Pharmacopsychiatry 1993; 26(4): 107-113
DOI: 10.1055/s-2007-1014353
© Georg Thieme Verlag KG Stuttgart · New York

Benzodiazepine Substitution in Medical Practice

Analysis of Pharmacoepidemiologic Data Based on Expert Interviews*Die Substitution von Benzodiazepinen in der ärztlichen Praxis. Pharmakoepidemiologische Analysen auf der Basis von ExpertenbefragungenM.  Linden , H.  Gothe
  • Outpatient Research Group at the Department of Psychiatry, Free University of Berlin, Berlin, Germany
* This Study was partly funded by WHO, Programme on Substance Abuse, Geneva, and supported by the Scientific Institute of General Health Insurance (WIdO), Bonn, Germany. This article is dedicated to Professor Hanfried Helmchen on the occasion of his 60th birthday.
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Publication History

Publication Date:
13 March 2008 (online)


Pharmacoepidemiologic data have shown a consistent reduction in benzodiazepine (BZ) prescriptions over the past decade. The question remains as to whether BZs are simply put aside or whether other medications are used as substitutes. Expert interviews, at which a stratified sample of 114 psychiatrists, internists, and general practitioners were presented with case studies, were conducted to learn about the therapeutic alternatives in the field of benzodiazepine-related indications administered in daily practice. These results were used to analyze trends in pharmacoepidemiologic prescription data for all patients under the general health insurance plan from 1981 to 1988. The experts identified distinct alternatives to BZs in different clinical situations, including neuroleptics, antidepressants, phytotherapeutics, and analgesics. When these findings were transferred to pharmacoepidemiologic data, results revealed an increase in the prescription of alternative medications that apparently compensated for reduced BZ use. Overall there was no change (or, rather, no increase) in the total of psychotropic prescriptions during the period of reduced BZ prescriptions. Our findings indicate that reduction in benzodiazepines prescription is associated with substitution by various other psychotropic drugs. This has positive as well as negative consequences, and there must be discussed in detail before sound recommendations can be given as to which type of drug. BZs included, is the best choice in which type of illness.


Pharmakoepidemiologische Daten deuten auf einen Rückgang in der Verordnungshäufigkeit von Benzodiazepinen hin. Offen bleibt, ob dies ein Verzicht auf Verordnungen insgesamt bedeutet oder ob andere Medikamente an deren Stelle treten. Einer stratifizierten Stichprobe von 114 Psychiatern, Internisten und Allgemeinärzten wurden Kasuistiken vorgelegt mit der Frage, welche Alternativen sie an Stelle von Benzodiazepinen in diesen Fällen verordnen würden. Als wichtigste Benzodiazepinalternativen wurden Neuroleptika, Antidepressiva, Phytotherapeutika und Analgetika genannt. Die Ergebnisse wurden zur Grundlage für pharmakoepidemiologische Analysen auf der Basis des GKV-Index von 1981-1988 benutzt. Die Ergebnisse zeigen, daß der Rückgang in den Benzodiazepinverordnungen durch vermehrte Verordnung der Alternativen voll kompensiert wird. Dies hat positive wie negative Folgen, die in einer Kosten-Nutzen-Analyse berücksichtigt werden müssen, wenn Empfehlungen für den Umgang mit Benzodiazepinen ausgesprochen werden.