Other Therapeutic Uses

OTHER THERAPEUTIC USES

Table 22–2 summarizes several other important clinical uses of drugs in the sedative-hypnotic class. Drugs used in the manage-ment of seizure disorders and as intravenous agents in anesthesia are discussed.

For sedative and possible amnestic effects during medical or surgical procedures such as endoscopy and bronchoscopy—as well as for premedication prior to anesthesia—oral formulations of shorter-acting drugs are preferred.

Long-acting drugs such as chlordiazepoxide and diazepam and, to a lesser extent, phenobarbital are administered in progressively decreasing doses to patients during withdrawal from physiologic dependence on ethanol or other sedative-hypnotics. Parenteral lorazepam is used to suppress the symptoms of delirium tremens.

Meprobamate and the benzodiazepines have frequently been used as central muscle relaxants, though evidence for general effi-cacy without accompanying sedation is lacking. A possible excep-tion is diazepam, which has useful relaxant effects in skeletal muscle spasticity of central origin .

Psychiatric uses of benzodiazepines other than treatment of anxiety states include the initial management of mania and the control of drug-induced hyperexcitability states (eg, phencyclidine intoxication). Sedative-hypnotics are also used occasionally as diagnostic aids in neurology and psychiatry.