Perfil de prescrição de benzodiazepínicos entre professores de medicina

Rafaella Dourado Lima; Ana Lúcia Cabulon; Júlia Martins do Amaral; Beatriz Moreti Bellenzani; Clarissa Garcia Custódio; Maria Valéria  Pavan

doi:10.23925/1984-4840.2022v24i1/4a5

Authors

Rafaella Dourado Lima Pontifícia Universidade Católica de São Paulo. Faculdade de Ciências Médicas e da Saúde https://orcid.org/0000-0002-7291-4464
Ana Lúcia Cabulon Pontifícia Universidade Católica de São Paulo. Faculdade de Ciências Médicas e da Saúde https://orcid.org/0000-0003-2205-5099
Júlia Martins do Amaral Pontifícia Universidade Católica de São Paulo. Faculdade de Ciências Médicas e da Saúde
Beatriz Moreti Bellenzani Pontifícia Universidade Católica de São Paulo. Faculdade de Ciências Médicas e da Saúde
Clarissa Garcia Custódio Pontifícia Universidade Católica de São Paulo. Faculdade de Ciências Médicas e da Saúde
Maria Valéria Pavan Pontifícia Universidade Católica de São Paulo. Faculdade de Ciências Médicas e da Saúde

DOI:

https://doi.org/10.23925/1984-4840.2022v24i1/4a5

Keywords:

receptors, GABA-A, sleep initiation and maintenance; anxiety, panic disorder

Abstract

Benzodiazepines (BZD), introduced into clinical practice in the 1950s, are among the most widely used medications in the world, despite their side effects. Objective: To understand the prescription profile of BZD among medical faculty and to raise awareness about the associated risks of their use. Methods: A quantitative and qualitative, exploratory, cross-sectional study with an educational component. A semi-structured questionnaire was applied, organized with alternating pages of questions and informative content about BZD. All 148 medical faculty members of a medical course were invited to respond to online questionnaire (Google Forms®). Results: 75 faculty members responded (50.7%; 43 men), the average years of medical practice were 30.9 ± 10.9 (mean ± SD). Among the respondents, there were 38 clinicians, 10 pediatricians, 8 surgeons, 6 gynecologists/obstetricians, 3 epidemiologists, 3 psychiatrists, 3 orthopedists, 2 family and community medicine doctors, 2 others. 62.6% work in the Unified Health System (SUS), 68% in the private health system, and 20% are solely engaged in academic activities. Among the participants, 75% prescribe BZD, predominantly for insomnia, anxiety, panic attacks, and chronic pain. The most recognized side effects were drowsiness (78.6%), amnesia (62.6%), and mental confusion (53.3%). 48% reported implementing a planned gradual withdrawal of BZD and providing guidance on alternative or complementary therapy. More than 80% of participants found the scientific information included in the questionnaire to be useful and important. Conclusion: Most participants prescribe BZD and acknowledge their adverse effects, with indications for other treatments. The educational research model was well-praised by the participants.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biography

Rafaella Dourado Lima, Pontifícia Universidade Católica de São Paulo. Faculdade de Ciências Médicas e da Saúde

Médica, graduada pela Pontifícia Universidade Católica de São Paulo.

References

Rang HP, Ritter JM, Flower R, Henderson G. Fármacos ansiolíticos e hipnóticos. In: Rang HP, Ritter JM, Flower R, Henderson G. Rang & Dale Farmacologia. Rio de Janeiro: GEN Guanabara Koogan, 2016.

López-Muñoz F, Alamo C, García-García P. The discovery of chlordiazepoxide and the clinical introduction of benzodiazepines: half a century of anxiolytic drugs. J Anxiety Disord. 2011;25(4):554-62. doi: 10.1016/j.janxdis.2011.01.002.

Soyka M. Treatment of benzodiazepine dependence. N Engl J Med. 2017;376:1147–57. doi: 10.1056/NEJMra1611832.

Horowitz MA, Wright JM, Taylor D. Risks and benefits of benzodiazepines. JAMA. 2021;325(21):2208–9. doi: 10.1001/jama.2021.4513.

Fiorelli K, Assini FL. A prescrição de benzodiazepínicos no Brasil: uma análise da literatura. ABCS Health Sci. 2017;42(1):40-4. doi: 10.7322/abcshs.v42i1.948.

Azevedo AJP, Araújo AA, Ferreira MAF. Consumo de ansiolíticos benzodiazepínicos: uma correlação entre dados do SNGPC e indicadores sociodemográficos nas capitais brasileiras. Ciênc Saúde Coletiva. 2016;21(1): 83-90. doi: 10.1590/1413-81232015211.15532014.

Freire MBO, Silva BGC, Bertoldi AD, Fontanella AT, Mengue SS, Ramos LR, et al. Utilização de benzodiazepínicos em idosos brasileiros: um estudo de base populacional. Rev Saúde Publica. 2022;56:10. doi: 10.11606/s1518-8787.2022056003740.

Donnelly K, Bracchi R, Hewitt J, Routledge PA, Carter B. Benzodiazepines, Z-drugs and the risk of hip fracture: a systematic review and meta-analysis. PLoS ONE. 2017;12(4):e0174730. doi: 10.1371/journal.pone.0174730.

Orriols L, Philip P, Moore N, Castot A, Gadegbeku B, Delorme B, et al. Benzodiazepine-like hypnotics and the associated risk of road traffic accidents. Clin Pharmacol Ther. 2011;89:595–60. doi: 10.1038/clpt.2011.3.

Patorno E, Glynn RJ, Levin R, Lee MP, Huybrechts KF. Benzodiazepines and risk of all-cause mortality in adults: cohort study. BMJ. 2017; 6;358:j2941. doi: 10.1136/bmj.j2941.

Fegadolli C, Varela NMD, Carlini ELA. Uso e abuso de benzodiazepínicos na atenção primária à saúde: práticas profissionais no Brasil e em Cuba. Cad Saúde Pública. 2019;35(6):e00097718. doi: 10.1590/0102-311X00097718.

Scheffer M, coordenador. Demografia médica no Brasil 2020. São Paulo: FMUSP, CFM, 2020.

Firmino KF, Abreu MHNG, Perini E, Magalhães SMS. Utilização de benzodiazepínicos no Serviço Municipal de Saúde de Coronel Fabriciano, Minas Gerais. Ciênc Saúde Coletiva. 2012;17(1):157–66. doi: 10.1590/S1413-81232012000100018.

Naloto DCC, FC Lopes FC, Barberato-Filho S, Lopes LC, Del Fiol FS, Bergamaschi CC. Prescrição de benzodiazepínicos para adultos e idosos de um ambulatório de saúde mental. Ciênc Saúde Coletiva. 2016;21(4):1267-76. doi: 10.1590/1413-81232015214.10292015.

Baldoni AO, Zadra PF, Vilar LG, Anacleto Junior MA, Pimentel ACL, Nalon JVL, Bichara IM, et al. Elaboração e validação do protocolo de desprescrição do clonazepam em idosos. Rev Bras Med Fam Comunidade. 2020;5(42):2105. doi: 10.5712/rbmfc15(42)2105.

Vicens C, Leiva A, Bejarano F, Sempere-Verdú E, Rodríguez-Rincón RM, Fiol F, et al. Evaluation of a multicomponent intervention consisting of education and feedback to reduce benzodiazepine prescriptions by general practitioners: The BENZORED hybrid type 1 cluster randomized controlled trial. PLoS Med. 2022;19(5):e1003983. doi: 10.1371/journal.pmed.1003983.

Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-33. doi: 10.7326/M15-2175.

Riemann D, Baglioni C, Bassetti C. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26: 675-700. doi: 10.1111/jsr.12594.

Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1):S1. doi: 10.1186/1471-244X-14-S1-S1.

De George KC, Grover M, Streeter GS. Generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2022;106(2):157-64.

American Society of Anesthesiologists Task Force on Chronic Pain Management, American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010;112(4):810-33. doi: 10.1097/ALN.0b013e3181c43103.

National Institute for Health and Care Excellence (NICE). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. London: National Institute for Health and Care Excellence (NICE), 2021.

Woelk H, Schlafkes S. A multi-center, double-bind, randomised study of lavender oil preparation Silexan in comparison to lorazepam for generalized ansiety disorder. Phytomedicine. 2010;17(2):94-9. doi: 10.1016/j.phymed.2009.10.006.

Machado EM, Caetano CB, Freitas LM, Souza CH, Santos MM. A efetividade do método Pilates no tratamento da dor lombar crônica inespecífica: ensaio clínico randomizado. Acta Fisiátr. 2021;28(4):214-20. doi: 10.11606/issn.2317-0190.v28i4a190072.

Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, et al; Acupuncture Trialists' Collaboration. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455-74. doi: 10.1016/j.jpain.2017.11.005.

Brasil. Resolução nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Of. União; 23 jun 2014. Seção 1, p. 8-11.

Silva LA, Muhl C, Moliani MM. Ensino médico e humanização: análise a partir dos currículos de cursos de medicina. Psicol Arg. 2015;33(80):298-309. doi 10.7213/psicol.argum.33.080.AO06.

Sancho KA, Pfeiffer CRCC, Carlos RS. Medicalização, diagnóstico clínico e queixa-conduta: redes de significação em jogo. Interface. 2019;23:e170633. doi: 10.1590/Interface.170633.

Lynch T, Ryan C, Hughes CM, Presseau J, van Allen Z M, Bradley CP, et al. Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis. Addiction. 2020;115:1618–39. doi: 10.1111/add.14981.