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苯二氮䓬類藥物戒斷症候群

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苯二氮䓬類藥物戒斷症候群
類型戒斷狀態[*]、苯二氮䓬類藥物依賴性
分類和外部資源
醫學專科精神病學
ICD-10F13.3（持續用藥後）
[編輯此條目的維基數據]
苯二氮䓬類
Chemical structure diagram of a benzene ring fused to a diazepine ring. Another benzene ring is attached to the bottom of the diazepine ring via a single line. Attached to the first benzene ring is a side chain labeled R7; to the second, a side chain labeled R2'; and attached to the diazepine ring, two side chains labeled R1 and R2.
苯二氮䓬類藥物的核心結構。 "R"表示側鏈基團所處的常見位置，不同的R基組合搭配可以使不同的藥物有不同的屬性。

苯二氮䓬類藥物戒斷症候群又稱苯二氮卓戒斷綜合症（英語：Benzodiazepine withdrawal syndrome），通常縮寫為苯並戒斷（benzo withdrawal）或BZD戒斷（BZD withdrawal） ，是指服用苯二氮䓬類藥物（可能因醫療原因或娛樂性原因用藥）並產生生理依賴性後，減少用量或停藥時產生的藥物戒斷徵狀。覓藥行為或按處方服藥均可能導致生理依賴性與藥物成癮（或二者之一）以及因此產生的戒斷徵狀。某些徵狀可能持續數年。苯二氮䓬類藥物戒斷症候群的顯著特徵徵狀包括：睡眠障礙、易怒、緊張焦慮、恐慌發作、手顫、發抖、出汗、難以集中精神、意識混亂和認知障礙、記憶減退、噁心乾嘔、體重下降、心悸、頭痛、肌肉疼痛僵硬、知覺變化、幻覺、癲癇發作、思覺失調[1]以及自殺[2][3]。此外，這些徵狀可能時好時壞，每日或每周的嚴重程度不一，而不是持續穩定好轉。[4]

苯二氮䓬類戒斷徵狀可能很嚴重，徵狀複雜且常常長期持續。[5][6]長期使用苯二氮䓬類（即每日用藥，持續至少三個月）[7]可能有更高的藥物依賴風險[8]，亦可能造成用量增加、藥效降低、增加事故和摔倒的概率（尤其是老年人），[9]還可能與認知、[10]神經系統和智力損傷有關[11]。因此不宜長期使用苯二氮䓬類藥物。[8]將苯二氮䓬類藥物作為短效安眠藥使用，在入睡時可能有效，但可能因戒斷反應而導致後半段睡眠質量不佳。[12]儘管如此，對於長期服用苯二氮䓬類藥物者，不應違背其意願強迫停藥。[5]

苯二氮䓬類戒斷可能有重症反應，甚至產生癲癇發作等危及生命的徵狀，[13]尤其是突然戒斷或減量過快的大劑量或長期用藥者。[5]然而逐步減量或相對用量較少的短期用藥者亦可能出現重症戒斷反應，[14]在動物模型中甚至曾有單次大劑量用藥後戒斷出現重症反應。[15][16]少數人會出現遷延性戒斷徵狀（英語：post-acute-withdrawal syndrome），徵狀可能在戒斷後數月甚至數年內持續，維持在亞急性狀態。緩慢而逐步的減少藥物用量能使遷延性戒斷徵狀的出現概率儘可能降低。[17]

長期使用苯二氮䓬類藥物會導致神經適應，降低藥物效果，造成耐受和依賴。[18]即使是持續服用治療劑量期間，長期使用苯二氮䓬類藥物亦可能引起類似戒斷反應的徵狀，尤其是在服藥間隔期。[19]停藥或減少用量後，用藥者即會出現藥物戒斷徵狀，直至其生理適應恢復。[20]這些反跳徵狀（英語：Rebound effect）可能與最初服藥前的病症相同，亦可能是戒斷症候群的一部分。[21]在重症病例中，戒斷反應可能會惡化，或與嚴重的精神疾病相似，如狂躁、精神分裂症，尤其在大劑量用藥者中還會出現癲癇重積狀態。[22]若不能正確診斷出戒斷症候群，可能會誤診為服藥前的疾病復發而需要繼續用藥，導致戒斷失敗、重新開始用藥，而重新用藥往往比之前的劑量更大。[22]

提高戒斷成功率的方法包括：提升對戒斷反應的意識，針對用藥者的戒斷反應嚴重程度而制定個人化的逐步戒斷方法，以及增加其他替代方法輔助，如使用藥者安心、參加苯二氮䓬類藥物戒斷互助小組。這些方法都能有效提高戒斷的成功率。[23][24]

徵狀和體徵

[編輯]
地西泮，其2毫克與5毫克片劑常用於治療苯二氮䓬類戒斷反應[25]
氯二氮平（英語：Chlordiazepoxide），其5毫克膠囊劑有時可作為地西泮的替代藥物，用於治療苯二氮䓬類戒斷反應。氯二氮平與地西泮都有較長的消除半衰期和長效活性代謝產物

苯二氮䓬類、巴比妥類等鎮靜安眠藥物或酒精成癮者在停用後會產生嚴重的戒斷反應徵狀。《臨床成人精神醫學手冊》顯示這些戒斷徵狀比鴉片類藥物的戒斷徵狀更嚴重、危害更大。[26]使用者在停藥時一般甚少獲得相關建議和支持。[27]一些戒斷徵狀與用藥治療之前的病症相同，[21]可能徵狀嚴重或長期持續。半衰期較長的苯二氮䓬類藥物可能在停用長達三周之後才會出現戒斷反應，而半衰期較短的藥物則較早出現戒斷反應，一般在停用24-48小時後即會出現。[28]不同劑量用藥者的戒斷徵狀種類可能沒有重大差異，但大劑量用藥者的徵狀嚴重程度往往更高。[29]

在用藥量減少時，服藥者可能會首次出現戒斷反應，包括失眠、焦慮、痛苦、體重下降、暈眩、夜汗、肌肉抽搐、恐慌發作、抑鬱、失實症、偏執等。這些徵狀更常見於短效苯二氮䓬類停藥時，例如三唑侖等藥物。[22][30]日間徵狀可能在夜間用藥給藥數日至數周后出現，[31][32]亦可能出現於佐匹克隆等Z藥物使用者。[33]即使是間歇服用苯二氮䓬類，[34]亦可能在戒斷後出現失眠徵狀反彈，可能比服藥前更加嚴重。[35][36]

逐步或突然減少藥量可能出現下列徵狀：

迅速停藥可能會引發更嚴重的徵狀：

參考來源

[編輯]
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