It is, by far, the most dispensed active principle and with the greatest participation in the psychoactive drug market. The most popular, the most consumed and the one that always -and without any exception- should be sold in pharmacies under filed prescription. It belongs to the group of benzodiazepines, which have an anxiolytic, hypnotic and antiepileptic effect. Cristina Renteli has been taking it for several years, when she just turned 75, to combat insomnia. Also Susana Caldas, Cristina’s friend, to calm her general anxiety and “appease”, as she says, the panic attacks caused by the vertiginous syndrome that has afflicted her for two years.
Clonazepam, in different doses and presentations from up to four different laboratories, was the active pharmaceutical ingredient (API) with the highest participation among the hundred most dispensed psychotropic drugs during the past year, according to data from the latest survey carried out by the Observatory of Health, Medicines and Society of the Argentine Pharmaceutical Confederation (COFA), which carries out studies and research on the drug market and its evolution, such as the number of units sold each year, Average prices and their variations. The observatory, which started up in 2001, is currently coordinated by Dr. Laura Raccagni, and all publications can be freely consulted on its website.
Psychopharmaceuticals: the top 5 best sellers
According to that report, the annual dispensation of psychotropic drugs in 2022 reached 52,943,888 units. Compared to 2021, there was a retraction of -2.77%, which translates into 1,507,336 fewer units. On the other hand, and within the medicines that act on the central nervous system, psychoactive drugs represent 41% of that segment; while if the incidence that they have within the total drug market is analyzed, the percentage is 6.7 percent.
In a ranking that lists the most prescribed active pharmaceutical ingredients (APIs) over the past year, behind clonazepam (with more than 10 million units dispensed) appear on alprazolam (with 6,325,630 units); he lorazepam (1,160,774 units); he zolpidem (1,411,000 units) and sertraline (1,171,693 units).
Benzodiazepines decrease neuronal excitability and, according to the experience of specialists, They have been used for decades as a treatment for various conditionsfrom generalized anxiety, phobias, obsessive compulsive disorders, certain psychiatric emergencies such as psychomotor agitation or personality disorders and insomnia. However, experts warn that prolonged use is risky.
Clonazepam and other anxiolytics: dispense “a mansalva”
Within psychoactive drugs, experts in pharmacy and psychiatry explain, benzodiazepine anxiolytics are those that end in “pam”, such as the famous clonazepam, which began to be marketed in the country almost 50 years ago, but which gained increasing prominence in the last three decades.
Source: Observatory of Medicines, Health and Society of COFA.
Dr. Elsa Costanzo is head of the Psychiatry service in the adult and child and adolescent area of the Fleni Institute, and explains -among other reasons- that the “mansalva” dispensation of anxiolytics was supported by the rapid sensation of calm that they generate in the patientalmost automatically. However, he warns that its sustained use over time has potentially serious consequences, such as tolerance, withdrawal and dependence.
“Mass prescription responds, in large part, to the ‘safety’ that this drug apparently offers. But its chronic use produces, among other adverse effects already mentioned, serious memory disorders, predisposes to falls, especially in older adults, and it is something that we see very often in our offices,” warns Costanzo, and draws attention to the indication -unwise- of clonazepam for anxiety disorders, depression or insomnia.In the latter case, for example, although anxiolytics are “good hypnotics” because they make the person who takes them fall asleep and not respond to external or internal stimuli, generate tolerance (that is, habituation to the dose, requiring an increase in the dose to obtain the same effect) and dependence (both physical and psychological) if administered for a long time. A habit that, according to Dr. Costanzo, happens too often.
“Something similar occurs with panic attacks or depression. Clonazepam can be indicated to treat the acute episode, the crisis, but then an antidepressant must be prescribed, which today are safe and widely tested drugsas in the case, for example, of Sertraline”, reports the expert.
Experts recommend increasing serotonin levels
Now, why don’t people abuse sertraline? Costanzo retorts. “Because it is a drug that, approximately, takes a month to take effect. It is an antidepressant whose action consists in the recovery of serotonin levels (which helps to maintain mental balance)”.
In other words, and to bring the concept down to a more everyday health picture, the head of the Fleni Psychiatry service, a center specializing in neurology, neurosurgery and rehabilitation, makes the following analogy: “It could be said that clonazepam is something like such as ibupirac or paracetamol, they go to them to quickly alleviate the symptom; while sertraline would be the antibiotic, which must be correctly indicated”.
As president of COFA, Ricardo Presenti analyzes the report, and in reference to the decrease in units registered last year, compared to 2021, establishes a relationship with the deterioration in sleep hygiene caused by the habit disorder that caused the confinement lived during the pandemic. “The market between one year and the next is stabilized, although there were more units dispensed during 2021 than 2022. This can be related to the disorder in people’s habits as a result of isolation. The home office was a critical point in many cases, which modified the routines and unbalanced the habits of eating, sleeping and resting. That is why the prescription of psychotropic drugs rose, in part,” explains the expert.
Source: Observatory of Medicines, Health and Society of COFA.
Patients who do not consult and self-medicate: the warning of specialists
Costanzo also makes his contribution on the consequences of the pandemic on mental health. “The figures of the World Health Organization show the evolution of mental illnesses, which increased their prevalence by 25 percent”. In addition, due to the isolation and the health emergency caused by Covid-19, there were many people who stopped being treated, who did not consult and opted for self-medication.
From the consultations that the psychiatrists of the Fleni Institute receive daily, an increase in what is called refractory psychiatric pathology is also verified. “This means that the one who was well got bad, and the one who was bad is now worse, and it may even be that this patient does not improve with the usual treatments. At Fleni we have the pharmacological and non-pharmacological tools necessary to give the appropriate response to each particular case. Mental pathology, like the virus that caused the pandemic, has also become more resistant,” concludes Costanzo.
