Kiezen voor de juiste benzodiazepine

Werkingsmechanisme en farmacokinetiek
Stand van zaken
Christiaan H. Vinkers, Joeri K. Tijdink, Jurjen J. Luykx en Roeland Vis

Choosing the correct benzodiazepine: mechanism of action and pharmacokinetics

  • There is a discrepancy between the recommendation for caution and daily practice in the prescription of benzodiazepines.

  • Although there is heterogeneity in the registered indications, all benzodiazepine agonists have almost the same mechanism of action.

  • There are, however, substantial pharmacokinetic differences between individual benzodiazepine agonists.

  • During short-term use of benzodiazepines, the elimination half-life is no measure of duration of action.

  • Benzodiazepine lipophilicity determines the speed of action.

  • If a rapid effect is desired, for instance in acute anxiety or agitation, then regarding oral medication the use of a lipophilic benzodiazepine such as diazepam is a rational choice.

  • An accumulation factor can be used to estimate benzodiazepine accumulation during chronic use.

  • In theory, accumulation does not occur with once-daily dosage of benzodiazepines that have an elimination half-life markedly shorter than 24 h, such as oxazepam, temazepam, and lorazepam.

  • Conflict of interest: none declared. Financial support: none declared.