BENZODIACEPINAS

El uso de las benzodiacepinas en la sintomatologa del vrtigo podra

justificarse por su accin sedante y ansioltica, ya que la liberacin de la
ansiedad que el ataque de vrtigo produce puede contribuir a aliviar la
situacin. No ejercen, por tanto, una verdadera accin antivertiginosa.
Parece ser que mejoran la respuesta emocional del paciente a los acfenos,
aunque se cree que tambin suprimen los acfenos directamente. stos
pueden deberse en algunos pacientes a un efecto insuficiente de la
neurotransmisin inhibitoria en el sistema auditivo ascendente. Las
benzodiacepinas pueden actuar intensificando la actividad del
neurotransmisor inhibitorio GABA; inhiben la actividad en reposo de los
ncleos vestibulares y pueden reducir la actividad en el sistema reticular
activador. Las dosis de benzodiacepinas de duracin intermedia que se
utilizan suelen ser pequeas.

Benzodiazepines
Benzodiazepines are gamma-amino butyric acid (GABA) modulators, acting
centrally to suppress vestibular responses. In small doses, these drugs are
extremely useful. Addiction, impaired memory, increased risk of falling, and
impaired vestibular compensation are their main shortcomings. Lorazepam
is a particularly useful agent because of its effectiveness and simple kinetics.
Addiction, the biggest problem, can usually be avoided by keeping the dose
to 0.5 mg BID or less. Similarly, low doses of diazepam (Valium) (2 mg) can
be quite effective. Clonazepam (Klonopin), appears as effective a vestibular
suppressant as lorazepam. The author prefers to avoid use of alprazolam
(Xanax) for vestibular suppression, because of the potential for a difficult
withdrawal syndrome. Long acting benzodiazepines are not helpful for relief
of vertigo. Peracitam is a derivative of GABA that has a wide range of
neurological effects, including relief of vertigo (Winbald, 2005).

FORMAFARMACUTICAYFORMULACIN:
CadaTABLETAcontiene:
Alprazolam................................................................0.25y2mg
INDICACIONESTERAPUTICAS:ALPRAZOLAMestil
paraeltratamientodelosdiferentescuadrosasociadosconlos
sntomasdeansiedadcomolaneurosisdeansiedad,eltrastornode
pnico,etc.

Ansiedadasociadacondepresin:Estosepuededescribirvariada
mentecomounamezcladeansiedaddepresin,ansiedadasociada
conladepresin.
Trastornosdepnico:Estoincluyelostrastornosdepnicocono
sinagorafobia.
CONTRAINDICACIONES:
ALPRAZOLAMestcontraindicadoenpacientesconsensibilidad
conocidaalasbenzodiacepinas.
Ansiedad:0.75a1.5mgdiarios,administradosendosisdivididas
de0.5a0.75mg.
Trastornosdepnico:0.5a1.0mgadministradosalahorade
dormir,o0.5mgtresvecesalda.Ladosisdebeajustarseala
respuestadelpacienteconincrementosnomayoresde1mg/dacada
3a4das.
Dosisadicionalessepuedenestablecerhastaobtenerunhorariode
tresacuatrovecesalda.(Ladosispromedioenunestudio
multicntricograndefuede5.72.27mg,conpacientes
ocasionalesquerequierenunmximode10mgporda).
We carried out a retrospective survey of 25 years of clinical experience
with the use of clonazepam as a vestibular and tinnitus suppressant in
the pharmacological treatment of vestibular or cochleovestibular
disorders due to different causes. We reviewed the medical records of
3,357 outpatients treated with a 0.5- or 1.0-mg daily dosage of oral
clonazepam during 60-180 days. Complete or substantial control of
vertigo or nonvertiginous dizziness was achieved in 77.4% of the vertigo
patients. Tinnitus was improved in 32.0% of the tinnitus patients. Light
or mild drowsiness, depression, nightmares, or lowering of libido,
reported by 16.9% of the patients as adverse side effects, tended to
subside with continued therapy. We concluded that clonazepam is a very
useful and safe drug for the symptomatic treatment of patients suffering
from cochleovestibular disorders.