Understanding the pharmacokinetics of anxiolytic drugs

Alfredo Carlo Altamura, Donatella Moliterno, Silvia Paletta, Michele Maffini, Massimo Carlo Mauri, Silvio Bareggi

Research output: Contribution to journalArticle

Abstract

Introduction: Anxiety disorders are considered the most common mental disorders and they can increase the risk for comorbid mood and substance use disorders, significantly contributing to the global burden of disease. For this reason, anxiolytics are the most prescribed psychoactive drugs, particularly in the Western world. Areas covered: This review aims to analyze pharmacokinetic profile, plasma level variations so as the metabolism, interactions and possible relation to clinical effect of several drugs which are used primarily as anxiolytics. The drugs analyzed include benzodiazepines, anticonvulsants (pregabalin, gabapentin), buspirone, β-blockers and antihistamines (hydroxyzine). Regarding the most frequently used anxiolytic benzodiazepines, data on alprazolam, bromazepam, chlordesmethyldiazepam, chlordiazepoxide, clotiazepam, diazepam, etizolam, lorazepam, oxazepam, prazepam and clonazepam have been detailed. Expert opinion: There is a need for a more balanced assessment of the benefits and risks associated with benzodiazepine use, particularly considering pharmacokinetic profile of the drugs to ensure that patients, who would truly benefit from these agents, are not denied appropriate treatment. An optimal pharmacological approach involving an integrative pharmacokinetic and pharmacodynamic optimization strategy would ensure better treatment and personalization of anxiety disorders. So it would be desirable for the development of new anxiolytic drug(s) that are more selective, fast acting and free from the unwanted effects associated with the traditional benzodiazepines as tolerance or dependence.

Original languageEnglish
Pages (from-to)423-440
Number of pages18
JournalExpert Opinion on Drug Metabolism and Toxicology
Volume9
Issue number4
DOIs
Publication statusPublished - Apr 2013

Keywords

  • Anticonvulsants
  • Anxiolytic drugs
  • Benzodiazepines
  • Pharmacokinetics

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology

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