated with barbiturate use include:

• Physical and psychological dependence
• Tolerance, requiring higher doses for the same effect
• Severe withdrawal symptoms upon discontinuation
• Respiratory depression, especially in overdose
• Increased risk of accidents due to impairment
• Potential for fatal overdose, particularly when combined with other CNS depressants

Can barbiturates cause long-term health effects? Yes, chronic use of barbiturates can lead to:

1. Cognitive impairment and memory problems
2. Liver damage
3. Increased risk of osteoporosis
4. Chronic sleep disturbances
5. Mood disorders and depression

Barbiturate Abuse and Addiction

Despite their decreased medical use, barbiturates are still sometimes abused for their euphoric and sedative effects. This abuse carries significant risks and can quickly lead to addiction.

Signs of Barbiturate Abuse

Indicators that someone may be abusing barbiturates include:

• Slurred speech and lack of coordination
• Confusion or difficulty concentrating
• Frequent drowsiness or “nodding off”
• Mood swings or irritability
• Doctor shopping or seeking multiple prescriptions
• Using barbiturates with alcohol or other drugs

Addiction and Withdrawal

Barbiturate addiction can develop quickly due to their high potential for physical and psychological dependence. Withdrawal from barbiturates can be dangerous and potentially life-threatening, with symptoms including:

• Anxiety and restlessness
• Tremors and seizures
• Hallucinations and delirium
• Severe insomnia
• Nausea and vomiting
• Dangerous changes in heart rate and blood pressure

Why is barbiturate withdrawal so dangerous? The abrupt cessation of barbiturates can lead to severe rebound excitation in the central nervous system, potentially causing life-threatening seizures or other complications. This is why medical supervision is crucial during barbiturate detoxification.

Comparing Barbiturates to Other Sedatives

Barbiturates have largely been replaced by other medications for most indications. Understanding how they compare to these alternatives can provide context for their current limited use.

Barbiturates vs. Benzodiazepines

Benzodiazepines have largely replaced barbiturates for anxiety and insomnia treatment. Key differences include:

• Safety: Benzodiazepines have a wider therapeutic window and lower overdose risk
• Addiction potential: Both are addictive, but barbiturates tend to produce dependence more quickly
• Withdrawal: Barbiturate withdrawal is generally more severe and dangerous
• Onset and duration: Barbiturates often have a faster onset but benzodiazepines offer more flexibility in duration

Barbiturates vs. Non-Benzodiazepine Sleep Aids

Newer sleep medications like zolpidem (Ambien) or eszopiclone (Lunesta) are now preferred over barbiturates for insomnia. Comparisons include:

• Selectivity: These drugs are more selective for sleep-promoting effects with fewer side effects
• Addiction risk: Generally lower risk of dependence compared to barbiturates
• Hangover effects: Usually less residual drowsiness the next day compared to barbiturates
• Safety profile: Lower risk of severe respiratory depression and overdose

Why have these alternatives largely replaced barbiturates? The main reasons are improved safety profiles, reduced risk of dependence, and more targeted effects for specific conditions like insomnia or anxiety.

Legal Status and Regulation of Barbiturates

Due to their high potential for abuse and associated risks, barbiturates are tightly regulated in most countries.

Scheduling and Classification

In the United States, most barbiturates are classified as Schedule II, III, or IV controlled substances under the Controlled Substances Act. This classification is based on their medical use and potential for abuse. For example:

• Schedule II: Secobarbital, pentobarbital
• Schedule III: Butabarbital
• Schedule IV: Phenobarbital

Prescription and Dispensing Regulations

The prescribing and dispensing of barbiturates are subject to strict regulations:

• Require a written prescription from a licensed medical practitioner
• Often limited to a 30-day supply with no automatic refills
• May require special prescription forms or electronic prescribing systems
• Subject to careful monitoring and reporting to prevent diversion and abuse

How do these regulations impact barbiturate availability? The strict controls have significantly reduced the availability of barbiturates for non-medical use, contributing to their decreased prevalence in both medical practice and recreational drug scenes.

Future of Barbiturates in Medicine

While the use of barbiturates has declined dramatically over the past few decades, research continues to explore their potential in specific medical contexts.

Ongoing Research and Potential Applications

Areas of current research and potential future use for barbiturates include:

• Neuroprotection in traumatic brain injury
• Treatment of certain rare epilepsy syndromes
• Use in medically-induced comas for severe brain swelling
• Exploration of new, safer barbiturate derivatives
• Potential applications in end-of-life care

Challenges and Limitations

Despite ongoing research, several factors limit the resurgence of barbiturates in mainstream medicine:

• Continued concerns about safety and addiction potential
• Availability of safer alternatives for most indications
• Stigma associated with barbiturate use and abuse
• Regulatory hurdles for developing new barbiturate-like drugs

Will barbiturates ever make a comeback in routine medical practice? It’s unlikely that barbiturates will return to widespread use given their risks and the availability of safer alternatives. However, they may continue to play niche roles in specific medical situations where their unique properties are beneficial.

List of Common Barbiturates + Uses & Side Effects

Barbiturates are a class of drugs that were used extensively in the 1960s and 1970s as a treatment for anxiety, insomnia, and seizure disorders. Apart from a few specific indications, they are not commonly prescribed these days, having been largely superseded by benzodiazepines, which are much safer, although still potentially addictive.

Barbiturates are known as central nervous system depressants. They enhance the action of GABA, a neurotransmitter that inhibits the activity of nerve cells in the brain.

What are Barbiturates used for?

Historically, barbiturates were used in the treatment of anxiety, epilepsy, to induce sleep, and as anesthetics. Nowadays, their use is limited to a few specific conditions, such as:

• extreme cases of insomnia
• seizures that are unresponsive to other, less toxic, agents
• the induction of anesthesia
• in combination with acetaminophen and caffeine to relieve tension headaches.

Research indicates that the abuse of barbiturates is on the rise, especially among adolescents. They are often used to counteract the stimulant effects from drugs such as cocaine and methamphetamine. This has earned them the nickname “downers”.

The “high” from barbiturate abuse is similar to alcohol intoxication. In small doses, the user feels drowsy, disinhibited and intoxicated. In higher dosages, the user develops confusion, slurred speech, and staggers like they are drunk. Too high a dose can lead to unconsciousness, breathing difficulties, and sometimes death. In the 1970s many people died after taking barbiturates, and this, together with the fact that they are extremely addictive, are the reasons they are hardly ever prescribed today.

What are the differences between barbiturates?

The main difference between barbiturates is how long they act for. Long-acting barbiturates such as phenobarbital can last for well over 24 hours, which makes them useful in combination with other agents to prevent seizures in epilepsy. Thiopental is relatively short-acting and is used to induce anesthesia before general anesthetics are given.

Injectable forms of barbiturates are classified as class A drugs, and oral and rectal forms as class B drugs. This means that any form of possession or supply apart from legitimately with a prescription is a punishable offense.

Common Barbiturates available in the U.S.

What are the side effects of barbiturates?

Barbiturates have been associated with many, potentially serious, side effects. Some of the more common side effects include:

Barbiturates are extremely dangerous in overdose. Symptoms may include:

• difficulty concentrating
• impaired judgment
• incoordination
• sluggishness
• speech disturbances
• staggering
• unusually slow and shallow breathing
• coma and death.

People who survive an overdose of barbiturates may be left with permanent kidney damage.

Barbiturates are also highly addictive and there is a high chance of becoming emotionally and physically dependent on them if a person takes them for more than a couple of weeks. In addition, tolerance quickly develops with their use (within two weeks). This is when the same dose no longer gives the same effect, and a dosage increase is needed to ease symptoms again.

Abrupt discontinuation of barbiturates in people who have been taking them for longer than one month can cause severe withdrawal symptoms, such as hallucinations, a high fever, and seizures.

Babies born to women who have taken barbiturates during pregnancy can be born addicted to barbiturates and suffer withdrawal symptoms.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Barbiturates List – Examples Prescribed In The United States

Trusted Content

Barbiturates belong in a class of drugs called Central Nervous System Depressants and are typically prescribed to treat people with insomnia or symptoms of anxiety.

Barbiturates are a class of drugs called central nervous system (CNS) depressants. When taken as prescribed, barbiturates help people with insomnia or with symptoms of anxiety. However, the abuse of these medications can have fatal consequences. Because barbiturates are highly addictive, they present a large risk of abuse and overdose. Knowing which barbiturates are prescribed in the United States, how they are abused, and side effects of abuse can aid in treating addiction before it’s too late. Use our barbiturates list to help you understand these drugs in more detail.

What Are Barbiturates?

Barbiturates are CNS depressants, also called sedatives or tranquilizers, which are used to treat anxiety and sleep disorders. These drugs have largely been replaced in prescription use by benzodiazepines, but are still used for surgeries and to treat seizure disorders. They can also be highly addictive and present high risk of overdose, according to the National Institute on Drug Abuse (NIDA).

Barbiturates work by suppressing the CNS—essentially, they slow brain functions. Slowing brain function affects the parts of the body which control voluntary actions. With increased dosage, barbiturates affect a person’s automatic, unconscious functions, such as breathing and heart rate. It is in this way that barbiturate abuse and addiction is dangerous.

How Are Barbiturates Abused?

Many barbiturates are available in oral form, so typical abuse is through oral ingestion (swallowing the tablet). But for a quicker onset of the drug’s effects, some may choose to inject the drug directly into their veins. In this way, barbiturate abuse looks a lot like heroin abuse.

Injecting barbiturates requires a larger needle gauge as the drugs are thick when converted to liquid form. Using a larger needle results in large abrasions to the injection sites, similar in appearance to cigarette burns. Of those who abuse barbiturates, or develop addiction to them, the majority obtain them through a personal prescription or from someone they know.

What Are The Side Effects Of Barbiturate Abuse?

Side effects of barbiturates are similar to those of alcohol, which is also a depressant, and may include:

• Changes in concentration
• Changes to judgment
• Confusion
• Headache
• Lack of or low regard for inhibitions
• Impact to coordination and vision
• Impact on speech: slow, mumbling, or incoherent
• Memory problems
• Slowed reflexes
• Vomiting

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Drug Info – Are There Risks With Barbiturate Abuse?

Yes. Barbiturate abuse is dangerous because it slows brain and body functions at an increased rate. Use of barbiturates presents risk; abuse of barbiturates can lead to a host of long-term effects, including:

• Breathing troubles
• Chronic fatigue
• Depression
• Sexual issues
• Sleep issues
• Fatal overdose

One of the biggest risks associated with barbiturates is the margin of overdose—increasing barbiturate dosage by only a small amount can lead to overdose. Before someone you know risks his or her life, help get necessary treatment by calling RehabCenter.net.

List Of Drugs Classified as Barbiturates

When looking for signs of barbiturate abuse, it may be helpful to know which barbiturates are on the market. Barbiturates are classified in four groups: ultra short acting, short acting, intermediate acting, and long acting.

Ultra short acting are typically used in anesthesia, injected intravenously, and produce anesthetic results in one minute or less. Short acting to intermediate acting achieve results in 15 to 40 minutes. Long acting barbiturates take effect in about an hour, and last about 12 hours.

Barbiturates are listed by a generic name and marketed under different brand names. When sold for recreational use and abuse, the drugs have other names. Barbiturates are also available in combination with pain relievers.

Brand Names:

• Allonal
• Amytal Sodium
• Brevital
• Butabarb
• Butalan
• Buticaps
• Butisol Sodium
• Luminal
• Mebaral
• Mephyltaletten
• Nembutal
• Nembutal Sodium
• Oramon
• Pentothal
• Phemiton
• Prominal
• Sarisol
• Seconal
• Somnifaine
• Surital

Generic Names:

• Amobarbital sodium
• Aprobarbital
• Butabarbital
• Mephobarbital (methylophenobarbital)
• Methohexital
• Pentobarbital
• Phenobarbital
• Primidone
• Secobarbital
• Thiopental sodium
• Thyamilal

Street Names:

• Amobarbital: blue heavens, blue devils, blue velvet, downers
• Pentobarbital: abbots, Mexican yellow, nembies, yellow jackets
• Phenobarbital: goof balls, purple hearts
• Secobarbital: F-40s, lily, pinks, pink ladies, red birds, red devils, reds, seggy,
• General street names: barbs, blockbusters, christmas trees, downers, phennies, sleepers

Ultra Short-Acting:

• Brevital (Methohexital)
• Pentothal (Thiopental sodium)
• Surital (Thiamylal)

Short-Acting to Intermediate Acting:

• Amytal (Amobarbital)
• Alurate (Aprobarbital)
• Butisol (Butobarbital)
• Nembutal (Phenobarbital)
• Seconal (Secobarbital)

Long-Acting:

• Luminal (Phenobarbital)
• Mebaral (Mephobarbital)
• Prominal (Methylophenobarbital)

Combination Barbiturates:

Combinations of Butalbital (barbiturate) and Acetaminophen (pain reliever) are available in the following brand names:

• Anolor 300
• Bupap
• Capacet
• Cephadyn
• Dolgic LQ
• Esgic
• Esgic-Plus
• Ezol
• Fioricet
• Geone
• Margesic
• Orbivan CF
• Phrenilin
• Phrenilin Forte
• Zebutal

What Are The Available Treatments For Barbiturate Abuse?

If you know someone who needs help for barbiturate abuse and addiction, do not despair. Treatment is not impossible—it’s actually quite possible when you find the right help. Inpatient rehab centers offer a quality of care you won’t find elsewhere.

The rehab center difference is a comprehensive treatment plan for all addicted individuals. This means participants get help with treating any and all disorders (dual diagnosis). Healing in one of our rehab centers allows you to get away from the triggers of your usual environment.

Stepping away from the stressors of everyday life is important to your recovery. Your number one focus during recovery should be healing of your body, mind, and spirit. Many rehab centers combine a number of treatment methods which allow you to do just that. Just some of the methods available at our treatment centers are:

Get Into Drug Treatment Today and Improve Your Health

Every addicted individual deserves a chance at a new life. Inpatient rehab can give you or your loved one that chance. Don’t let barbiturate abuse rob you of the life you deserve. Contact us today at RehabCenter.net for more information on rehab centers, treatment options, and help with addiction.

Article Sources

California State University-Long Beach – CNS Depressants

Drug Free World – Depressants

Mayo Clinic – Butalbital And Acetaminophen Combination

Medical News Today – What Are Barbiturates?

National Institute On Drug Abuse – Prescription Drugs: Abuse And Addiction

National Institute On Drug Abuse – What Are CNS Depressants?

U.S. National Library Of Medicine – Barbiturate Intoxication And Overdose

Trazodone Drug Class: Narcotic Or Controlled Substance?

There are many questions about Trazodone drug classification due to the multiple ways the drug is used. Its properties are very similar to several types of drugs and cause many problems with the schedule and class of this medication. Firstly, is Trazodone addictive? What effects does it have and how can it be classified?
Trazodone uses are not limited to the general antidepressant effects. This medication is known to disrupt the activities of neurotransmitters that coordinate brain functions. The drug is considered a mild serotonin reuptake inhibitor as well as a mild antihistamine. So, what drug class is Trazodone?
Trazodone is an antidepressant drug also known as generic Desyrel, Oleptro or Trialodine. Since the approval of Trialodine by the FDA in 1981 the drug has been applied in many fields of medicine and classified according to its functions. Trazodone classification is often misconstrued due to its similarity in function to other drug types.

Table of Contents

Is Trazodone A Controlled Substance?

Trialodine may induce a hypnotic effect as a serotonin modulator; however, is Trazodone a controlled substance? Trialodine affects the activities of norepinephrine, serotonin, and dopamine. Its impact on the brain causes increased energy levels and activity. It acts to restore serotonin balance in the brain. So, is Trazodone controlled? A substance that can be termed as “controlled” is one that is illegal or purchased over the counter with a strict prescription for certain specific conditions. The laws on controlled substances are regulated by the federal government to mitigate the distribution of harmful drugs. On this basis, is Trazodone controlled? No, it is not, at least not in the United States.

Is Trazodone A Narcotic?

There are a few off-label applications of Desyrel which are not approved by the federal Drug Agency. The Trazodone narcotic misconception is quite common because of this. So, is Trazodone a narcotic?  No, it is not. Even though they are sometimes administered off-label and for investigation purposes for conditions such as alcohol withdrawal, schizophrenia, cocaine withdrawal, erectile dysfunction, obsessive-compulsive disorder, and other health issues, or tend towards abuse, it is not addictive. However, tolerance for this drug can be developed, especially in the case of Trazodone recreation use.

Is Trazodone A Sleeping Pill?

Trialodine has been prescribed for people with cases of insomnia, specifically for people with severe depression, panic disorder, and used to calm migraine.
Is Trazodone a sleeping pill? Yes, it is often administered in a low dosage in the place of benzodiazepines to induce sleep. The Trazodone dosage for sleep may depend on the medical doctor’s specification. Trazodone sleeping pill comes in 100mg and 50mg tablets.
Some people have experienced alterations in weight while on Desyrel medication, so, does Trazodone cause weight gain? Simply put, weight gain or loss is one of the numerous possible side effects of Trialodine, along with dizziness, swellings, vision impairment, diarrhea, and others. Trazodone half-life on usage is 5-9 hours, and it should only be prescribed by a medical professional to avoid a Desyrel overdose.

Is Trazodone A Benzo?

Benzos are used as sedatives, muscle relaxants, and anticonvulsants. Is Trazodone a Benzo?? From all indications, it is not. While Trialodine regulates the activities of neurotransmitters, benzodiazepines reduce activities of neurotransmitters by enhancing the mechanism of action of gamma-aminobutyric acid (GABA).
Clinical psychiatrists use Trialodine as an alternative to benzos because some patients may be prone to addiction or abuse if treated with a benzodiazepine. The Trazodone antidepressant may help with cases such as insomnia, and it does not cause functional defects to the brain, unlike benzodiazepines.

Is Trazodone An Opioid?

Opioids and opiates are classes of drugs that are considered as extremely addictive. They include prescription drugs such as hydrocodone and oxycodone as well as illegal drugs. Physical dependencies easily occur even on prescription. So what is the relationship here? Is Trazodone an opiate?
Trialodine is one of the medications administered in the treatment of withdrawal symptoms of opioid addiction. So, is Trazodone and opioid? No, it is not. However, it’s is quite useful in dealing with the psychological symptoms of opioids and barbiturates.
Trialodine, if taken wrongly with other drugs, may lead to serotonin syndrome. Mixtures such as Trazodone and weed can lead to serious health problems as the drug will naturally escalate the effects of the substance. The Trazodone class of antidepressants may react negatively with other medications such as MAOI; allow two weeks gap before switching to either one.

Is Trazodone A Muscle Relaxant?

The term “muscle relaxant” is used to categorize drugs that reduce tension in the muscle fiber and causes a form of relaxation. Some muscle relaxants work on the central nervous system to dampen stimulated nerves, causing a reduction in activity, while some relaxants work specifically on the muscles and cause drowsiness.
Desyrel is prescribed for insomnia and helps the muscles to relax. It can cause drowsiness and dizziness which can be problematic if one is operating heavy machinery or driving. Even though Trialodine may induce sedation while improving the quality of sleep, it is not a muscle relaxant and cannot be used as an alternative to one.

Is Trazodone An Antidepressant?

As stated earlier, Trialodine is an antidepressant; however, there are several classes of antidepressants which include:

• SSRIs
• MAOIs
• TCAs
• NRIs
• SARIs

Is Trazodone an SSRI?

Desyrel is not an SSRI. Selective Serotonin Reuptake Inhibitors (SSRI) are typical antidepressants while Trialodine falls into the category of atypical antidepressant. SSRIs limit the reabsorption of serotonin, and Trazodone inhibits the reuptake of serotonin, norepinephrine, and dopamine, and also antagonizes the α1-adrenergic receptors. So, it has more possible functions than SSRIs.

Is Trazodone an MAOI?

Desyrel cannot be an MAOI due to its structure. Monoamine Oxidase Inhibitors are antidepressant drugs with a completely different chemical composition. They inhibit monoamine oxidase enzymes and prevent the breakdown of monoamine neurotransmitters instead of inhibiting the reuptake of some chemical compounds.

Is Trazodone a TCA?

Oleptro is not the TCA, as they have a different mechanism of action and structure. These drugs work as serotonin and norepinephrine transporter blockers, thereby increasing their concentration. Tricyclic antidepressants are also quite effective, but their side effects are too severe. That’s why they were mostly replaced by the newer classes of the antidepressants. By the way, Trazodone was the first non-tricyclic antidepressant approved by the FDA.

Is Trazodone an NRI?

Trialodine is not an NRI as this type of antidepressant drugs acts as reuptake inhibitors for norepinephrine and epinephrine, but does not antagonize the α1-adrenergic receptors. Their mechanism of action is different.

Is Trazodone a SARI?

Trazodone is a SARI – Serotonin Antagonist And Reuptake Inhibitor and also has the sedating effect. It is potent serotonin and α1-adrenergic receptor antagonist, a weak serotonin reuptake inhibitor (SRI), and a weak antihistamine.
Trialodine is a triazolopyridine derivative and atypical antidepressant. Its mode of action involves the prevention of serotonin reuptake and the prevention of particles of serotonin in the synapse from binding to specific receptors that do not enable effective mood circuit functions through nerve cells. It is unrelated to typical neurotransmitter inhibitors such as SSRIs, SNRIs, MAOIs, and TCAs as Trazodone stops neurotransmitters from binding to specific receptors in addition to serotonin reuptake inhibition.

Take The Medications With Precautions

Trialodine is an antidepressant also known as generic Desyrel. It is usually prescribed for anxiety, depression, obsessive-compulsive disorder, and other mental issues. It is categorized as a serotonin antagonist and reuptake inhibitor (SARI). The drug is not a barbiturate, although it is administered as a medication for the withdrawal symptoms of barbiturates.
Desyrel is not categorized as a controlled substance and can be purchased over-the-counter on prescription. Care must be taken while using this drug as a certain level of dependency may develop if abused.
The drug abuse rehab clinics offer different recovery options for those suffering from antidepressant abuse. It is quite possible to treat addiction to prescription medications, especially with professional assistance.

Page Sources

1. https://medlineplus.gov/druginfo/meds/a681038.html
2. https://www.ncbi.nlm.nih.gov/pubmed/3321131

Published on: April 1st, 2019

Updated on: June 16th, 2020

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.

List Of Barbiturates From Strongest To Weakest

What Are Barbiturates?

Barbiturates were quite often the first line of treatment in the 60’s and 70’s to treat anxiety, insomnia, and seizure disorders. Today, barbiturates are used less often and for specific indications. And usually only after the commonly prescribed, less toxic, medication has not successfully treated the issue.

Barbiturates affect the central nervous system (CNS) and are classified as a depressant. They specifically work on the GABA neurotransmitter in the brain. This specific neurotransmitter works in the brain to slow the activity of the nerve cells in the brain, causing the depressive response of the CNS. Depressing the CNS can result in confusion, respiratory failure, and death.

The way that barbiturates affect the brain is one of the reasons it has the potential to be extremely addictive, so individuals who take barbiturates tend to be at a higher risk for abuse. Being able to identify barbiturates and the effects of barbiturate abuse may assist in recognizing the need for intervention and treatment of barbiturate addiction.

List Of Barbiturates From Strongest To Weakest

When considering which barbiturates are the strongest or the weakest, it is important to understand how different barbiturates react in the body.

Barbiturates are typically broken into four classifications:

• ultra short acting
• short acting
• intermediate acting
• long acting barbiturates

The ultra short acting barbiturates are injected intravenously and used in anesthesia, are effective within a minute, and last a short time. The short to intermediate acting barbiturates are helpful for sleep disorders, and last between three to eight hours. Long acting barbiturates take about an hour before they take effect and last approximately twelve hours, which make them useful when treating seizures disorders.

Ultra Short-Acting Barbiturates

The sedative effects of these barbiturates are almost immediate, and render the individual unconscious for a short time (ranging from an average of 5 to 25 minutes). In addition to use in anesthesia, ultra short acting barbiturates have been used in lethal injection and assisted suicide.

Ultra short-acting barbiturates include:

• methohexital (Brevital)
• thiopental sodium (Pentothal)
• thiamylal (Surital)

Short-Acting Barbiturates

Short acting barbiturates usually take ten to fifteen minutes to take effect and can last approximately three to four hours. These medications are used for short term sleeping problems and sometimes as a sedative before surgery.

Short-acting barbiturates include:

• pentobarbital (Nembutal)
• secobarbital (Seconal)

Intermediate-Acting Barbiturates

These intermediate acting barbiturates take about an hour to reach therapeutic level, and typically maintain effectiveness for six to eight hours. These barbiturates are primarily used for treating sleeping disorders, like insomnia, for short periods of time, for sedative purposes, or prior to situations using anesthetic.

Intermediate-acting barbiturates include:

• amobarbital (Amytal)
• aprobarbital (Alurate, Allonal, Oramon, Somnifaine)
• butabarbital (Butisol, Butabarb, Butalan, Sarisol)
• butalbital (combined with acetaminophen to treat migraines)

Qualities unique to butabarbital and butalbital are that they have a half life (amount of time it takes for half of the dose to leave the body) of 34 to 42 hours, which can cause excessive sleepiness that can last into the next day after the last dose. In addition, butabarbital is not for new patients, this medication is only recommended for use in individuals who are already taking another barbiturate.

Long-Acting Barbiturates

These types of barbiturates are used for anxiety, insomnia, seizures, or combined with other medications to treat migraines. Because these medications can last up to twelve hours, they can also be used to treat the withdrawal symptoms of barbiturate addiction during a medically supervised detox program.

Long-acting barbiturates include:

• phenobarbital (Luminal)
• mephobarbital (Mebaral)
• primidone (Mysoline)
• methylphenobarbital (Prominal, Mephyltaletten, Phemiton)
• metharbital

Ultra short acting barbiturates, in general, could be considered the strongest barbiturates, as they take effect quickly and result in unconsciousness, followed by short acting, and then intermediate acting barbiturates. The weakest could be considered the long acting barbiturates because they take an hour to take effect and typically do not cause unconsciousness.

Street Names For Barbiturates

Street names, or nicknames, for barbiturates can depend on which barbiturate is being referred to. General street names for barbiturates include: barbs, downers, phennies, sleepers, christmas trees, and blockbusters.

The following are some of the more common names associated with each barbiturate:

• pentobarbital (mexican yellows, yellow jackets, nembies, abbots)
• amobarbital (blue velvet, downers, blue heaven, blue devil)
• secobarbital (lilys, pinks, reds, red devil, seggy F-40s, pink ladies)
• phenobarbital (goofballs, purplehearts)

Barbiturate Abuse

Abusing barbiturates can result in many dangerous consequences. As with any substance abuse, there is increased risk for overdose. There is not an antidote to a barbiturate overdose, reversing the effects of a barbiturate overdose are quite difficult. Depressing the CNS can cause automatic body functions (breathing, heartbeat) to stop.

Most individuals who abuse barbiturates take the drug in pill form. However, injecting barbiturates is not totally uncommon. This form of intravenous abuse can be more noticeable, because the marks left at the injection site are much larger due to the need for a larger needle.

Side Effects Of Barbiturate Abuse

As with any substance of abuse, barbiturate abuse comes with a list of side effects. Barbiturate abuse has similar side effect to alcohol abuse. Some may be desirable to the person abusing the barbiturate, others are not.

Side effects of barbiturate abuse may include:

• altered judgment
• speech becomes incoherent
• decreased inhibitions
• unable to focus
• difficulty concentrating
• problems with coordination
• vomiting
• overall reflexes are slowed
• problems with sleep
• depression
• sexual dysfunction
• overdose, potentially fatal

Barbiturate Overdose

Small increases in dosage can easily result in overdose with barbiturates, since this type of overdose is essentially poisoning the body with barbiturates. It is sometimes referred to as barbiturate toxicity. Knowing what a person who may be overdosing on barbiturates looks like could save their life.

If someone who is taking barbiturates shows any of the following symptoms, call 9-1-1 immediately:

• excessive confusion
• memory loss
• irritability
• impaired alertness
• overall inability to function

Treatment For Barbiturate Abuse Or Addiction

Substance abuse treatment centers are equipped to help individuals struggling with barbiturate abuse. These programs can assess and determine what services are necessary for each individual to achieve sobriety.

Using intervention techniques like medically assisted detoxification programs to help lift the cloud of confusion off a person struggling with barbiturate abuse. This can help them benefit from the services offered during treatment. A medical detox can also alleviate any discomfort associated with barbiturate withdrawal. People are not advised to stop taking barbiturates cold turkey. After the detox process is complete, treatment can begin, followed by aftercare.

Struggling with barbiturate abuse or addiction does not have to be a life sentence. Contact us today if you or someone you care about is suffering with barbiturate addiction.

Written by the Addiction Resource Editorial Staff

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Trazodone Addiction, Abuse, and Symptoms

Behavioral Symptoms of Trazodone Usage and Abuse

How trazodone affects the brain

Trazodone increases the amount of serotonin in the brain, relieving some of the symptoms of major depressive disorder. Serotonin is a hormone that helps the nerves send messages to each other. In people with depression, an imbalance of serotonin and other chemicals produces symptoms such as loss of appetite, reduced self-esteem, and persistent feelings of sadness.

Trazodone may also affect the amounts of dopamine and norepinephrine in the brain. Like serotonin, dopamine and norepinephrine are chemicals that help the nerves communicate with each other. In people with depression, trazodone can correct imbalances of these chemicals, relieving depression symptoms.

Behavioral signs of trazodone usage and abuse

The signs of trazodone misuse are not always obvious right away, but long-term use can cause several behavioral changes. It may be difficult to carry on a conversation with someone who misuses trazodone, as long-term trazodone use can interfere with the ability to speak or understand what people are saying. Individuals who use trazodone may also experience mood swings or sudden emotional changes, making it difficult to predict how they will react to certain situations.

In adolescents, misuse of trazodone or another similar substance can lead to behavioral changes such as skipping school, not putting effort into personal grooming, loss of interest in sports or other activities, and a decline in school performance. Trazodone misuse can also interfere with the relationships adolescents form with their family members and peers.

Adults who misuse trazodone may miss work frequently, lose interest in hobbies they used to enjoy, ask friends and relatives to borrow money, stop paying attention to personal hygiene, or exhibit drastic changes in their behavior. Some individuals try to hide what they are doing by being secretive about where they go, refusing to let other people enter their rooms, or refusing to introduce new acquaintances to their friends or family members.

Physical Symptoms of Trazodone Abuse

How trazodone affects the body

Trazodone increases the amounts of serotonin and norepinephrine in the brain, which has a relaxing effect on the body. As the body relaxes, the individual may start to feel sleepy. Trazodone may also cause dry mouth, dizziness, nausea and vomiting, weakness, fatigue, sweating, and blurry vision. Long-term use of trazodone may cause a loss of appetite, leading to unintended weight loss.

Early physical effects of trazodone

After taking trazodone, an individual can expect to experience several physical and psychological effects within as little as 30 minutes. Some of these side effects are undesirable, while others can be dangerous.

This table illustrates the possible short-term physical effects associated with trazodone.

Severe and long-term physical effects of trazodone

Individuals who use trazodone for long periods often develop a tolerance to the drug. Once this tolerance develops, it takes more trazodone to produce the same effects that used to occur with smaller doses. As a result, it becomes necessary to take trazodone more frequently or increase the amount of trazodone in each dose. Increasing the amount of trazodone taken each day increases the risk for overdose, which can cause difficulty breathing, chest pain, abnormal heart rhythms, seizures, and tremors. In severe cases, trazodone overdose can cause an individual to stop breathing or slip into a coma.

Prolonged use of trazodone has also been associated with symptoms similar to the ones produced by Parkinson’s disease. These symptoms include muscle spasms, altered mental status, and rigidity of the arms and legs. Parkinsonian symptoms are more likely to develop in elderly users of trazodone.

The physical effects of trazodone are more pronounced when trazodone is combined with another substance. Some individuals use trazodone to enhance the effects of alcohol or balance out the effects of stimulants, such as cocaine. Trazodone is especially dangerous when combined with alcohol, other sedatives, and barbiturates, as combining these substances affects the central nervous system, which is responsible for breathing and other critical functions.

This table illustrates the possible long-term physical effects associated with trazodone.

How are They Similar and How are They Different?

Trazodone and Ambien (zolpidem) are both prescription drugs that can be used to treat sleep disorders like insomnia. Trazodone is typically prescribed as an antidepressant and Ambien is a non-barbiturate hypnotic. This means that they both work to improve sleep but in different ways.

Let’s look at a comparison:

Trazodone:

• Trazodone is the generic name for Desyrel and Oleptro.
• It was primarily developed as an antidepressant. It works by helping to increase the availability of serotonin in the brain. Serotonin is considered a natural mood stabilizer. It is also the chemical that helps with sleeping, eating, reducing depression, and regulating anxiety. 
• Trazodone is approved by the FDA to treat depression, but it is frequently used “off label” at lower doses to treat insomnia. 
• Not as effective as other medications for depression.
• Causes more side effects when used for depression at higher doses including upset stomach and irregular heartbeat.
• Doses of trazodone can vary with the individual. To treat insomnia, 50 to 100mg before bedtime is a common dosage. Trazodone reaches its maximum levels in the body within one hour after consumption. However, it may take from 1 to 6 weeks to reach trazodone’s maximum effects.

Side Effects

• Drowsiness, Fatigue, Headache—Also called the trazodone “hangover”
• Diarrhea
• Blurred vision
• Higher risk of suicidal thoughts and behavior for people age 24 and younger

Serotonin Syndrome

Serotonin is a chemical your body makes that is needed for your nerve cells and brain to function. Serotonin syndrome is a possible and serious side-effect of any serotonin medication. As the drug increases the concentrations of serotonin in the brain, the neurotransmitters cause widespread changes in the body. Some of these changes can be fatal. Using high doses of trazodone can cause symptoms of Serotonin Syndrome such as:

• High body temperature
• Agitation
• Excessive sweating
• Increased reflexes
• Fast heart rate
• Breakdown of muscle tissue
• Seizures
• Muscle tremors
• Diarrhea
• Coma
• Death

Drug Interactions

• Central Nervous System depressants like alcohol and barbiturates
• Muscle relaxers
• Warfarin
• Digoxin
• Medications that cause drowsiness

Ambien

• Ambien is a brand name for zolpidem. 
• It is prescribed specifically to treat insomnia. Ambien is a non-barbiturate hypnotic which affects the receptors in the brain responsible for slowing down brain activity. 
• Can be habit-forming.
• It is usually taken as a 5mg or 10mg tablet at bedtime with at least 7 to 8 hours allowed for a full night’s sleep. 
• Effective to help people fall asleep quickly and sleep longer.
• Long-term treatment (more than 10 days) with Ambien is not recommended.
• May not be safe if you have liver, kidney, and lung problems or a history of depression.

Common Side Effects

• Drowsiness
• Dizziness
• Diarrhea
• Grogginess
• More likely to cause sleepwalking, sleep-driving, and sleep-eating

Drug Interactions

• Central Nervous System depressants like alcohol or barbiturates
• Muscle relaxers
• Medications that treat muscle weakness and narcolepsy
• Medications that may cause drowsiness

What are the Symptoms of Trazodone Misuse?

Signs of trazodone misuse can lead to behavioral changes such as:

In Adolescents

• Skipping school
• Loss of interest in sports or other activities
• Lack of personal grooming
• A decline in school performance
• Problems with relationships with family and friends

In Adults

• Frequently miss work
• Lose interest in hobbies they used to enjoy
• Asking to borrow money from relatives and friends
• Being secretive

Long-term Use of Trazodone

Long-term use of sedatives like trazodone can cause:

• Memory loss
• Sudden emotional shifts
• Involuntary eye movements
• Difficulty thinking clearly
• Difficulty understanding others when they speak
• May also cause the user to speak slowly

Is Trazodone Addictive?

There has been an increase in the harmful use of all prescription drugs in this country including antidepressants. The National Survey on Drug Use and Health (NSDUH), reported in 2018 that about 243,000 people, ages 12 and older were current misusers of prescription sedatives like trazodone. Subsequently, misuse of trazodone and other sedatives has increased especially among adolescents and young adults.

Although there is a relatively small number of people reported as being addicted to trazodone, there are still some people who use it recreationally. It’s not used for a euphoric “high.” Instead, it is used for its sedative effects and, for some people, for the level of cognitive impairment it causes. 

The National Institute of Drug Abuse has stated that people who use it for non-medical reasons (to seek a high) are more likely to become addicted. Some people take large doses of trazodone for the mild high it produces but taking larger doses can cause hallucinations. This puts these users at higher risk for addiction and overdose.

The speed with which trazodone helps anxiety attacks is one of the reasons it is prescribed. However, over time the individual’s tolerance level increases, requiring higher doses to be effective. Therefore, this can lead to addiction, even with a doctor’s prescription. 

Signs of Trazodone Addiction

Signs of trazodone addiction include:

1. Attempting to get trazodone without a prescription
2. Using up a prescription before the refill date
3. Combining trazodone with other drugs and alcohol
4. Doctor shopping for more trazodone prescriptions
5. Illegally buying trazodone
6. Use of trazodone begins to interfere with other parts of life such as work, school, and personal responsibilities
7. Taking trazodone to get high instead of treating depression or insomnia
8. Needing high doses to feel the effects

Trazodone Overdose

According to the National Institute on Drug Abuse (NIDA), in 2017, more than 5,000 U.S. deaths involved an antidepressant. Some were the result of antidepressants combined with opioids and some were combined with synthetic narcotics.

People who use trazodone for long periods frequently develop a tolerance to the drug. As tolerance develops, it takes more of the drug or more frequent doses to produce the same effects that occurred initially. Increasing the amount taken each day increases the risk of overdose. And the repeated high dosage by people who misuse the drug recreationally puts them at high risk for overdose.

Symptoms of Trazodone Overdose include:

• Difficulty breathing
• Chest pain
• Abnormal heart rhythms
• Seizures

• Loss of muscle coordination
• Nausea and vomiting
• Painful erection that doesn’t go away
• Respiratory arrest
• Coma

Who is Most at Risk?

1. Recreational users using high doses for the hallucinogenic effects
2. Long-term users who have built up a tolerance for the drug and require larger doses to achieve the desired effects
3. People who mix trazodone with other drugs or alcohol

What are Withdrawal Symptoms from Trazodone?

When an individual is addicted to trazodone, they will have painful side-effects known as withdrawal symptoms when the drug leaves their body. The body has adapted to regular high doses of trazodone by changing the receptors it interacts with. 

When there is no more of the drug in the body, these changes cause a sick feeling. The body has been compensating for the trazodone effects so without the drug, we lose the ability to regulate those affected neurotransmitters on our own. Withdrawal symptoms include:

• Severe depression
• Insomnia
• Anxiety
• Erectile dysfunction
• Agitation
• Suicidal thoughts

Is Trazodone Safer than Ambien?

There have been several studies that show that trazodone may improve sleep during the first two weeks of treatment. However, the drug hasn’t been thoroughly studied for longer than six weeks for people whose main problem is insomnia. As a result of that, not enough is known about how it works or how safe it is after that point. Also, an effective dose rate hasn’t been established for the drug when it’s used for chronic insomnia, although lower doses are usually prescribed.

Treatment guidelines from the American Academy of Sleep Medicine don’t recommend trazodone for insomnia. There isn’t enough evidence to support using any antidepressant to treat insomnia. But still, data suggests that some doctors are convinced that trazodone is an appropriate sleep medication.

Ambien Safety

According to Eric J. Olson, M.D., it’s unlikely for a person to become dependent on zolpidem (Ambien). Ambien and similar medications can be effective for sleep problems. And it is much less likely to become habit-forming than some other medications that are prescribed, such as benzodiazepine drugs. Medications for sleep are useful in the short term but long-term use isn’t the best solution for insomnia. Sleep medications can hide an underlying problem that needs to be addressed.

Four Steps in the Treatment of Trazodone Addiction

Step 1. Assessment

The first step in treating trazodone addiction is to check out the treatment facility you’re thinking of using. Learn about the programs and services available. After becoming oriented to the facility, you will need a professional assessment to determine your needs and to develop a specific treatment plan for you.

Step 2. Detoxification

The next step is a medically supervised detox to gradually eliminate trazodone from your body. This reduces the risks of severe withdrawal symptoms, some of which are life-threatening.

Step 3. Treatment

This step uncovers and treats the underlying causes of the addiction and gives you the tools to overcome the addiction and resist triggers. You will have the chance to take part in therapy in group sessions and one-on-one with your counselor. Therapy sessions and social support are necessary for changing the harmful thoughts and behaviors that caused your addiction. Social support is also a key part of maintaining your recovery. 

While you attend therapy sessions, you will either live at the facility as part of a residential program. Or you may attend therapy sessions during the day and go home every evening as part of an outpatient program. These issues will be discussed with input from your doctors, therapist, and yourself as to what is best for you.

Step 4. Aftercare

The purpose of the last phase is to assist you in transitioning into programs that will help continue the lifelong process of recovery. You may choose to continue counseling, join support groups such as narcotics anonymous, or look into sober housing. Studies show that people who take part in some type of aftercare have a better chance of preventing relapse.

Find a Treatment Center

Sudden withdrawal from trazodone can have serious consequences. You need a treatment center that is experienced in the detox process. Discovery Institute has licensed medical professionals who can help you ease your way through withdrawal.

In addition, we have certified substance use counselors to help you discover your reasons for misusing trazodone and help you learn new thoughts and behaviors to stay clean. So don’t wait. Check out our facility. Contact us now. We are always available to you and all information is confidential.

Reviewed for Medical & Clinical Accuracy by Dr. Jeffrey Berman, MD

Dr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.

More About Dr. Jeffrey Berman, MD

Sedative/Hypnotics, Antidepressants, Melatonin Agonists, Orexin Receptor Antagonists

90,000 Treatment of anxiety in general medical practice

Article No. 64. Anxiety disorders are often found in general medical practice in patients with somatic diseases: more than 20% of patients who come to medical consultations have clinically significant symptoms of anxiety. However, the word “anxiety” itself is rarely found in the complaints presented. More often you can hear complaints of anxiety about little things, insecurity, constant concern for your future, excessive fears, a feeling of constant expectation, easily arising anxiety, difficulty falling asleep or interrupted sleep, unpleasant dreams, irritability, inability to concentrate.These complaints are mental in nature and directly indicate the presence of anxiety. More difficult in the differential diagnosis are somatic complaints, such as fussiness, tension headaches, tremors, inability to relax, tachycardia, sweating, dry mucous membranes, difficulty breathing, nausea, dyspepsia, diarrhea, chills, persistent weakness, heart failure, feeling compression or compression in the chest, increased blood pressure (BP), abdominal cramping, back and lower back pain, myalgia, pallor or redness, goose bumps, itching, urticaria, sexual dysfunction, etc.[one]. Most of the somatic complaints are due to muscle tension and autonomic dysfunction, which is characteristic of anxiety.

The ability to recognize possible somatic symptoms of anxiety is important for physicians in somatic specialties in order to differentiate between anxiety disorders and somatic diseases, taking into account their frequent combination with each other.

The ICD-10 diagnostic criteria for generalized anxiety disorder (F41.1) are as follows.

1. Generalized persistent anxiety, not limited to any specific circumstances (or arising mainly under these circumstances).

2. Related:

– fears (fears) for health and your life, the life and health of loved ones, other misgivings;

– motor (muscle) tension – fussiness, tremor, inability to relax;

– vegetative and vegetative pain symptoms.

3. Having symptoms most days of the week for several weeks or months [2].

In clinical practice, it often happens that in the presence of psychological and somatic symptoms of increased anxiety, their number or duration is insufficient for a definite diagnosis; then they speak of subsyndromal anxiety. It is often caused by high levels of personal anxiety. According to neurophysiological studies in such persons, there is a tendency to a background increase in pulse rate, blood pressure, heart disorders, as well as large shifts in these indicators in mental activity and stress [3].The question of the need to prescribe pharmacotherapy for subsyndromic anxiety is decided individually, in contrast to clinically expressed anxiety disorders. Numerous studies have shown that anxiety disorders have a long-term undulating course, exacerbating after stress. After 5 years, spontaneous complete remission is observed in only 1/3 of patients. In this regard, the mandatory appointment of anti-anxiety pharmacotherapy becomes clear.

The search for the most effective drugs for the treatment of anxiety disorders is ongoing.It is known that neurochemical and neuroendocrine levels are involved in the development of anxiety: GABAergic, noradrenergic, serotonergic, histaminergic systems, as well as hormones or peptides like corticotropic releasing hormone associated with corticosteroid, neurosteroid hormones, hypothalamus hypothalamus axis and hypothalamus axis and hypothalamus axis. This explains such a wide range of pharmacological drugs used to relieve anxiety disorders.

At the beginning of the XX century.bromides have been used to treat anxiety and insomnia; in the 40s – ethyl alcohol and its structural analogs, for example, Paraldehyde and Chloral hydrate; in the 50s. – barbiturates and propanediol derivatives, including meprobamate. In the 1960s. appeared benzodiazepines, which are still the most frequently prescribed drugs [4]. In modern medicine, in addition to the latter, “small” antipsychotics, antidepressants and non-benzodiazepine anxiolytics are also used. Let’s dwell on each of these groups in more detail.

The effect of taking benzodiazepine drugs in case of anxiety is due to inhibition of the central nervous system through GABA receptors. At relatively low doses, they exhibit anxiolytic properties, and at higher doses, sedative-hypnotics. Based on the varying degrees of evidence of the studies carried out, as well as on their pharmacokinetic properties for each of the drugs, a predominant indication was derived. For example, Phenazepam, Flurazepam, Temazepam and Triazolam are used more often for the treatment of insomnia due to the pronounced hypnotic effect.

Diazepam (Sibazon, Relanium, Seduxen) is effective in the drug treatment of situational anxiety at a dosage of 5 mg 3 times a day. If necessary, the dose can be increased to 30 mg / day. In the case of generalized anxiety disorder, the daily dose may be increased from 15-30 mg to 40-50 mg. In some patients, stable improvement occurs after 2–6 weeks of therapy, but in most cases, discontinuation of therapy leads to a relapse of anxiety. In this regard, it is recommended to combine psychopharmacotherapy with cognitive-behavioral psychotherapy [4].

Alprazolam and Clonazepam have an obvious advantage of efficacy and pharmacokinetic parameters in the treatment of panic attacks. Alprazolam is usually prescribed at 2-6 mg / day, divided into 3-4 doses. Let’s consider the main problems associated with taking Alprazolam. He has a higher risk of developing addiction, which leads to more severe relapses and more severe withdrawal symptoms. Due to the short half-life in some patients, relapses of anxiety develop in the intervals between doses.Despite the frequent use of Alprazolam, patients may experience significant discomfort when the effect of the last dose wears off. They constantly monitor the time of taking the drug and often independently increase the dosage.

When using Clonazepam, due to the longer half-life, the above problems can be avoided. Its daily dose is 1-4 mg and is divided into 2 doses, although the therapeutic range varies from 0.5 to 6.0 mg / day. The disadvantage of therapy with Clonazepam compared to Alprazolam is a higher risk of depression [4].

The widespread use of benzodiazepines in general medical practice in patients with complaints of anxiety and insomnia is due to a combination of efficacy and relative safety. However, over the past 20 years, addiction and abuse have increased. Indeed, with long-term use of even therapeutic doses of benzodiazepines (6 months or more), the risk of developing dependence or withdrawal syndrome is high. Most often, addiction is caused by drugs of pronounced, but short-term action, such as Alprazolam and Lorazepam.The use of benzodiazepines is also limited by their various side effects, such as muscle relaxation, daytime sleepiness, ataxia, memory impairment, decreased concentration, recoil syndrome and the already mentioned addiction, drug dependence and withdrawal syndrome [4].

Until now, there are no detailed generally accepted recommendations on the tactics of cancellation of long-term benzodiazepines by outpatients. For these purposes, the most commonly used SSRI (trittico) [5].At the State Scientific Center for St. Petersburg and JV them. V.P. Serbian, a study was conducted using the atypical antipsychotic Eglek (Sulpiride) as a “cover-up therapy” for the period of withdrawal and subsequent replacement therapy. Providing a pronounced anti-anxiety effect already at a dose of 200 mg / day, Eglek effectively influenced the prevailing anxiety disorders of both paroxysmal and generalized nature. No less important is the somatotropic and vegetative stabilizing effects of Eglek [6].

Due to its pronounced anxiolytic and sedative effect in general medical practice, another “small” neuroleptic is often prescribed – Thioridazine (Sonapax).The experience of its application in clinical practice, especially in outpatient practice, has confirmed its firm position as a means necessary in the treatment of a wide range of anxiety-neurotic disorders. Undoubted indications for the appointment of Thioridazine are actually anxiety disorders, anxiety-phobic disorders with a different content of phobias, somatoform neurotic disorders, the so-called latent depression with senesto-hypochondriac and vegetative-vascular manifestations, acting under the guise of vegetative-vascular dystonia or various algic syndromes.The daily dose of the drug can vary from 10 to 300 mg. In general, Thioridazine is well tolerated, however, with the appointment of high doses and long-term administration, manifestations of arterial hypotension, especially orthostatic, are possible, although extremely rare, which are functional and reversible [7]. Neuroendocrine disorders can manifest as weight gain.

From the middle of the XX century. antidepressants are increasingly being used in the treatment of anxiety disorders. As shown by numerous studies, the use of classical (tricyclic) antidepressants (Amitriptyline, Imipramine, Clomipramine) gives a more pronounced and lasting clinical effect.Moreover, antidepressant therapy excludes the possibility of the development of frequent complications arising from the use of anxiolytics – changes in tolerance, the formation of drug dependence and withdrawal syndrome. However, there are many complications in it – side effects. If it is necessary to use high doses of tricyclic antidepressants for long courses (from six months and more), such undesirable phenomena as excessive sedative effect, weakening of concentration, a decrease in the speed of reaction complicate social and professional, especially intellectual activity, study, create restrictions in work that requires speed and accuracy of actions (including driving).It should also be noted that the use of tricyclic antidepressants is impossible with some concomitant somatic diseases (severe cardiovascular pathology, prostate diseases, open-angle glaucoma) [8, 9].

Antidepressants of the next generations, due to their selective effect, are safer when prescribed to patients with concomitant somatic diseases. Currently, selective serotonin reuptake inhibitors are most commonly used: Fluvoxamine, Fluoxetine, Trazodone, Citalopram, Escitalopram, Paroxetine, Sertraline, etc.Due to the fact that the therapeutic effect of antidepressants develops only on the 2-4th week of their use, in practice, if a somatic patient has a depressive disorder and severe anxiety symptoms, in about 80% of cases, doctors prescribe both an antidepressant and an anxiolytic at the same time. In about 75% of cases, it is benzodiazepine, which causes problems associated with its side effects and their pharmacokinetic interactions with each other. The result of a study carried out in France was the conclusion that the joint appointment of SSRIs and benzodiazepines is inappropriate, due to the fact that the latter reduce the antidepressant effect.Researchers suggest that, if necessary, the simultaneous administration of SSRIs and an anti-anxiety drug, prescribe a non-benzodiazepine anxiolytic. Representatives of this group are Atarax, Buspirone and Azophene.

Atarax (Hydroxyzine) is an antagonist of histamine H1 receptors. It is used in a dose of 25-100 mg / day, divided into 3 doses. The advantages of Atarax are the absence of dependence and withdrawal syndrome. Due to the pronounced M-anticholinergic action, it is recommended not to prescribe or prescribe with caution Atarax to patients with glaucoma, prostatic hypertrophy, difficulty urinating, and constipation.Also, the drug during 1 week lowers attention and responsiveness, which limits its use in outpatient practice.

Buspirone is a partial agonist of 5-HT1A receptors, whereby it reduces the serotonin turnover. In terms of the effectiveness of monotherapy for generalized anxiety disorders, it is comparable to benzodiazepines, but only with regular use. Significant advantages of Buspirone are the absence of sedation, dependence and withdrawal symptoms, as well as the presence of an antidepressant effect, which manifests itself when taking large doses of the drug.An obstacle to use is the lack of registration of the drug in Russia [4].

As a result of a long search for the most optimal drug in the Scientific Research Institute of Pharmacology of the Russian Academy of Medical Sciences, a new selective anxiolytic, Afobazol, was created. It prevents the development of membrane-dependent changes in the GABA receptor. Afobazol has both anxiolytic and mild stimulating (activating) effect, which compares favorably with its predecessors. Reduction or elimination of anxiety (anxiety, bad feelings, apprehension, irritability), tension (fearfulness, tearfulness, feelings of anxiety, inability to relax, insomnia, fear), and therefore, somatic (muscle, sensory, cardiovascular, respiratory, gastrointestinal) intestinal symptoms), vegetative (dry mouth, sweating, dizziness), cognitive (difficulty concentrating, impaired memory) disorders are observed on the 5-7th day of treatment.The drug is taken at 30 mg / day, divided into 3 doses. The duration of the course is 2-4 weeks. If necessary, the daily dose can be increased to 60 mg. Afobazol has passed clinical trials in many leading clinics in Moscow and St. Petersburg. A small number of contraindications contributes to the wider prescription of Afobazol by doctors of general medical practice. The advantages of the drug are also the absence of muscle relaxant properties, negative effects on cognitive processes, drug dependence and withdrawal syndrome.Due to the fact that anxious affect is often accompanied by severe vegetative disorders, attention should be paid to the vegetative effect of Afobazol [10].

Thus, Afobazol is an effective drug both for monotherapy and for the combined treatment with antidepressants in patients with generalized anxiety disorders and adjustment disorders that are so common in general medical practice.

References

one.Starostina E.G. Generalized anxiety disorder and symptoms of anxiety in general medical practice // BC. 2004. T. 12. No. 22. P. 2–7.

2. Classification of diseases in psychiatry and narcology: A guide for doctors / Ed. M. M. Milevsky. M., 2003.

3. Vegetative disorders: clinical picture, diagnosis, treatment / Ed. A. M. Wein. M., 2003.

4. Arana J., Rosenbaum J. Pharmacotherapy of mental disorders / Per. from English M., 2004.

five.Register of medicines of Russia. Radar – Encyclopedia of Medicines. 14th issue / Ed. G. L. Vyshkovsky. M .: RLS-2006, 2005.

6. Yastrebov D. V., Cheberda O. A., Kostycheva E. A. The effectiveness of the drug “Eglek” as a means of substitution therapy in patients taking benzodiazepine tranquilizers for a long time // Psychiatry and psychopharmacotherapy. 2005. T. 7. No. 4. P. 200–205.

7. Raisky VA Psychotropic drugs in the clinic of internal diseases. M., 1988.

8. Kolyutskaya EV Anxiety disorders (diagnosis and therapy) // BC. 2004.Vol. 132.No. 15, pp. 1019–1021.

9. Mosolov SN Anxiety and depression: problems of diagnosis and therapy // Psychopharmacotherapy of depression. 2005. No. 4. P.1-15.

10. Avedisova AS et al. A new anxiolytic afobazole in the treatment of generalized anxiety disorder (results of a comparative study with diazepam). [In the press].

V. I. Kurpatov, Doctor of Medical Sciences,

FROM.A. Osipova

Medical Academy of Postgraduate Education, St. Petersburg, Russia

The use of trazodone (Trittico) for premedication in planned surgical interventions Text of a scientific article in the specialty “Clinical Medicine”

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UDC 616.53-025: 258.3

A. N. KOLESNIKOV, S. O. CHERNUTSKY, V. N. STASYUKOV

KMU “Clinical Mine Hospital”, Makeevka, Donetsk region

APPLICATION OF TRAZODONE (TRITTICO) FOR PREDICTION IN REGULATED SURGICAL INTERVENTIONS

Summary. The article deals with the problem of changes in the psychoemotional state in patients before planned surgical interventions and the possibility of correcting these changes.It has been shown that trazodone (Trittico) at a dosage of 75 mg provides the greatest premedication effect compared to zopiclone and diazepam.

Keywords: surgical interventions, premedication, trazodone.

Relevance

Anxiety is a normal emotional response of a person before surgery. In many cases, talking between the anesthesiologist and the patient prior to surgery will relieve anxiety more effectively than sedation.However, for a number of patients, waiting for surgical treatment is associated with severe emotional stress. Inadequate premedication, in our opinion, is an anesthetic complication, since preoperative emotional stress in the absence of anti-stress protection negatively affects almost all body functions, increasing the degree of operational risk and the risk of developing perioperative complications.

Given the modern concept of anesthesia, premedication is considered mandatory.She pursues the following goals:

1) prevention of preoperative emotional stress;

2) achievement of neurovegetative stabilization;

3) decreased response to external stimuli;

4) decrease in glandular secretion;

5) creation of optimal conditions for the manifestation of the action of general anesthetics;

6) prevention of allergic reactions to the use of medicines and infusion media during general anesthesia.

The basis of premedication is reliable protection of the patient from preoperative emotional stress, the inevitable consequence of which is a complex of somatovegetative hyperdynamic reactions of blood circulation, activation of respiration and various types of metabolism, especially carbohydrate metabolism.

Upon admission to the operating room in a patient with ineffective premedication or without it,

, emotional excitement is given, which makes it difficult to normal contact and manipulations with the patient, an increased reaction to external stimuli, which under normal conditions is tolerated by him calmly (venopuncture, etc.), increased blood pressure (BP) and heart rate (HR), increased sweating, difficulty in achieving stable anesthesia, despite the increased consumption of general anesthetics. In this condition, especially in patients with severe cardiovascular diseases, diabetes, breakdowns with the development of stressful cardiovascular reactions (difficult to stop arterial hypertension, tachyarrhythmia, myocardial ischemia), stress hyperglycemia are possible.

To assess the effect of premedication in practical work, they focus primarily on the psychoemotional state of the patient (presence or absence of increased excitability, negative emotional reactions, fear), clinical and vegetative indicators of emotional stress (blood pressure and heart rate, color and moisture of the skin) …Adequate premedication should be understood as such a complex of therapeutic and prophylactic measures that would cause the normalization of all constants of homeostasis and psychoemotional status, maximally increase the reactivity and resistance of the body to the extreme effects of surgical intervention (Bunya-tyan A.A., 1994).

Arterial hypertension, tachycardia, ex-trasystole, hyperemia of the skin of the face, excessive sweating indicate unresolved emotion-

© Kolesnikov A.w

nal reaction and, consequently, to the ineffectiveness of premedication.

At present, hypnotics (barbiturates), psychotropic drugs (tranquilizers of the benzodiazepine series), neuroleptics (derivatives of butyrophenone), narcotic analgesics, anticholinergic and anti-histamines are used to solve the main problems of preventive premedication.

Traditionally, benzodiazepine tranquilizers (one of them diazepam) are used for premedication, which have the necessary activity to eliminate the symptoms of anxiety, fear, mild depressive disorders, and sleep disorders.Anxiolytic, sedative, hypnotic, muscle relaxant, anticonvulsant, vegetative-stabilizing effects of benzodiazepine derivatives contribute to the fact that they are currently the leading agents for premedication.

However, as clinical experience shows, the use of a tranquilizer as the main component of premedication is not always justified. It is known that these effects of benzodiazepine tranquilizers largely depend on the phenotype of the emotional stress reaction (Blednov Yu.A. et al., 1995; Pippingskold K. et al., 1991; Pekcan M. et al., 2005). In addition, it is not uncommon for the conventional dosage of a benzodiazepine tranquilizer to have either insufficient or excessive effect. In such cases, it is necessary to ascertain inadequate premedication.

One of the ways to solve the problem of adequate premedication and its optimization is also the development of new drugs that do not differ in effectiveness from classical anxiolytics, but at the same time are devoid of their drawbacks.

In this aspect, in our opinion, the use of antagonists of serotonin receptors (5-HT2) and inhibitors of serotonin reuptake, in particular Trit-tico (trazodone), belonging to a new generation of multimodal antidepressants – SARI, is promising in premedication. Unlike other groups of antidepressants (SSRIs – paroxetine, sertraline, etc., tricyclic – amitriptyline, imipramine, etc., and tetracyclic – maprotiline, mianserin, etc.)it has no anticholinergic activity. For this reason, Trittico has no side effects associated with the effect on the autonomic nervous system (ANS), such as tachycardia, constipation, urinary retention, etc., which accompany the intake of other antidepressants. Side effects that occur when taking Trittico – drowsiness, headache, dizziness, insomnia, decreased blood pressure – are extremely rare (2 in 10,000).

The aim of the study was to study the use of trazodone (Trittico) in premedication on the eve of planned surgery.

Materials and methods

The study was carried out among patients of I and II surgical and ENT departments of the KMU “Clinical Mine Hospital” in Makeevka. Examined 202 patients (age from 18 to 65 years), prepared for planned surgery under general anesthesia (Table 1). Depending on the drugs used to provide a favorable psychoemotional background, the patients were divided into 3 groups.

In the first group of patients, trazodone (Trittico) in tablet form and a dosage of 75 mg was used for premedication 9-12 hours before the operation, at night.

In group II – zopiclone 7.5 mg in tablet form at night.

In the third group of patients for premedication, an intramuscular injection of 0.5% diazepam (0.015 mg / kg) was used on the eve of the operation at bedtime.

Patients of each group received standard anesthesia: total intravenous (sodium thiopental, propofol in combination with fentanyl) or inhalation (sevoflurane in combination with fentanyl).

Premedication “on the table” was carried out according to the standard scheme: i.v. 0.1% atropine (0.01 mg / kg), 1% suprastin (0.2 mg / kg), 0.5% sibazone (0.015 mg / kg ), fentanyl (1-1.5 μg / kg), dexamethasone (0.04 mg / kg), 40 mg controls.

All patients underwent preoxygenation for 3-5 minutes, tracheal intubation was ensured by the use of ditilin (2 mg / kg), artificial lung ventilation was carried out in the normoventilation mode (tidal volume 5-7 ml / kg). Intraoperative monitoring included non-invasive measurement of blood pressure, determination of heart rate, Br02, minimum alveolar concentration, pCO2.

The intensity of emotional stress, SBP, heart rate were measured during hospitalization, the first visit of the anesthesiologist, 2 hours before the operation, immediately before the operation and after transfer to the ward.

Emotional stress was assessed using a 10-point visual analogue scale (VAS):

– 0 points – absence;

– 1-3 – anxiety;

– 4-6 – moderate emotional stress;

– 7-8 – strong emotional stress;

– 9-10 – very strong emotional stress.

Results and discussion

In all patients at the stages of the study in the preoperative period, to one degree or another, there was a significant increase in emotional stress associated with the forthcoming surgical intervention. In our opinion, the increase in anxiety and emotional stress was due to such structural components as phobic

Original Researches

component, emotional discomfort and anxious assessment of prospects.These changes in the psychoemotional status in the preoperative period were accompanied by the corresponding reactions of the autonomic nervous system and changes in hemodynamic parameters.

In patients of group I (Table 2), who took trazodone, an increase in emotional stress was not accompanied by pronounced changes in hemodynamics and reactions of the autonomic nervous system. Hemodynamically, this was manifested by the stability of the indicators of heart performance, heart rate and mean blood pressure throughout the study

This scheme of premedication helped to limit the growth of the activity of the sympathetic division of the autonomic nervous system and preserve the adaptive capabilities in the regulation of the heart rate.We see the absence of pronounced activation of blood circulation before the start of the operation, which suggests that the inclusion of Trittico in premedication helps to optimize the functional activity of the cardiovascular system in the pre-, intra- and postoperative periods.

In group II patients (Table 3), the use of a sleeping pill allows you to achieve close to physiological sleep. However, 2 hours before the operation and “on the table” there was a strong emotional stress, which negatively affects the patient’s stress-limiting system, primarily the circulatory system, which can create a risk of decompensation, especially in patients with concomitant diseases of the cardiovascular system …

In group III patients (Table 4) who received diazepam in the evening, the state of psychoemotional

tension in the preoperative period was characterized by an average degree of severity and did not differ significantly from group I. However, the analysis of the study showed that in this group of patients immediately before the operation, the degree of changes in the psychoemotional state remained at the level of anxiety, while we observed activation of the ANS, which was manifested by an increase in hemodynamic parameters, which indicates a reduced adaptive capacity of the body.In the intra- and postoperative period, stable hemodynamics were observed, with a tendency to tachycardia and a slight increase in MAP (Table 5).

Thus, in the Trittico group, the greatest effect of premedication is noted, which is expressed in the lowest level of emotional stress 2 hours before the operation and immediately before the operation. The analysis of the average blood pressure and heart rate indices also indicates the optimal values ​​of these values ​​in the perioperative period in patients of group I.Patients of groups II and III have a tendency to arterial hypertension and tachycardia, which indicates an excessive activation of the sympathetic nervous system.

Conclusions

1. In planned surgery in the preoperative period, a qualitative and quantitative assessment of the psychoemotional status of patients should be carried out in order to prescribe adequate premedication.

2.In the preoperative period in patients of groups II and III, there is a different degree of emotional stress, causing activation of the ANS, which was manifested by an increase in the indices of r-

Table 1. Distribution of patients in groups by main parameters

Signs of the formation of groups I group II group III group

Number of patients 84 72 46

Age, years 53.8 ± 2.4 50.6 ± 1.9 54.1 ± 3.9

Sex,% M 42.3 44.9 42.6

F 57.7 55.1 57.4

Indicator On admission During an anesthesiologist’s visit In the morning, 2 hours before surgery On the operating table After transportation to the ward

VAS, points 7.30 ± 1.25 8.5 ± 1.5 2.7 ± 1.5 3.4 ± 2.3 2.2 ± 1.1

Avg, mm Hg.Art. 98.5 ± 5.5 109.1 ± 6.8 92.3 ± 3.3 93.5 ± 2.2 90.0 ± 1.3

HR, beats / min 80.0 ± 6.5 88.0 ± 9.4 75.0 ± 4.3 77.0 ± 2.5 68.0 ± 2.4

Table 3. Change in indicators of emotional stress and hemodynamics

in patients of group II (zopiclone)

Indicator On admission During an anesthesiologist’s visit In the morning, 2 hours before surgery On the operating table After transportation to the ward

VAS, points 7.80 ± 1.55 8.4 ± 1.4 6.3 ± 0.5 4.2 ± 0.7 2.4 ± 1.1

Avg, mm Hg.Art. 93.4 ± 6.2 109.1 ± 6.3 117.8 ± 5.7 108.4 ± 4.8 94.0 ± 2. w

Table 4.Change in indicators of emotional stress and hemodynamics

in patients of group III (diazepam)

Indicator On admission During an anesthesiologist’s visit In the morning, 2 hours before surgery On the operating table After transportation to the ward

VAS, points 8.00 ± 1.25 8.8 ± 1.4 3.1 ± 0.5 3.8 ± 2.3 2.2 ± 1.1

Avg, mm Hg.Art. 95.9 ± 5.5 112.3 ± 8.1 108.2 ± 4.1 109.4 ± 2.7 97.0 ± 4.2

HR, beats / min 81.7 ± 6.5 92.7 ± 7.1 94.5 ± 5.1 92.4 ± 2.5 88.0 ± 2.7

Table 5. Comparative assessment of the parameters of the adequacy of premedication in the studied patients

Parameters Group I (Trittico) Group II (zopiclone) Group III (diazepam)

YOUR, points

During anesthesiologist visit 8.5 ± 1.5 8.4 ± 1.4 8.8 ± 1.4

2 hours before surgery 2.7 ± 1.5 6.3 ± 0.5 3.1 ± 0.5

On the operating table 3.4 ± 2.3 4.2 ± 0.7 3.8 ± 2.3

When transferred to the ward 2.2 ± 1.1 2.4 ± 1.1 2.2 ± 1.1

Avg, mm Hg.Art.

During anesthesiologist visit 109.1 ± 6.8 109.1 ± 6.3 112.3 ± 8.1

2 hours before surgery 92.3 ± 3.3 117.8 ± 5.7 108.2 ± 4.1

On the operating table 93.5 ± 2.2 108.4 ± 4.8 109.4 ± 2.7

When transferred to the ward 90.0 ± 1.3 94.0 ± 2.5 97.0 ± 4.2

HR, beats / min

During anesthesiologist visit 88.0 ± 9.4 88.4 ± 6.6 92.7 ± 7.1

2 hours before surgery 75.0 ± 4.3 99.5 ± 4.1 94.5 ± 5.1

On the operating table 77.0 ± 2.5 84.4 ± 2.5 92.4 ± 2.5

When transferred to the ward 68.0 ± 2.4 87.0 ± 4.3 88.0 ± 2.7

modinamics (heart rate, avg), which indicates reduced adaptive capabilities of the body.

3. In planned surgery with premedication with trazodone (Trittico) at a dosage of 75 mg, we observed the absence of pronounced activation of blood circulation in patients before the operation, which indicates the optimization of the functional activity of the cardiovascular system in the pre-, intra- and postoperative periods.

References

1.A.I. Golovko, G.A. Sofronov Modern concepts of the molecular structure of benzodiazepine receptors // Bulletin of the Russian Academy of Medical Sciences. – 2009. – No. 7. – S. 20-24.

2. Gorkov V.A. Pharmacokinetic predictors of the effectiveness of psychotropic substances // (Fundamental research

studies as the basis for the creation of medicines: Collection of theses of the I Congress of the Russian Scientific Society of Pharmacologists.- Volgograd, 2007 .– S. 121.

3. Kabanova NV, Yasnogor LA .. On the issue of premedication: components, criteria of adequacy (literature review) // Medicine of emergency conditions. – 2011. — No. 4 (35). – S. 40-45.

4. Khaikin S.S., Bobrinskaya I.G., Yaltonsky V.M., Shilnikov V.A. Psychoemotional state of patients in the preoperative period, as a criterion for the effectiveness of premedication // Transbaikal Medical Bulletin.- 2007. – No. 1. – S. 15-18.

5. Khaikin S.S., Bobrinskaya I.G., Yaltonsky V.M., Shilnikov V.A. Hemodynamic indicators at the stages of preparation for surgical treatment // Proceedings of the interregional scientific-practical conference “Surgeons of Transbaikalia in Russia”. – Chita, 2007 .– S. 180-182.

Received 10/09/13 □

Kolesnikov A.M., Chernutsky S.O., Stasyuk V.M.

KMU “Kl1n1chna Rulnichna l1karnya”, m. MakP’vka, Donetsk

area

STAYED TRAZODONU (TRITPKO) FOR PREDICTIONS FOR PLANNED X | MANUAL HANDLING

Summary. The statp is looking at the problem of a psycho-emotional stance in a paschenth before the planned Khrurpchnyi involved in that mozlivosp korektsy qih zmshIt has been shown that trazodone (Tritpco) in a dose of 75 mg will provide the best premedicated effect due to zodiac i dazepam.

Kro40Bi words: surgical engagement, premedicated, trazodon.

Kolesnikov A.N., Chernutsky S.O., Stasyuk V.N. Public Municipal Institution “Clinical Mine Hospital”, Makiyivka, Donetsk Region, Ukraine

APPLICATION OF TRAZODONE (TRITTICO) FOR PREMEDICATION DURING ELECTIVE SURGERY

Summary.The article deals with the problem of psychoemo-tional state changes in patients before elective surgery and limitations for correction of these changes. It is demonstrated that trazodone (Trittico) in a dose of 75 mg provides maximum effect of premedication compared to diazepam and zopiclone.

Key words: surgery, premedication, trazodone.

Interaction between Ibuprofen and Trittico with simultaneous use

Interacts with

• Antidepressant, antidepressants, Other antidepressants

When used simultaneously with ibuprofen inducers of microsomal oxidation (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, increasing the risk of developing severe hepatotoxic reactions.

In therapeutic doses, ibuprofen does not enter into significant interactions with widely used drugs. Inducers of microsomal oxidation enzymes in the liver (phenytoin, ethanol, barbiturates, flumecinol, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, increasing the risk of severe intoxication. Inhibitors of microsomal oxidation – reduce the risk of developing hepatotoxic effects.Reduces the hypotensive activity of vasodilators and the natriuretic effect of furosemide and hydrochlorothiazide. Reduces the effectiveness of uricosuric drugs. Enhances the effect of indirect anticoagulants, antiplatelet agents, fibrinolytics (which increases the risk of bleeding). Strengthens the side effects of mineralocorticosteroids, glucocorticosteroids (the risk of gastrointestinal bleeding increases), estrogens, ethanol; enhances the hypoglycemic effect of sulfonylurea derivatives. Antacids and cholestyramine reduce the absorption of ibuprofen.Increases the concentration in the blood of digoxin, lithium preparations and methotrexate. Concomitant administration of other NSAIDs increases the incidence of side effects. Caffeine enhances the analgesic (pain relieving) effect. With the simultaneous appointment of ibuprofen, it reduces the anti-inflammatory and antiplatelet effect of acetylsalicylic acid (it is possible to increase the incidence of acute coronary insufficiency in patients receiving small doses of acetylsalicylic acid as an antiplatelet agent after starting ibuprofen).Cefamandol, cefoperazone, cefotetan, valproic acid, plikamycin increase the incidence of hypoprothrombinemia with simultaneous administration. Myelotoxic drugs increase the manifestations of the drug’s hematotoxicity. Cyclosporine and gold preparations increase the effect of ibuprofen on the synthesis of prostaglandins in the kidneys, which is manifested by an increase in nephrotoxicity. Ibuprofen increases the plasma concentration of cyclosporine and the likelihood of developing its hepatotoxic effects. Drugs that block tubular secretion reduce excretion and increase the plasma concentration of ibuprofen.

Cefamandol, cefaperazone, cefotetan, valproic acid, plikamycin, increases the incidence of hypoprothrombinemia. Cyclosporine and gold preparations increase the effect of ibuprofen on the synthesis of prostaglandins in the kidneys, which is manifested by an increase in nephrotoxicity. Ibuprofen increases the plasma concentration of cyclosporine and the likelihood of developing its hepatotoxic effects. Drugs that block tubular secretion reduce excretion and increase the plasma concentration of ibuprofen.Microsomal oxidation inducers (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, increasing the risk of severe intoxication. Inhibitors of microsomal oxidation reduce the risk of hepatotoxic effects. Reduces the hypotensive activity of vasolidators, natriuretic and diuretic in furosemide and hydrochlorothiazide. Reduces the effectiveness of uricosuric drugs, enhances the effect of indirect anticoagulants, antiplatelet agents, fibrinolytics (increasing the risk of hemorrhagic disorders), enhances the ulcerogenic effect with bleeding of mineralocorticosteroids, glucocorticosteroids, colchicine, escrogens, ethanol.Enhances the effect of oral hypoglycemic drugs and insulin, sulfonylurea derivatives. Antacids and cholestyramine reduce absorption. Increases the concentration in the blood of digoxin, lithium preparations, methotrexate. Caffeine enhances the analgesic effect.

– Inducers of microsomal oxidation (phenytoin, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) : when used together, they increase the production of hydroxylated active metabolites, increasing the risk of severe intoxication.

When combined with antidepressants, barbiturates, zixorin, rifampicin, phenylbutazone, phenytoin, the risk of severe intoxication increases due to an increase in the production of hydroxylated active metabolites of ibuprofen.

Inducers of microsomal oxidation (ethanol, barbiturates, rifampicin, tricyclic antidepressants) increase the production of hydroxylated active metabolites, increasing the risk of developing severe toxic liver damage.

Do not use two or more non-steroidal anti-inflammatory drugs at the same time, as the risk of side effects increases. When used together, ibuprofen reduces the antiaggregatory and anti-inflammatory properties of acetylsalicylic acid. When used together with thrombolytic drugs (streptokinase, alteplase, urokinase), the possibility of bleeding increases.Ibuprofen enhances the properties of antiplatelet agents, indirect anticoagulants, fibrinolytics. The combined use of ibuprofen and inducers of microsomal oxidation (ethanol {alcohol, vodka}, phenytoin, barbiturates, phenylbutazone, rifampicin, tricyclic antidepressants) increases the risk of developing severe hepatotoxic effects. Microsomal oxidation inhibitors reduce the potential for hepatotoxic effects. Cholestyramine and antacids reduce the absorption of ibuprofen. Caffeine increases the pain relieving effect of ibuprofen.Cefoperazone, cefamandol, valproic acid, cefotetan increase the incidence of hypoprothrombinemia. Myelotoxic drugs increase the hematotoxicity of ibuprofen. Gold preparations and cyclosporine increase the nephrotoxicity of ibuprofen. Ibuprofen increases the plasma levels of cyclosporine, thereby increasing its hepatotoxicity. Drugs that block tubular secretion decrease excretion and increase plasma levels of ibuprofen. Ibuprofen reduces the effect of antihypertensive drugs, diuretic and natriuretic activity of hydrochlorothiazide and furosemide, the effectiveness of uricosuric drugs.Strengthens the side effects of glucocorticoids, mineralocorticoids, ethanol, estrogens. Increases the effects of oral hypoglycemic drugs and insulin. Increases the content of lithium, digoxin and methotrexate preparations in the blood. Ibuprofen may decrease the clearance of aminoglycosides (which may increase the possibility of ototoxicity and nephrotoxicity). Ibuprofen for intravenous administration should not be mixed with other drugs.

How are we treated for insomnia

The possibility of side effects, however, remains here.For Generation Z drugs, according to a review in the Journal of Medical Toxicology, these include decreased alertness and rare sleepwalking. Therefore, it is still better to take them under the supervision of a doctor and try not to drive a car. Only zaleplon does not have the last contraindication, which can even be taken by American aviation pilots just six hours before the flight (this is the shortest required period between the allowed taking of sleeping pills and going on the flight). None of the drugs in this group should be combined with alcohol.

Zaleplon’s action is the fastest (and ends the fastest). The effects and side effects of zolpidem and zopiclone are similar, but zopiclone (which usually costs much less) is more addictive if used for more than two weeks. In general, all three drugs are safest to use sporadically, rather than long-term – this will avoid dependence. Zopiclone does not help children with ADHD fall asleep, although it is safe for them. He also has a more pronounced sedative effect than his colleagues with the letter “z”.

Although “real” sleeping pills are dispensed according to a medical prescription, the patient needs to know about them: if you have chronic insomnia, and only “mild” sedative herbs (like Novo-Passit) are prescribed, or they recommend to follow the regimen, perhaps this is a reason to change your doctor. Or it may mean that your case is not so serious and your doctor hopes that modifying your sleep conditions or a placebo effect can help you. The hypnotic effects of valerian, kava and chamomile extracts are statistically insignificant according to the Sleep Medicine Review.

Our advice cannot be equated with a doctor’s prescription. Before you start taking this or that drug, be sure to consult with a specialist.

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Description CHLORPROMAZINE indications, dosages, contraindications of the active substance CHLORPROMAZINE

With the simultaneous use of drugs that have a depressing effect on the central nervous system, ethanol, ethanol-containing drugs, it is possible to increase the inhibitory effect on the central nervous system, as well as respiratory depression.

With the simultaneous use of tricyclic antidepressants, maprotiline, MAO inhibitors, the risk of developing ZNS may increase.

With simultaneous use with anticonvulsants, it is possible to reduce the threshold of convulsive readiness; with drugs for the treatment of hyperthyroidism – an increase in the risk of developing agranulocytosis; with drugs that cause extrapyramidal reactions – an increase in the frequency and severity of extrapyramidal disorders is possible; with drugs that cause arterial hypotension – an additive effect on blood pressure is possible, which leads to severe arterial hypotension, increased orthostatic hypotension.

With simultaneous use with amphetamines, antagonistic interactions are possible; with anticholinergics – increased anticholinergic action; with anticholinesterase agents – muscle weakness, worsening of myasthenia gravis.

With simultaneous use with antacids containing aluminum and magnesium hydroxide, the concentration of chlorpromazine in the blood plasma decreases due to a violation of its absorption from the gastrointestinal tract.

With the simultaneous use of barbiturates increase the metabolism of chlorpromazine, inducing microsomal liver enzymes and thereby reducing its concentration in blood plasma.

With the simultaneous use of hormonal contraceptives for oral administration, a case of an increase in the concentration of chlorpromazine in the blood plasma is described.

With simultaneous use with epinephrine, a “perversion” of the pressor action of epinephrine is possible, as a result of this, only β-adrenergic receptors are stimulated and severe hypotension and tachycardia occur.

When used simultaneously with amitriptyline, the risk of developing tardive dyskinesia increases. Cases of development of paralytic ileus are described.

With the simultaneous use of chlorpromazine can reduce or even completely inhibit the antihypertensive effect of guanethidine, although in some patients the hypotensive effect of chlorpromazine may appear.

With simultaneous use with diazoxide, severe hyperglycemia is possible; with doxepin – potentiation of hyperpyrexia; with zolpidem – the sedative effect is significantly enhanced; with zopiclone – it is possible to enhance the sedative effect; with imipramine – the concentration of imipramine in the blood plasma increases.

With the simultaneous use of chlorpromazine inhibits the effects of levodopa due to blockade of dopamine receptors in the central nervous system. Increase in extrapyramidal symptoms is possible.

With simultaneous use with lithium carbonate, severe extrapyramidal symptoms, neurotoxic effect are possible; with morphine – development of myoclonus is possible.

With the simultaneous use of nortriptyline in patients with schizophrenia, the clinical condition may worsen, despite the increased level of chlorpromazine in the blood plasma.Cases of development of paralytic ileus are described.

With simultaneous use with piperazine, a case of seizures has been described; with propranolol – an increase in plasma concentrations of propranolol and chlorpromazine; with trazodone – arterial hypotension is possible; with trihexyphenidyl – there are reports of the development of paralytic ileus; with trifluoperazine – cases of severe hyperpyrexia have been described; with phenytoin – it is possible to increase or decrease the concentration of phenytoin in the blood plasma.

With simultaneous use with fluoxetine, the risk of developing extrapyramidal symptoms increases; with chloroquine, sulfadoxine / pyrimethamine, the concentration of chlorpromazine in the blood plasma increases with the risk of developing the toxic effect of chlorpromazine.

With the simultaneous use of cisapride, the QT interval on the ECG is additively lengthened.

With simultaneous use with cimetidine, it is possible to reduce the concentration of chlorpromazine in the blood plasma. There is also evidence to suggest an increase in the concentration of chlorpromazine in the blood plasma.

With the simultaneous use of ephedrine, it is possible to weaken the vasoconstrictor effect of ephedrine.

TRITTIKO – instructions, composition, application, dosage, indications, contraindications, reviews

Application for children and adolescents.

Trazodone should not be used in children and adolescents. In a clinical study in children and adolescents, suicidal behavior (attempted suicide and planning suicide) and hostility (mainly aggressiveness, protest behavior, and anger) were more common in the antidepressant group than in the placebo group. In addition, there are currently no data on the long-term safety of the drug in children and adolescents, given its effects on growth, puberty, and cognitive and behavioral development.

Suicide / suicidal ideation or clinical deterioration.

Depression is associated with an increased risk of suicidal thoughts, self-harm and suicide (manifestations of suicidal behavior) by the patient. This risk persists until significant remission occurs. There may be no improvement in the condition during the first few weeks of therapy or longer. Patients should be carefully monitored until such improvement occurs. General clinical experience indicates a possible increased risk of suicide in the early stages of recovery.

It is known that patients with a history of suicidal behavior or patients who had a significant degree of suicidal thinking before starting therapy have a higher risk of developing suicidal thoughts or suicidal attempts, therefore, during treatment, they need careful supervision. In a meta-analysis of placebo-controlled clinical trials of antidepressants for mental disorders, it was shown that among patients under 25 years of age, individuals in the antidepressant group had a higher risk of suicidal behavior than in the placebo group.

Drug therapy should be accompanied by careful monitoring of patients, including those from a high-risk group, especially at the beginning of treatment and after changing the dose of the drug.

Patients (and their caregivers) should be warned to watch for any clinical signs of deterioration, suicidal behavior or thoughts, and unusual changes in behavior, and if found, seek medical advice immediately.

To minimize the potential risk of suicidal attempts, especially at the beginning of therapy, the physician should prescribe only limited amounts of trazodone to the patient at each visit.

It is recommended to carefully select the dosage regimen and to carry out regular monitoring of patients with the following conditions:

epilepsy, in particular, such patients should not sharply increase or decrease the dose;

liver or kidney dysfunction, especially serious;

heart diseases such as angina pectoris, cardiac conduction disorders or various degrees of blockade; recent myocardial infarction

hyperthyroidism

urinary disturbance, for example, with prostatic hypertrophy, although such problems are not expected since the anticholinergic effect of trazodone is negligible;

acute glaucoma, increased intraocular pressure, although significant changes in position are not expected, since the anticholinergic effect of trazodone is negligible.

If the patient develops jaundice, trazodone therapy should be discontinued.

With the use of antidepressants in patients with schizophrenia or other psychotic disorders, psychotic symptoms may increase. Paranoid thoughts may become more pronounced. Against the background of trazodone therapy, the depressive phase in manic-depressive psychosis can change into the manic phase. In this case, the use of trazodone should be discontinued.

Concomitant use with other serotonergic drugs such as other antidepressants (eg tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors and MAO inhibitors) and antipsychotics, drug interactions with the development of serotonin have been reported neuroleptic syndrome.Cases of fatal neuroleptic malignant syndrome have been reported with simultaneous use with antipsychotics, for which this syndrome is a known possible adverse reaction. For more information, see the sections “Interaction with other medicinal products and other forms of interaction” and “Adverse reactions”.

Since agranulocytosis can clinically present as a flu-like condition, sore throat and fever, laboratory blood counts should be checked if these symptoms appear.

The occurrence of arterial hypotension, including orthostatic hypotension and syncope, has been reported in patients treated with trazodone. With the simultaneous use of antihypertensive drugs and trazodone, it may be necessary to reduce the dose of the antihypertensive drug.

Elderly patients are often more susceptible to unwanted effects of antidepressants, especially orthostatic hypotension, drowsiness and other anticholinergic effects.

Attention should be paid to possible additive effects when used concomitantly with other drugs, such as other psychotropic or antihypertensive drugs, or to the presence of risk factors, such as concomitant diseases, which may exacerbate such reactions.

It is recommended that information be provided to the patient / supervisor, if such reactions are possible, and to closely monitor the occurrence of such effects after initiation of therapy, before and after dose escalation.

At the end of the course of trazodone therapy, especially if this course was long, it is recommended to gradually reduce the dose until the drug is completely discontinued in order to minimize the likelihood of withdrawal symptoms, which include nausea, headache and general malaise.

There is currently no indication that trazodone hydrochloride is addictive.

With the use of potent inhibitors of cytochrome CYP3A4, serum trazodone levels may increase.For more information, see the section “Interaction with other medicinal products and other forms of interaction”.

Like other drugs with alpha-adrenergic blocking activity, trazodone in very rare cases causes priapism. If it occurs, an intracavernous injection of an alpha-adrenergic agent such as epinephrine or metaraminol should be given. However, cases of trazodone-induced priapism have been reported when surgery was required or when permanent sexual dysfunction resulted.Trazodone should be discontinued immediately in patients with suspicion of this adverse reaction.

Trittico, extended-release tablets, contains sucrose. This drug should not be used in patients with rare hereditary diseases such as fructose intolerance, glucose-galactose malabsorption syndrome or sucrase-isomaltose deficiency.

If you have a history of intolerance to some sugars, consult your doctor before taking this medication.

Effect on urinalysis.

When an immunological test is used to detect drugs in urine, the reactivity of the trazodone metabolite m-chlorophenylpiperazine (m-CPP), which is structurally similar to methylenedioxymethampitamin (MDMA, ecstasy), can cause a false positive test for amphetamine. In such a case, a mass spectrometry (MS) assay is recommended.

TRITTIKO – instructions, composition, application, dosage, indications, contraindications, reviews

Application for children and adolescents.

Trazodone should not be used in children and adolescents. In a clinical study in children and adolescents, suicidal behavior (attempted suicide and planning suicide) and hostility (mainly aggressiveness, protest behavior, and anger) were more common in the antidepressant group than in the placebo group. In addition, there are currently no data on the long-term safety of the drug in children and adolescents, given its effects on growth, puberty, and cognitive and behavioral development.

Suicide / suicidal ideation or clinical deterioration.

Depression is associated with an increased risk of suicidal thoughts, self-harm and suicide (manifestations of suicidal behavior) by the patient. This risk persists until significant remission occurs. There may be no improvement in the condition during the first few weeks of therapy or longer. Patients should be carefully monitored until such improvement occurs. General clinical experience indicates a possible increased risk of suicide in the early stages of recovery.

It is known that patients with a history of suicidal behavior or patients who had a significant degree of suicidal thinking before starting therapy have a higher risk of developing suicidal thoughts or suicidal attempts, therefore, during treatment, they need careful supervision. In a meta-analysis of placebo-controlled clinical trials of antidepressants for mental disorders, it was shown that among patients under 25 years of age, individuals in the antidepressant group had a higher risk of suicidal behavior than in the placebo group.

Drug therapy should be accompanied by careful monitoring of patients, including those from a high-risk group, especially at the beginning of treatment and after changing the dose of the drug.

Patients (and their caregivers) should be warned to watch for any clinical signs of deterioration, suicidal behavior or thoughts, and unusual changes in behavior, and if found, seek medical advice immediately.

To minimize the potential risk of suicidal attempts, especially at the beginning of therapy, the physician should prescribe only limited amounts of trazodone to the patient at each visit.

It is recommended to carefully select the dosage regimen and to carry out regular monitoring of patients with the following conditions:

epilepsy, in particular, such patients should not sharply increase or decrease the dose;

liver or kidney dysfunction, especially serious;

heart diseases such as angina pectoris, cardiac conduction disorders or various degrees of blockade; recent myocardial infarction

hyperthyroidism

urinary disturbance, for example, with prostatic hypertrophy, although such problems are not expected since the anticholinergic effect of trazodone is negligible;

acute glaucoma, increased intraocular pressure, although significant changes in position are not expected, since the anticholinergic effect of trazodone is negligible.

If the patient develops jaundice, trazodone therapy should be discontinued.

With the use of antidepressants in patients with schizophrenia or other psychotic disorders, psychotic symptoms may increase. Paranoid thoughts may become more pronounced. Against the background of trazodone therapy, the depressive phase in manic-depressive psychosis can change into the manic phase. In this case, the use of trazodone should be discontinued.

Concomitant use with other serotonergic drugs such as other antidepressants (eg tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors and MAO inhibitors) and antipsychotics, drug interactions with the development of serotonin have been reported neuroleptic syndrome.Cases of fatal neuroleptic malignant syndrome have been reported with simultaneous use with antipsychotics, for which this syndrome is a known possible adverse reaction. For more information, see the sections “Interaction with other medicinal products and other forms of interaction” and “Adverse reactions”.

Since agranulocytosis can clinically present as a flu-like condition, sore throat and fever, laboratory blood counts should be checked if these symptoms appear.

The occurrence of arterial hypotension, including orthostatic hypotension and syncope, has been reported in patients treated with trazodone. With the simultaneous use of antihypertensive drugs and trazodone, it may be necessary to reduce the dose of the antihypertensive drug.

Elderly patients are often more susceptible to unwanted effects of antidepressants, especially orthostatic hypotension, drowsiness and other anticholinergic effects.

Attention should be paid to possible additive effects when used concomitantly with other drugs, such as other psychotropic or antihypertensive drugs, or to the presence of risk factors, such as concomitant diseases, which may exacerbate such reactions.

It is recommended that information be provided to the patient / supervisor, if such reactions are possible, and to closely monitor the occurrence of such effects after initiation of therapy, before and after dose escalation.

At the end of the course of trazodone therapy, especially if this course was long, it is recommended to gradually reduce the dose until the drug is completely discontinued in order to minimize the likelihood of withdrawal symptoms, which include nausea, headache and general malaise.

There is currently no indication that trazodone hydrochloride is addictive.

With the use of potent inhibitors of cytochrome CYP3A4, serum trazodone levels may increase.For more information, see the section “Interaction with other medicinal products and other forms of interaction”.

Like other drugs with alpha-adrenergic blocking activity, trazodone in very rare cases causes priapism. If it occurs, an intracavernous injection of an alpha-adrenergic agent such as epinephrine or metaraminol should be given. However, cases of trazodone-induced priapism have been reported when surgery was required or when permanent sexual dysfunction resulted.Trazodone should be discontinued immediately in patients with suspicion of this adverse reaction.