Hindari Penghentian Diazepam secara Tiba-Tiba

Oleh :

Audric Albertus

Penghentian diazepam atau benzodiazepin reseptor agonis lainnya secara tiba-tiba dapat menyebabkan dampak buruk, seperti rebound penyakit dan gejala withdrawal. Dokter harus menghindari penghentian obat ini secara tiba-tiba dan melakukan penurunan obat secara bertahap (tapering off).

Obat benzodiazepin reseptor agonis (BZRA), seperti diazepam atau zolpidem, sampai sekarang masih merupakan salah satu pilihan terapi utama dalam menangani insomnia. Akan tetapi, penggunaan jangka panjang dapat menyebabkan dampak buruk pada populasi geriatri, seperti gangguan kognitif, pusing, dan kehilangan keseimbangan. Di sisi lain, penghentian obat secara tiba-tiba juga dapat menyebabkan dampak yang tidak kalah buruknya, berupa risiko rebound penyakit dan gejala withdrawal.[1,2]

Penggunaan Benzodiazepine Reseptor Agonis (BZRA) untuk Insomnia

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Ellis JG, Perlis ML, et al. The natural history of insomnia: focus on prevalence and incidence of acute insomnia. J Psychiatr Res. 2012;46(10):1278–1285.
2. Buysse DJ. Insomnia. JAMA : the journal of the American Medical Association. 2013;309(7):706-716.
3. Pottie K, Thompson W, et al. Deprescribing benzodiazepine receptor agonists. Can Fam Physician. 2018;64(5):339 LP-351.
4. Pollmann AS, Murphy AL, Bergman JC, Gardner DM. Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: A scoping review. BMC Pharmacol Toxicol. 2015;16(1):1–12.
5. Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: Meta-analysis of risks and benefits. Br Med J. 2005;331(7526):1169–73
6. Inagaki T, Miyaoka T, Tsuji S, Inami Y, Nishida A, Horiguchi J. Adverse Reactions to Zolpidem: Case Reports and a Review of the Literature. Primary Care Companion to The Journal of Clinical Psychiatry. 2010;12(6):PCC.09r00849.
7. Sithamparanathan K, Sadera A, Leung L. Adverse effects of benzodiazepine use in elderly people: A meta-analysis. Asian J Gerontol Geriatr. 2012;7(2):107–11.
8. MacFarlane J, Morin CM, Montplaisir J. Hypnotics in insomnia: the experience of zolpidem. Clin Ther. 2014 Nov 1;36(11):1676-701.
9. Roehrs TA, Randall S, Harris E, Maan R, Roth T. Twelve Months of Nightly Zolpidem Does Not Lead to Dose Escalation: A Prospective Placebo-Controlled Study. Sleep. 2011;34(2):207-212.
10. Ram D, Eiman N, Gowdappa B. Multimodal Hallucination (Audio-visual, Kinaesthetic and Scenic) Associated with the Use of Zolpidem. Clinical Psychopharmacology and Neuroscience. 2015;13(2):215-217.
11. Lu T-H, Lee Y-Y, Lee H-C, Lin Y-M. Doctor Shopping Behavior for Zolpidem Among Insomnia Patients in Taiwan: A Nationwide Population-Based Study. Sleep. 2015;38(7):1039-1044. doi:10.5665/sleep.4806.
12. Belleville G, Guay C, Guay B, Morin CM. Hypnotic taper with or without self-help treatment of insomnia: a randomized clinical trial. J Consult Clin Psychol. 2007;75(2):325-35.
13. Vissers FHJA, Knipschild PG, Crebolder HFJM. Is melatonin helpful in stopping the long-term use of hypnotics? A discontinuation trial. Pharm World Sci. 2007;29(6):641-6.
14. Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, et al.. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700.
15. WHO. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. 2009.
16. Yamada Y, Fujiwara M, et al. Failed prevention of benzodiazepine withdrawal symptoms due to spontaneous expulsion of diazepam suppository administrated via stoma: A case report. PCN Rep. 2024 Aug 22;3(3):e70001. doi: 10.1002/pcn5.70001.