Driving and Benzodiazepine Use

Although the data are sparse, epidemiological studies show that benzodiazepine use increases the relative risk of being involved in a traffic accident by a factor of from 1.5 to about 6.5, depending on dose, number of benzodiazepines used and recency of use. These risks are similar to those associated with blood alcohol concentrations of about 0.6 and 1 g/L, respectively. Experimental studies employing on-the-road driving, driving simulation and laboratory tests measuring skills related to driving have clearly established the dose-dependent performance-impairing effects of benzodiazepines.Benzodiazepine hypnotics vary considerably in their potential to produce residual effects in the morning after nocturnal use. The main determinants of the degree and duration of action after a single dose are size of dose, rate and extent of distribution, lipophilicity and receptor affinity. With repeated administration, compounds with a long elimination half-life (t1/2β) are likely to accumulate and produce increased sedation. Diazepam may have a rapid onset of action precipitating the risk of sudden intoxication, but its duration of action is relatively short after a single dose (acute tolerance). The impairing effects of diazepam on driving performance may persist at least during the first 3 weeks of daily administration. The issue of tolerance has not yet been adequately explored and patients should be warned that their performance may not return to the premedication level. Elderly patients may be more sensitive to the sedative and performance-impairing effects than the young, although the evidence is equivocal. Caution is warranted with concomitant use of CNS depressants, such as alcohol, and with drugs interfering with the metabolic pathways of benzodiazepines. Considerable interindividual differences in sensitivity to the behavioural effects of benzodiazepines warrant the careful monitoring of patients. Physicians should educate their patients about the risk of traffic accident during benzodiazepine use

[1]  W. Riedel,et al.  A STUDY COMPARING THE HYPNOTIC EFFICACIES AND RESIDUAL EFFECTS ON ACTUAL DRIVING PERFORMANCE OF MIDAZOLAM 15 MG, TRIAZOLAM 0.5 MG, TEMAZEPAM 20 MG AND PLACEBO IN SHIFTWORKERS ON NIGHT DUTY , 1988 .

[2]  J. Lépine,et al.  [Epidemiology of the use of anxiolytic and hypnotic drugs in France and in the world]. , 1996, L'Encephale.

[3]  David Wheatley,et al.  Psychopharmacology of Sleep , 1981 .

[4]  D. Kripke,et al.  Sleep evaluation in chronic insomniacs during 14-day use of flurazepam and midazolam. , 1990, Journal of clinical psychopharmacology.

[5]  N. Muntjewerff,et al.  Considering the P450 cytochrome system as determining combined effects of antidepressants and benzodiazepines on actual driving performance of depressed outpatients , 1997, International clinical psychopharmacology.

[6]  M. Augsburger,et al.  Drugs and alcohol among suspected impaired drivers in Canton de Vaud (Switzerland). , 1997, Forensic science international.

[7]  E. Rüther,et al.  Aspects of driving after hypnotic therapy with particular reference to temazepam , 1986, Acta psychiatrica Scandinavica. Supplementum.

[8]  Suzanne G. Leveille,et al.  Psychoactive Medications and Injurious Motor Vehicle Collisions Involving Older Drivers , 1994, Epidemiology.

[9]  S. Pompéia,et al.  Impairment of performance associated with long-term use of benzodiazepines , 1995, Journal of psychopharmacology.

[10]  S. Golombok,et al.  Cognitive impairment in long-term benzodiazepine users , 1988, Psychological Medicine.

[11]  J. Sheikh,et al.  Anxiety in the elderly. Course and treatment. , 1995, Psychiatric Clinics of North America.

[12]  A. Rothschild.  Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature. , 1992, The Journal of clinical psychiatry.

[13]  M. Eysenck,et al.  Attention and Arousal , 1982 .

[14]  M Linnoila,et al.  Residual effects and skills related to driving after a single oral administration of diazepam, medazepam or lorazepam. , 1976, British journal of clinical pharmacology.

[15]  C. Wright.  Clinical pharmacokinetics of alprazolam extended release: a summary , 1995 .

[16]  P. Cook.  Benzodiazepine hypnotics in the elderly , 1986, Acta psychiatrica Scandinavica. Supplementum.

[17]  M. Linnoila,et al.  Psychomotor Effects of Diazepam in Anxious Patients and Healthy Volunteers , 1983, Journal of clinical psychopharmacology.

[18]  D. Greenblatt,et al.  Current Status of Benzodiazepines , 1983 .

[19]  I. Hindmarch,et al.  Benzodiazepine Receptor Ligands, Memory and Information Processing , 1988, Psychopharmacology Series.

[20]  H Gjerde,et al.  Incidence of alcohol and drugs in fatally injured car drivers in Norway. , 1993, Accident; analysis and prevention.

[21]  A C Gudgeon,et al.  THE EFFECTS OF 1,4 AND 1,5 BENZODIAZEPINES ON ASPECTS OF CAR DRIVING BEHAVIOUR : A PRELIMINARY INVESTIGATION , 1980 .

[22]  A. Pickering,et al.  Lack of cognitive recovery following withdrawal from long-term benzodiazepine use , 1994, Psychological Medicine.

[23]  A. Johan,et al.  Handbook of depression and anxiety : a biological approach , 1995 .

[24]  J Pikkarainen,et al.  Drugs usage of drivers suspected of driving under the influence of alcohol and/or drugs. A study of one week's samples in 1979 and 1993 in Finland. , 1996, Forensic science international.

[25]  E. Volkerts,et al.  HYPNOTICS' RESIDUAL EFFECTS ON DRIVING PERFORMANCE , 1989 .

[26]  R. N. Brogden,et al.  Buspirone: An Updated Review of its Clinical Pharmacology and Therapeutic Applications , 1997 .

[27]  M. Folan,et al.  Coadministration of nefazodone and benzodiazepines: I. Pharmacodynamic assessment. , 1995, Journal of clinical psychopharmacology.

[28]  R Doll,et al.  Minor tranquillisers and road accidents. , 1979, British medical journal.

[29]  H. Moskowitz,et al.  Psychomotor performance in chronic insomniacs during 14-day use of flurazepam and midazolam. , 1990, Journal of clinical psychopharmacology.

[30]  D. Greenblatt,et al.  Sensitivity to triazolam in the elderly. , 1991, The New England journal of medicine.

[31]  W A Ray,et al.  Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. , 1992, American journal of epidemiology.

[32]  C. I. Neutel,et al.  Risk of traffic accident injury after a prescription for a benzodiazepine. , 1995, Annals of epidemiology.

[33]  B. Saletu,et al.  Recent advances in the clinical pharmacology of benzodiazepines part I: Pharmacokinetics , 1987 .

[34]  J F O'Hanlon,et al.  Anxiolytics' effects on the actual driving performance of patients and healthy volunteers in a standardized test. An integration of three studies. , 1995, Neuropsychobiology.

[35]  R. F. Borkenstein,et al.  The role of the drinking driver in traffic accidents (the Grand Rapids study) , 1974 .

[36]  M D Robertson,et al.  Responsibility analysis: a methodology to study the effects of drugs in driving. , 1994, Accident; analysis and prevention.

[37]  L. George,et al.  Benzodiazepine anti-anxiety agents: prevalence and correlates of use in a southern community. , 1991, American journal of public health.

[38]  M. Gold,et al.  Epidemiology of benzodiazepine use and dependence. , 1995 .

[39]  O H Drummer.  DRUGS AND ACCIDENT RISK IN FATALLY-INJURED DRIVERS , 1995 .

[40]  M. Lader,et al.  Alpidem and lorazepam in the treatment of patients with anxiety disorders: comparison of physiological and psychological effects. , 1992, Pharmacopsychiatry.

[41]  J. Manno,et al.  The use of microcomputer-based psychomotor tests for the evaluation of benzodiazepine effects on human performance: a review with emphasis on temazepam. , 1992, British journal of clinical pharmacology.

[42]  I Hindmarch.  Psychomotor function and psychoactive drugs. , 1980, British journal of clinical pharmacology.

[43]  A Smiley,et al.  Effects of minor tranquilizers and antidepressants on psychomotor performance. , 1987, The Journal of clinical psychiatry.

[44]  W. Bickel,et al.  Acute behavioral effects of lorazepam and caffeine, alone and in combination, in humans , 1994, Behavioural pharmacology.

[45]  E. Ellinwood,et al.  Benzodiazepines, the popular minor tranquilizers: dynamics of effect on driving skills. , 1985, Accident; analysis and prevention.

[46]  J. Woods,et al.  Abuse liability of flunitrazepam. , 1997, Journal of clinical psychopharmacology.

[47]  E. Volkerts,et al.  A comparative study of on‐the‐road and simulated driving performance after nocturnal treatment with lormetazepam 1 mg and oxazepam 50 mg , 1992 .

[48]  T. Seppälä,et al.  Development of tolerance and cross-tolerance to the psychomotor actions of lorazepam and diazepam in man. , 1983, British journal of clinical pharmacology.

[49]  K. Goa,et al.  Zopiclone , 1986, Drugs.

[50]  P. Benfield,et al.  Zolpidem , 1990, Drugs.

[51]  T. Roth,et al.  Reversal by caffeine of triazolam-induced impairment of waking function. , 1988, Psychopharmacology series.

[52]  K. Brookhuis,et al.  Repeated dose effects of nitrazepam and temazepam upon actual driving performance , 1985 .

[53]  T. Roth,et al.  Determinants of residual effects of hypnotics. , 1985, Accident; analysis and prevention.

[54]  H-P Krueger,et al.  THE GERMAN ROADSIDE SURVEY 1992-1994. SALIVA ANALYSES FROM AN UNSELECTED DRIVER POPULATION: LICIT AND ILLICIT DRUGS , 1995 .

[55]  J F O'Hanlon,et al.  Methodological guidelines for experimental research on medicinal drugs affecting driving performance: An international expert survey , 1994 .

[56]  E. Volkerts,et al.  Therapeutic Effects and Effects on Actual Driving Performance of Chronically Administered Buspirone and Diazepam in Anxious Outpatients , 1992, Journal of clinical psychopharmacology.

[57]  I. Hindmarch.  The psychopharmacology of clobazam , 1995 .