Talk:Benzodiazepine/Archive 6

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Therapeutic Use

Shouldn't Veterinary use be moved to the Therapeutic section of the article, instead of being tacked on to the very bottom? —Preceding unsigned comment added by Edwinhenryjr (talk • contribs) 19:24, 27 January 2010 (UTC)

This should be discussed on the talk page of WP:MEDMOS as this guideline suggests that veterinary use go to the bottom of articles.--Literaturegeek | T@1k? 09:31, 4 February 2010 (UTC)

Lots of Misinformation in this Article (Reads like a Drug-Company Sales Pamphlet)

Citations do not by themselves a neutral article make. There is a lot of legitimate controversy (at the professional level) about benzodiazapines, their safety and side effects. Really there should be a controversy section in this article.

There are also plenty of citations available that counter some of the claims made in the article. It should be noted that there are major efforts in several countries to ban benzodiazapine use altogether, and that a number of these efforts are being spearheaded by Medical Doctors.

I encourage anyone with the time and knowledge to follow wiki guidelines while posting numerous alternative citations to the blatant drug company sales propaganda in this article.

69.171.160.51 (talk) 22:31, 3 February 2010 (UTC)

I also encourage people not to be shy about appealing to Wikipedia administrators over the heads of anyone who reverts legitimate additions or changes to this article without proper justification (watch out also for phony justifications)--

Automatically reverting changes that you don't like (or that you are being paid not to like) without justification is considered vandalism by Wikipedia standards and will usually be dealt with if reported often enough to Wikipedia administrators.

You also have the right to appeal to more than one administrator.

69.171.160.51 (talk) 22:46, 3 February 2010 (UTC)

I think that the article is reasonably neutral and reflects the current medical literature fairly. There are no organised efforts to ban benzos either by professionals or "citizen" groups and it will never happen as they are too useful in the short-term. There is controversy around long-term use which this article addresses and there are efforts to reduce long-term use especially in the UK, Australia, Holland, Denmark and Norway and to a lesser extent in other countries. Which claims does the article make which have not been "countered"? Which sections or statements are not neutral? What areas of controversy have not been covered? Also do note that this article is the main benzodiazepine article and therefore is only meant to summarise important points. More indepth discussions on areas of adverse effects, harm and risks benzos are done on the other benzo articles such as benzodiazepine withdrawal syndrome, benzodiazepine overdose, benzodiazepine misuse and long-term effects of benzodiazepines. You may not have read these articles.

Randomly accusing editors who you have never even met or interacted with of being paid by the drug companies and threatening editors is not particularly helpful. I suggest that you tone yourself down and find citations to back up what you say or think is wrong with the article.--Literaturegeek | T@1k? 22:51, 3 February 2010 (UTC)

Here is a Medical Doctor (now deceased) who spearheaded efforts to outlaw benzodiazapines: http://www.benzo.org.uk/peartbio.htm

Note the title of his article-- the "Chemical Rape of Body, Mind and Soul - An Account of Benzodiazepine Dependence"

This is an article written by a Medical Doctor, not an extremist.

I accused no specific Editor of anything. But paid Wikipedia editors are an increasing problem.

69.171.160.51 (talk) 23:55, 3 February 2010 (UTC)

I am familar with him and have never read that he wants benzos banned, he wanted long-term use banned though I think. Do you have a quote where he specifically says that he wants benzos banned?--Literaturegeek | T@1k? 00:04, 4 February 2010 (UTC)

You have made the accusation that the article reads like a drug sales leaflet, I suggest that you actually compare the article to a product information sheet and I think that you will find that this article discusses a lot of things which are ommited from drug data sheets, protracted withdrawal being one and long-term effects being another. The article is not controlled by drug companies so well sourced edits will not get reverted if they comply with WP:NPOV, WP:DUE and WP:MEDRS. The article is a good article now so only recent secondary sources should be added unless there is very good reason for not doing so. I recommend that you retract your accusations.--Literaturegeek | T@1k? 00:04, 4 February 2010 (UTC)

Quote from your last post: "he wanted long-term use banned though I think."

That's right. Which is a ban. You yourself just used the word 'banned'.

69.171.160.51 (talk) 00:23, 4 February 2010 (UTC)

Also from your last post: "I recommend that you retract your accusations."

I have a right to express my opinion about the quality of this article. You have no right to intimidate me into silence just because I do not agree with your opinion.

This article is biased. It isn't neutral and it misinforms. The discussion area is for people to debate the writing of the article.

Neutrality is a common concern when discussing and editing a Wikipedia article. Wikipedia encourages discussing neutrality so I do not need to retract my opinion about the biased quality of the writing.

I also made no personal accusations, so no one accused you of anything and I do not have to retract anything.

69.171.160.51 (talk) 00:19, 4 February 2010 (UTC)

It does not matter what you or I say, you need a source which specifically says what you are quoting someone of saying in order to reference it in an encyclopedia. You have not explained specifically what parts of the article are not neutral and where it misinforms. The content that you have so far discussed is related to "political" campaigns and so forth to get stronger restrictions on long-term use. I am not trying to silence you. There is nothing to stop you from creating an article on benzodiazepine controversies and covering these issues.--Literaturegeek | T@1k? 00:44, 4 February 2010 (UTC)

From the article: "Benzodiazepines are generally safe and effective in the short term".

This is disputed in the medical community.

Also from the article: "Benzodiazepine abuse is mostly limited to individuals who abuse other drugs, i.e. poly-drug abusers."

This is widely disputed and there are many professional sources that contradict this statement.

69.171.160.51 (talk) 00:58, 4 February 2010 (UTC)

First point, the term "generally" is used, the article discusses risks of short-term use, increased falls and confusion in elderly, paradoxical effects, increased risks of motor vehicile crashes etc.

Second point, it is sourced to Prof Ashton who is a leading expert in benzodiazepines. Please provide the sources you talk of.--Literaturegeek | T@1k? 01:05, 4 February 2010 (UTC)

With regard to your allegation that I was trying to intimidate you into silence, I suggest that you reread your first post and you will see that you came onto this page threatening editors with administrators and making allegations in an accusing tone with no provocation. The only thing I did was disagree with you. I said nothing intimidating and even sent you a welcome message and suggested you could create a controversies article to cover areas you wanted covered. You are more than welcome to edit the encyclopedia and your views are welcome.--Literaturegeek | T@1k? 09:18, 4 February 2010 (UTC)

Quote from you: "you came onto this page threatening editors with administrators"

What I actually said (quote from me): "I also encourage people not to be shy about appealing to Wikipedia administrators over the heads of anyone who reverts legitimate additions or changes to this article without proper justification (watch out also for phony justifications)--"

There is no threat in there. It is legitimate to encourage people to appeal inappropriate edits on Wikipedia.

Thanks for the welcome.

69.171.160.216 (talk) 22:11, 4 February 2010 (UTC)

You are brand new to this article and were not disputing any specific edits inappropriate or not, it appears that you just assumed and accused. Please give links to specific examples of inappropriate edits or reverts; claims need backed up by evidence.--Literaturegeek | T@1k? 22:21, 4 February 2010 (UTC)

Some considerations for panic disorder and benzos are worth noting. many, if not most, sufferers from panic disorder cannot tolerate antidepressants-especially SSRI's-due to their stimulating effects. Even for those for whom antidepressants are initially effective, the STAR*D study for optimizing AD choice for depression can perhaps be fairly summarized as concluding that 30-50% of the patients who stayed on therapy (and note that the drop-out rate was large) responded or were in remission an average of six months. That's after suffering side effects for perhaps two months. It would be very instructive to have a study similar to STAR*D except with panic disorder patients-it would be reasonable to assume that as unrewarding as AD therapy was shown to be with depression, it would be even less impressive with anxious patients, who would drop out at a higher rate. Given that a patient initially presenting with panic disorder has at best a 30-50% chance of response for an average of six months and must wait perhaps several two-month intervals to see if a given set of AD's work, it is not surprising that extended benzo therapy is a choice worth giving serious consideration. Some panic clinics (Stuart Shipko's clinic comes to mind) skip the AD route and go directly to alprazolam, with a high reported rate of success. The other alternative for panic disorder is therapy-and currently, CBT is all the rage-but again, the best quality studies (STAR*D again) show that CBT is no more promising than AD therapy in terms of efficacy. While it is claimed that CBT therapy "lasts" longer than medication-that isn't really an important result, since medication will, of course, often stop working when discontinued-and further, the claimed "increased" period of CBT efficacy is often measured in months; again, not promising for what for many is a life-long affliction. In terms of medication, it would be difficult to argue that benzos do not clearly have the safest long-term toxicity profile when compared with alternatives such as AD's, anticonvulsants, and atypical antipsychotics. For many anxiety patients, long-term benzo therapy makes sense-in fact, benzos may be the only choice, which is why long-term benzodiazepine therapy is commonly used (as the article implicitly states).

Dehughes (talk) 18:10, 15 December 2010 (UTC)

Aromaticity

I would just like to point out that it does not explicitly say anywhere whether benzodiazepines are aromatic or not. For instance; if all benzodiazepines are aromatic, one could either add that to this article, or change Category:Nitrogen heterocycles to Category:Aromatic nitrogen heterocycles in Category:Benzodiazepines, or both. Nirmos (talk) 15:01, 30 April 2010 (UTC)

The benzo ring is aromatic but the nitrogen containing azepine ring is not. Hence I think it is more accurate to describe a benzodiazepine as a nitrogen heterocycle rather than a aromatic nitrogen heterocycle. Cheers. Boghog (talk) 18:14, 30 April 2010 (UTC)

The problem is that none of the categories Category:Anxiolytics, Category:Anticonvulsants, Category:Hypnotics, Category:Sedatives, Category:Muscle relaxants and Category:Nitrogen heterocycles explicitly say that benzodiazepines are aromatic. Therefore, I have now added Category:Aromatic compounds to Category:Benzodiazepines. If anyone wants to change Category:Aromatic compounds to a more specific category, feel free to do so. Nirmos (talk) 22:28, 8 May 2010 (UTC)

Withdrawals good for you?

"In general, withdrawal from benzodiazepines leads to improved physical and mental health.[8][9]" this makes it sound like a good thing to take it, just to have the withdrawals to have improved physical and mental health. Is that the meaning behind this? or does it mean that cessation of taking benzos improves physical and mental health? If so it should be re-worded. 71.112.214.228 (talk) 02:38, 4 June 2010 (UTC)

The latter. Feel free to improve the wording if you want to. Regards, Looie496 (talk) 17:05, 4 June 2010 (UTC)

Benzodiazepine withdrawal syndrome says: "Withdrawal of benzodiazepines is usually beneficial due to the adverse effects associated with the long-term use of benzodiazepines.[7] However, it has been recommended that long-term users of benzodiazepines not be forced to withdraw against their will.[3]". I think it is better, but not very clear for me yet. 190.19.84.157 (talk) 14:50, 1 August 2010 (UTC)

I can see why the current text is unclear and agree that rewording similar to wording in the main benzodiazepine withdrawal article would make the article more clear for readers.--Literaturegeek | T@1k? 02:32, 4 August 2010 (UTC)

Literaturegeek, would you please review my single sentence in the withdrawal section that refers to a tapering technique in which the tablet size is slowly, systematically reduced. I was unable to find any reference whatever where this technique is discussed, but it is nonetheless a technique that causes little or no tapering discomfort-and one I think many people will find very useful. A description of the procedure appears at http://www.hughes12.com/tapering_xanax.htm. I wanted to point this out to you since I'm obviously biased since the reference would be to one of my Web sites. The referenced post is also pretty informal and perhaps states many things you don't agree with, but the point is really the tapering technique, so I wanted you to review and see if it comes out, warts and all, in the positive column. I also don't know how to insert a reference, should it be deemed a useful addition. Please review and if you find it useful as I do, please insert the reference or refer me to a description of how to do it without messing things up (why I didn't do it in the first place); if you do not find it useful, please feel free to remove the sentence from the text. Thanks. 71.251.130.113 (talk) 15:46, 8 June 2011 (UTC) Dehughes (talk) 15:48, 8 June 2011 (UTC)

PMID 19062773 is a recent review that describes tapering strategies. Wikipedia articles on medical-related topics should not use personal web pages as references except in extraordinary situations. This applies especially when the web pages describe approaches that are not covered in published articles. Looie496 (talk) 16:47, 8 June 2011 (UTC)

Paradoxical side effects: Hypomania with risk of suicide

In my country flunitrazepam its contraindicated in people with depression or mood disorders because can induce maniac states with risk of suicide.

http://www.hipocampo.org/flunitrazepam.asp --Realxsalo (talk) 09:21, 21 January 2011 (UTC)

Interesting Realxsalo. Unfortunately this article is about benzodiazepines as a drug class and we have to be pretty strict with sourcing standards for this article as it is now a GA article. You could perhaps consider adding this to the main flunitrazepam article, where it may be more relevant.--Literaturegeek | T@1k? 16:35, 22 January 2011 (UTC)

Article name

This article was moved from benzodiazepine to benzodiazepine drug in this edit. While I am sympathetic to the reason for the move (precision), I think conciseness, recognizability, and naturalness (see WP:NAMINGCRITERIA) favor the original name. In particular:

A topic is primary for a term, with respect to usage, if it is highly likely—much more likely than any other topic, and more likely than all the other topics combined—to be the topic sought when a reader searches for that term.
A topic is primary for a term, with respect to long-term significance, if it has substantially greater enduring notability and educational value than any other topic associated with that term.
— WP:PRIMARYTOPIC

The general public associates benzodiazepines with a class of drugs. Many fewer would think of benzodiazepines as a heterocyclic ring system. Hence I think common usage strongly favors the original concise name. Finally I note that this article has obtained WP:GA status. This implies that this article has undergone careful review and no one suggested in the GA review process that the article should be renamed. Because this article has reached GA status, any major change to the article such as a name change should first obtain consensus on this talk page.

For the above reasons, I have restored the original concise article name. Boghog (talk) 15:01, 10 August 2013 (UTC)

I don't think the general public associates benzodiazepines with anything at all. But my strong impression is that in the scientific literature it is much more common to see "benzodiazepines" than "benzodiazepine drugs", so I agree with moving the name back (although I also don't think this is a very important issue either way). Looie496 (talk) 15:36, 10 August 2013 (UTC)

Benzene is an intoxicant?

I am wondering why a drugs company thought of trying to create drugs based on benzene
and I seem to remember a school mate who liked sniffing the benzene he found in a school chemistry lab
- and claimed it was intoxicating
Laurel Bush (talk) 10:17, 14 August 2013 (UTC)

There is really no relation between benzene as a drug and benzodiazepines. You could try asking your question as the Science Reference desk. Looie496 (talk) 16:54, 14 August 2013 (UTC)

Benzene is an intoxicative drug?
That benzodiazepines are based on the benzine molecule is very clear from the benzodiazepine article
Laurel Bush (talk) 11:21, 15 August 2013 (UTC)

Yes, but the drug effects of a molecule are in most cases totally unrelated to the drug effects of its components. Receptors and drugs have a lock-and-key relationship -- you only only have part of a key, it won't open the lock, but there might be some different type of lock that it will open. That's a bit oversimplified, but I hope it helps to give an intuitive picture of the situation. Looie496 (talk) 15:00, 15 August 2013 (UTC)

My question was about what made benzene attractrive as potentially something which could be used to create a new drug. Intoxicative vapour seems likely to be the answer and I guess discovery of the molecule receptors came some time after invention of the first benzene-based drug. I also imagine - by the way - that a lot of supposedly medicinal herbs were first identified as such because of their scents. Laurel Bush (talk) 15:35, 16 August 2013 (UTC)

The benzene substructure is found in a wide range of drugs, not just tranquilizers. Futhermore benzene containing drugs have a wide range of biological targets and therapeutic effects. Why is this substructure found in so many drugs? Because benzene containing organic compounds are generally easy to synthesize, well tolerated (although there are notable exceptions), generally orally bioavailable, and most importantly, frequently contribute to high affinity binding of drugs to their biological target. In answer to the question posted in your edit summary, benzodiazepines were discovered long before its receptor, the GABA_A receptor. Ironically, volatile organic compounds such as benzene act as general anaesthetics and while not completely clear, the target of these drugs also appears to be the GABA_A receptor, but at a binding site that may differ from the benzodiazepine binding site. However I think this is pure coincidence. Sternbach synthesized benzodiazepines not because they contained a benzene ring but because he worked with similar compounds durring his postdoctoral studies. Boghog (talk) 22:48, 16 August 2013 (UTC)

Thanks Boghog
Laurel Bush (talk) 10:04, 26 August 2013 (UTC)

Fixing sentence to avoid copyright violation

In Benzodiazepine#Insomnia, reworded (diff) this sentence:

"This may make the non-benzodiazepines preferable as the first-line long-term treatment of insomnia."

Though attributed to Treatment options for insomnia it runs close enough to this book that I had to re-word it. This was pointed out by somebody else in passing at the Teahouse (TH Archive #181)

Insertion appears to be in this edit.

I doubt anybody did this on purpose, but Wiki gets anal about this kind of stuff. meteor_sandwich_yum (talk) 19:00, 11 February 2014 (UTC)

why no mention of midazolam for colonoscopy?

This a fine article for taking these drugs in daily doses for ongoing conditions, but I was looking to learn more about the class of drugs that includes Versed or midazolam, used for patients undergoing colonoscopy, and I assume other medical procedures. Is that worth a mention here, that whole category of uses? There is one oblique sentence under Other indications about midzolam used for amnesia, to forget pain in a surgical procedure, which is not much to say, compared to the line in the midzolam article "It is the most popular benzodiazepine in the intensive care unit (ICU) because of its short elimination half-life, combined with its water solubility and its suitability for continuous infusion. However, for long-term sedation, lorazepam is preferred due to its long duration of action,[20] and propofol has advantages over midazolam when used in the ICU for sedation, such as shorter weaning time and earlier tracheal extubation.[21]" (quote from the article about midazolam) If it is true that all benzodiazepine drugs are used mainly for day to day to medicines, and the hospital uses (that is, surgery or endoscopy) are a teeny fraction of the usage, then maybe keep the lowered focus, but with a clearer sentence on the usage in anesthesia, in-hospital procedures. I am not qualified at all to write about medical procedures and drugs but do like to learn about them as needed. --Prairieplant (talk) 16:01, 2 August 2014 (UTC)

medical use of Anterograde amnesia

Drugs are widely used during medical procedures (colonoscopies etc) that are known to induce short-term Anterograde amnesia; this is not a mere side-effect, but apparently considered at least somewhat desirable, or even the main desired effect, by doctors. It is quite convenient for doctors, for patients to have little memory of what they experienced during medical procedures. Some patients may be grateful for this, some may not -- but they are seldom offered meaningful choices. There are profound and complex ethical aspects to this. The article should address the intentional use of drugs by doctors to induce Anterograde amnesia -- and whether it is indeed always as short-term as intended.-71.174.175.150 (talk) 19:48, 9 December 2014 (UTC)

New material on neurosteroids

A couple of days ago an IP editor added a paragraph covering the possibility that some of the effects of benzos are mediated by their effects on neurosteroids (diff). I reverted the edit on the basis of inadequate sourcing -- the cited sources are primary research articles. The IP editor reverted the material back into the article, with edit summary "Reverted back to the added text: This text was imported from the article on Neurosteroids and all refererences have been verified. This information is relevant as it may explain the detrimental effects of benzodiazepines on cognition.". Doc James then moved the material to a different point in the article, thereby implicitly validating it.

I continue to feel that the material does not belong as written. Given that benzos have long been known to have direct effects on GABA receptors, we really need some good secondary source to tell us that their indirect effects mediated by neurosteroids are important enough to matter. The first source used in the added material has been cited by a couple of review papers. The most useful, I think, is http://www.sciencedirect.com/science/article/pii/S0091302214000557 (open access), which states, "Similarly, the effects of certain clinically important benzodiazepines (BDZs) may be mediated by (i) binding directly to the GABAAR (at a site between the α and γ subunits) to allosterically and rapidly enhance receptor function and (ii) activating TSPO to produce a delayed indirect enhancement of receptor function by increasing neurosteroid production." (The material that follows adduces evidence for that statement.) In my view this would justify a single sentence in our article saying that in addition to their direct action on GABA receptors, some benzos may also act on them indirectly by increasing production of neurosteroids. Looie496 (talk) 13:44, 1 August 2015 (UTC)

Have trimmed it. Yes better sources needed. Doc James (talk · contribs · email) 14:11, 1 August 2015 (UTC)

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Benzodiazepines & appetite

All journals articles say Benzodiazepines increases appetite but patients sites say opposite which one is correct? example: http://www.sciencedirect.com/science/article/pii/S0195666380800055

http://www.drugs.com/clonazepam.html — Preceding unsigned comment added by M-G (talk • contribs) 22:45, 18 March 2016 (UTC)

Removed review

@JzG: What's the diff where the author added his own paper? Anyone else have thoughts on the merit of including this review? Looks like everything is still cited after it is removed. Sizeofint (talk) 00:54, 18 August 2016 (UTC)

Ah, just saw the discussion on your talk page. Found the diff. Sizeofint (talk) 01:29, 18 August 2016 (UTC)

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College of Physicians and Surgeons of British Columbia recommendations

I am of the opinion that these sorts of specific recommendations from a specific regulatory body in one specific country might be better placed elsewhere as opposed to their current location in the general introductory paragraph of the Medical Uses section. That said, these recommendations are based upon well-established contraindications which are either noticeably absent or given just a scant sentence or two in the current Contraindications section of the article. As such, I recommend that the prescribing recommendations being made by the CPSBC be moved to a new section, perhaps a new subsection under Society and Culture, something along the lines of a 'Recommendations and Best Practices' sort of thing where data such as this from various regional jurisdictions around the globe could be collected. Furthermore, the contraindications on which these recommendations were based should be more clearly detailed in the Contraindications section, perhaps being given full subsection status themselves, alongside the current two which are already there (Pregnancy and Elderly). My understanding of the CPSBC recommendations is that they are primarily motivated by two areas of contraindication, namely taking benzos in concert with other central nervous system depressants such as opioids, barbiturates, alcohol, etc., and prescribing them to patients who have preexisting problems with addiction. Neither of these is very well detailed in the existing article, both are major areas of contraindication with benzodiazepines and both have been exhaustively treated in a veritable wealth of highly credible, peer-reviewed research which is readily available to anyone with an internet connection or a library card. Daystrom (talk) 19:01, 9 December 2016 (UTC)

Dear contributors to scientific articles

Please try to write some part of your bloody articles so that people not familiar with scientific nomenclature can understand the subject and integrate what they read into their framework for knowledge and understanding. In other words, USE SIMPLE LANGUAGE FOR MEDIAN READERS. I've just done this with one sentence in the lead: "In common, non-technical language, they are known as minor tranquilizers." Please follow suit. Tapered (talk) 00:50, 4 June 2017 (UTC)

Good luck with this idea. I've been trying to promote this concept for years, but it rarely takes hold. I guess people just like to sound smart, no matter what. Cheers. 73.6.96.168 (talk) 01:46, 25 September 2021 (UTC)

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