M. Linden et H. Gothe, BENZODIAZEPINE SUBSTITUTION IN MEDICAL-PRACTICE - ANALYSIS OF PHARMACOEPIDEMIOLOGIC DATA-BASED ON EXPERT INTERVIEWS, Pharmacopsychiatry, 26(4), 1993, pp. 107-113
Pharmacoepidemiologic data have shown a consistent reduction in benzod
iazepine (BZ) prescriptions over the past decade. The question remains
as to whether BZs are simply put aside or whether other medications a
re used as substitutes. Expert interviews, at which a stratified sampl
e of 114 psychiatrists, internists, and general practitioners were pre
sented with case studies, were conducted to learn about the therapeuti
c alternatives in the field of benzodiazepine-related indications admi
nistered in daily practice. These results were used to analyze trends
in pharmacoepidemiologic prescription data for all patients under the
general health insurance plan from 1981 to 1988. The experts identifie
d distinct alternatives to BZs in different clinical situations, inclu
ding neuroleptics, antidepressants, phytotherapeutics, and analgesics.
When these findings were transferred to pharmacoepidemiologic data, r
esults revealed an increase in the prescription of alternative medicat
ions that apparently compensated for reduced BZ use. Overall there was
no change (or, rather, no increase) in the total of psychotropic pres
criptions during the period.of reduced BZ prescriptions. Our findings
indicate that reduction in benzodiazepines prescription is associated
with substitution by various other psychotropic drugs. This has positi
ve as well as negative consequences, and there must be discussed in de
tail before sound recommendations can be given as to which type of dru
g. BZs included, is the best choice in which type of illness.