Tags

Type your tag names separated by a space and hit enter

Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach.

Abstract

BACKGROUND

Benzodiazepines are the most frequently used drug for the treatment of insomnia. Prolonged use of benzodiazepine therapy is not recommended. However, many patients, particularly older patients, have difficulties discontinuing therapy. Melatonin, a hormone that is produced at night by the pineal gland, promotes normal sleep in humans and augments sleep induction by benzodiazepine therapy.

OBJECTIVE

To assess whether the administration of melatonin could facilitate the discontinuation of benzodiazepine therapy in patients with insomnia.

METHODS

Thirty-four subjects receiving benzodiazepine therapy were enrolled in the 2-period study. In period 1, patients received (double-blinded) melatonin (2 mg in a controlled-release formulation) or a placebo nightly for 6 weeks. They were encouraged to reduce their benzodiazepine dosage 50% during week 2, 75% during weeks 3 and 4, and to discontinue benzodiazepine therapy completely during weeks 5 and 6. In period 2, melatonin was administered (single-blinded) for 6 weeks to all subjects and attempts to discontinue benzodiazepine therapy were resumed. Benzodiazepine consumption and subjective sleep-quality scores were reported daily by all patients. All subjects were then allowed to continue melatonin therapy and follow-up reassessments were performed 6 months later.

RESULTS

By the end of period 1, 14 of 18 subjects who had received melatonin therapy, but only 4 of 16 in the placebo group, discontinued benzodiazepine therapy (P = .006). Sleep-quality scores were significantly higher in the melatonin therapy group (P = .04). Six additional subjects in the placebo group discontinued benzodiazepine therapy when given melatonin in period 2. The 6-month follow-up assessments revealed that of the 24 patients who discontinued benzodiazepine and received melatonin therapy, 19 maintained good sleep quality.

CONCLUSION

Controlled-release melatonin may effectively facilitate discontinuation of benzodiazepine therapy while maintaining good sleep quality.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Aging Research and the Department of Internal Medicine, The E. Wolfson Medical Center, Holon, Israel.

    , ,

    Source

    Archives of internal medicine 159:20 1999 Nov 08 pg 2456-60

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Anti-Anxiety Agents
    Benzodiazepines
    Double-Blind Method
    Female
    Follow-Up Studies
    Humans
    Male
    Melatonin
    Middle Aged
    Sleep
    Sleep Initiation and Maintenance Disorders
    Substance-Related Disorders
    Time Factors
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    10665894

    Citation

    Garfinkel, D, et al. "Facilitation of Benzodiazepine Discontinuation By Melatonin: a New Clinical Approach." Archives of Internal Medicine, vol. 159, no. 20, 1999, pp. 2456-60.
    Garfinkel D, Zisapel N, Wainstein J, et al. Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach. Arch Intern Med. 1999;159(20):2456-60.
    Garfinkel, D., Zisapel, N., Wainstein, J., & Laudon, M. (1999). Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach. Archives of Internal Medicine, 159(20), pp. 2456-60.
    Garfinkel D, et al. Facilitation of Benzodiazepine Discontinuation By Melatonin: a New Clinical Approach. Arch Intern Med. 1999 Nov 8;159(20):2456-60. PubMed PMID: 10665894.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach. AU - Garfinkel,D, AU - Zisapel,N, AU - Wainstein,J, AU - Laudon,M, PY - 2000/2/9/pubmed PY - 2000/2/26/medline PY - 2000/2/9/entrez SP - 2456 EP - 60 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 159 IS - 20 N2 - BACKGROUND: Benzodiazepines are the most frequently used drug for the treatment of insomnia. Prolonged use of benzodiazepine therapy is not recommended. However, many patients, particularly older patients, have difficulties discontinuing therapy. Melatonin, a hormone that is produced at night by the pineal gland, promotes normal sleep in humans and augments sleep induction by benzodiazepine therapy. OBJECTIVE: To assess whether the administration of melatonin could facilitate the discontinuation of benzodiazepine therapy in patients with insomnia. METHODS: Thirty-four subjects receiving benzodiazepine therapy were enrolled in the 2-period study. In period 1, patients received (double-blinded) melatonin (2 mg in a controlled-release formulation) or a placebo nightly for 6 weeks. They were encouraged to reduce their benzodiazepine dosage 50% during week 2, 75% during weeks 3 and 4, and to discontinue benzodiazepine therapy completely during weeks 5 and 6. In period 2, melatonin was administered (single-blinded) for 6 weeks to all subjects and attempts to discontinue benzodiazepine therapy were resumed. Benzodiazepine consumption and subjective sleep-quality scores were reported daily by all patients. All subjects were then allowed to continue melatonin therapy and follow-up reassessments were performed 6 months later. RESULTS: By the end of period 1, 14 of 18 subjects who had received melatonin therapy, but only 4 of 16 in the placebo group, discontinued benzodiazepine therapy (P = .006). Sleep-quality scores were significantly higher in the melatonin therapy group (P = .04). Six additional subjects in the placebo group discontinued benzodiazepine therapy when given melatonin in period 2. The 6-month follow-up assessments revealed that of the 24 patients who discontinued benzodiazepine and received melatonin therapy, 19 maintained good sleep quality. CONCLUSION: Controlled-release melatonin may effectively facilitate discontinuation of benzodiazepine therapy while maintaining good sleep quality. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/10665894/Facilitation_of_benzodiazepine_discontinuation_by_melatonin:_a_new_clinical_approach_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/159/pg/2456 DB - PRIME DP - Unbound Medicine ER -