Posted by Kon on February 13, 2005, at 10:49:04
In reply to What Ever Happened To Valium?, posted by Phillipa on February 10, 2005, at 20:47:50
In the 1980s there were many studies (see below for a sample)comparing valium to the then newer "high-potency" benzos (lorazepam, xanax, clonazepam) and most of the studies suggested somewhat greater efficacy and better side-effect profile of the latter group compared to valium. Much of this research was company-sponsored and some publication bias is likely but I think this is also a reason (among many others)that most usually prescribe the "high potency benzos".
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Neuropsychobiology. 1983;9(2-3):139-41.
Intramuscular lorazepam. A double-blind comparison with diazepam and placebo.Ananth J, Van den Steen N.
In this double-blind, placebo-controlled study, 24 anxiety neurotic patients were randomly assigned equally into the intramuscular placebo, lorazepam or diazepam groups. The results indicated that lorazepam was as effective as diazepam in overall efficacy and was superior to diazepam in certain cluster scores including the Obsessive Compulsive Phobic Cluser of the Wittenborn Psychiatric Rating Scale.
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Acta Psychiatr Belg. 1978 Jul-Aug;78(4):619-34.
Time-blind videotaped evaluation of injectable diazepam, lorazepam and placebo.Bobon DP, Fanielle J, Mormont C, Breulet M, Bobon J.
Eighteen inpatients suffering from a severe anxiety received in double-blind and crossover conditions iv and im injections of 10 mg diazepam, 5 mg lorazepam or saline t.i.d. during 5 days. The morning injections was made iv in a CCTV studio. Before injection and 20 mn after it, the patient filled out a 100 mm Visual Analogue Scale; his doctor-in-charge proceeded to a standard interview and to physiological measurements (tremor of hand, patellar reflexes, blood pressure, pulse rate). The videotaped interviews were randomly, i.e. time-blind, rated by two independent observers on 3 scales: the VAS, the Hamilton Anxiety Scale and an ad hoc Verbal and Non-Verbal Anxiety Scale (VNVA). The statistical analysis was completed by a logical analysis according to Lewis Carroll. The results demonstrate the superiority of lorazepam over diazepam on psychic anxiety, somatic anxiety, sleep and blood pressure, the only significant side-effect being drowsiness.
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Dis Nerv Syst. 1976 Feb;37(2):58-61.
Lorazepam and diazepam in the treatment of neurotic anxiety: a double-blind trial.Valarino F, Perez-Lopez R.
Fifty-eight neurotic patients with intense anxiety were treated with either lorazepam or diazepam in a double blind between-patients trial. Statistical analysis indicated that the two groups were homogeneous before treatment and that the results of treatment were similar for both drugs. According to the global rating of illness week after week, after four weeks of treatment more patients on lorazepam than on diazepam were normal or had mild illness (82.1% vs. 70.8%). In the investigators' judgment, 71.9% of the patients treated with lorazepam had an excellent or good response compared with 56.7+ of those treated with diazepam. The mean reduction in score on the Hamilton Anxiety Scale was 17.7 for lorazepam and 16.5 for diazepam. However, none of the above differences in results were statistically significant. The largest dose of lorazepam required in treatment was 6 mg, compared with 30 mg of diazepam. Two patients treated with lorazepam had side effects, against six with diazepam. Six patients in the diazepam group did not complete the trial, including three who discontinued because of side effects (rash, tremors, agitation); no patients in the lorazepam group dropped out.
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J Clin Psychiatry. 1981 Sep;42(9):347-51.
Multicenter double-blind efficacy and safety study comparing alprazolam, diazepam and placebo in clinically anxious patients.Cohn JB.
Both alprazolam and diazepam were superior to placebo for the treatment of the clinical anxiety syndrome throughout a four-week double-blind multiclinic trial in 976 outpatients. At the fourth-week evaluation of the 845 patients completing the study, the 326 patients receiving alprazolam showed significantly more improvement than the 344 patients receiving diazepam on all 4 anxiety rating scales utilized (Hamilton Anxiety Rating Scale, Physician's Global Assessment, Patient's Global Assessment, and Target Symptoms).
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J Int Med Res. 1980;8(2):139-43.
Anxiolytic efficacy of alprazolam compared to diazepam and placebo.Maletzky BM.
The anxiolytic effects of alpraxolam (0.5--3.0 mg), diazepam (5--60 mg) and placebo were evaluated in eighty-six out-patients suffering from moderate to severe psychoneurotic anxiety in this 28-day, double-blind study. Efficacy was evaluated using five rating instruments, three rated by the physician (Hamilton Anxiety Rating Scale, Physician's Global Impressions and Target Symptoms) and two by the patients (Self-Rating Symptom Scale and Patient's Global Impressions). Alprazolam was more effective than placebo on all five measures of efficacy and, on several parameters, more effective than diazepam as well. The incidence of side-effects was lowest in the alprazolam group and decreased steadily over the course of the study, whereas the incidence in the diazepam and placebo groups remained relatively unchanged.
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Br J Clin Pharmacol. 1985;19 Suppl 1:37S-43S.
A double-blind comparison of alprazolam, diazepam and placebo in the treatment of anxious out-patients.Davison K, Farquharson RG, Khan MC, Majid A.
In a double-blind 28-day comparison of alprazolam, diazepam and placebo, alprazolam 1.5-3 mg/day was of equivalent anxiolytic effect to 15-30 mg diazepam/day and there was some evidence of antidepressant activity by alprazolam, but not diazepam, in neurotic depression. No serious side-effects or laboratory abnormalities were encountered.
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J Clin Psychiatry. 1980 Jul;41(7):245-8.
Alprazolam compared to diazepam and placebo in the treatment of anxiety.Aden GC, Thein SG Jr.
Alprazolam was compared to diazepam and placebo in 235 outpatients suffering from manifest anxiety. In this 28-day double-blind study, alprazolam was more effective than placebo and essentially equivalent to diazepam in alleviating the symptoms of anxiety. However, alprazolam produced a markedly lower incidence of side effects than either diazepam or placebo. Of particular note, drowsiness was reported less than half as frequently by alprazolam patients than by diazepam patients. These results were achieved with an average daily dose of 1.5 mg alprazolam compared to 18.6 mg diazepam.
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Psychopharmacology (Berl). 1983;80(4):308-10.
A double blind comparison of alprazolam, diazepam and placebo in the treatment of anxious out-patients.Davison K, Farquharson RG, Khan MC, Majid A.
The anxiolytic effects of alprazolam, a triazolobenzodiazepine, were evaluated in a double-blind 28-day comparison with diazepam and placebo in 46 out-patients suffering from anxiety states of moderate to severe intensity. Alprazolam 1.5-3 mg per day was found to be of at least equivalent anxiolytic effect to 15-30 mg diazepam per day, and there was evidence of antidepressant activity by alprazolam, but not diazepam, in neurotic depression. Side-effects occurred least often with alprazolam and were minor in nature. Laboratory data showed no changes attributable to alprazolam even in a patient who swallowed 15 capsules (7.5 mg). It was concluded that alprazolam is a safe and effective anxiolytic which is well-tolerated and also shows some antidepressant activity.
poster:Kon
thread:456080
URL: http://www.dr-bob.org/babble/20050212/msgs/457123.html