苯二氮䓬類藥物戒斷症候群

苯二氮䓬類藥物戒斷症候群又稱苯二氮卓戒斷症候群（英語：Benzodiazepine withdrawal syndrome），通常縮寫為苯並戒斷（benzo withdrawal）或BZD戒斷（BZD withdrawal） ，是指服用苯二氮䓬類藥物（可能因醫療原因或娛樂性原因用藥）並產生生理依賴性後，減少用量或停藥時產生的藥物戒斷症狀。覓藥行為或按處方服藥均可能導致生理依賴性與藥物成癮（或二者之一）以及因此產生的戒斷症狀。某些症狀可能持續數年。苯二氮䓬類藥物戒斷症候群的顯著特徵症狀包括：睡眠障礙、易怒、緊張焦慮、恐慌發作、手顫、發抖、出汗、難以集中精神、意識混亂和認知障礙、記憶減退、噁心乾嘔、體重下降、心悸、頭痛、肌肉疼痛僵硬、知覺變化、幻覺、癲癇發作、思覺失調^[1]以及自殺^[2][3]。此外，這些症狀可能時好時壞，每日或每周的嚴重程度不一，而不是持續穩定好轉。^[4]

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苯二氮䓬類藥物戒斷症候群
類型	戒斷狀態[*]、苯二氮䓬類藥物依賴性
分類和外部資源
醫學專科	精神病學
ICD-10	F13.3（持續用藥後）

苯二氮䓬類戒斷症狀可能很嚴重，症狀複雜且常常長期持續。^[5][6]長期使用苯二氮䓬類（即每日用藥，持續至少三個月）^[7]可能有更高的藥物依賴風險^[8]，亦可能造成用量增加、藥效降低、增加事故和摔倒的概率（尤其是老年人），^[9]還可能與認知、^[10]神經系統和智力損傷有關^[11]。因此不宜長期使用苯二氮䓬類藥物。^[8]將苯二氮䓬類藥物作為短效安眠藥使用，在入睡時可能有效，但可能因戒斷反應而導致後半段睡眠質量不佳。^[12]儘管如此，對於長期服用苯二氮䓬類藥物者，不應違背其意願強迫停藥。^[5]

苯二氮䓬類戒斷可能有重症反應，甚至產生癲癇發作等危及生命的症狀，^[13]尤其是突然戒斷或減量過快的大劑量或長期用藥者。^[5]然而逐步減量或相對用量較少的短期用藥者亦可能出現重症戒斷反應，^[14]在動物模型中甚至曾有單次大劑量用藥後戒斷出現重症反應。^[15][16]少數人會出現遷延性戒斷症狀（英語：post-acute-withdrawal syndrome），症狀可能在戒斷後數月甚至數年內持續，維持在亞急性狀態。緩慢而逐步的減少藥物用量能使遷延性戒斷症狀的出現概率儘可能降低。^[17]

長期使用苯二氮䓬類藥物會導致神經適應，降低藥物效果，造成耐受和依賴。^[18]即使是持續服用治療劑量期間，長期使用苯二氮䓬類藥物亦可能引起類似戒斷反應的症狀，尤其是在服藥間隔期。^[19]停藥或減少用量後，用藥者即會出現藥物戒斷症狀，直至其生理適應恢復。^[20]這些反跳症狀（英語：Rebound effect）可能與最初服藥前的病症相同，亦可能是戒斷症候群的一部分。^[21]在重症病例中，戒斷反應可能會惡化，或與嚴重的精神疾病相似，如狂躁、思覺失調症，尤其在大劑量用藥者中還會出現癲癇重積狀態。^[22]若不能正確診斷出戒斷症候群，可能會誤診為服藥前的疾病復發而需要繼續用藥，導致戒斷失敗、重新開始用藥，而重新用藥往往比之前的劑量更大。^[22]

提高戒斷成功率的方法包括：提升對戒斷反應的意識，針對用藥者的戒斷反應嚴重程度而制定個人化的逐步戒斷方法，以及增加其他替代方法輔助，如使用藥者安心、參加苯二氮䓬類藥物戒斷互助小組。這些方法都能有效提高戒斷的成功率。^[23][24]

症狀和體徵

地西泮，其2毫克與5毫克片劑常用於治療苯二氮䓬類戒斷反應^[25]

氯二氮平（英語：Chlordiazepoxide），其5毫克膠囊劑有時可作為地西泮的替代藥物，用於治療苯二氮䓬類戒斷反應。氯二氮平與地西泮都有較長的消除半衰期和長效活性代謝產物

苯二氮䓬類、巴比妥類等鎮靜安眠藥物或酒精成癮者在停用後會產生嚴重的戒斷反應症狀。《臨床成人精神醫學手冊》顯示這些戒斷症狀比鴉片類藥物的戒斷症狀更嚴重、危害更大。^[26]使用者在停藥時一般甚少獲得相關建議和支持。^[27]一些戒斷症狀與用藥治療之前的病症相同，^[21]可能症狀嚴重或長期持續。半衰期較長的苯二氮䓬類藥物可能在停用長達三周之後才會出現戒斷反應，而半衰期較短的藥物則較早出現戒斷反應，一般在停用24-48小時後即會出現。^[28]不同劑量用藥者的戒斷症狀種類可能沒有重大差異，但大劑量用藥者的症狀嚴重程度往往更高。^[29]

在用藥量減少時，服藥者可能會首次出現戒斷反應，包括失眠、焦慮、痛苦、體重下降、暈眩、夜汗、肌肉抽搐、恐慌發作、抑鬱、失實症、偏執等。這些症狀更常見於短效苯二氮䓬類停藥時，例如三唑侖等藥物。^[22][30]日間症狀可能在夜間用藥給藥數日至數周后出現，^[31][32]亦可能出現於佐匹克隆等Z藥物使用者。^[33]即使是間歇服用苯二氮䓬類，^[34]亦可能在戒斷後出現失眠症狀反彈，可能比服藥前更加嚴重。^[35][36]

逐步或突然減少藥量可能出現下列症狀：

• 靜坐不能
• 激動、焦慮，^[25]可能有驚恐及恐慌發作^[1][37]
• 視力模糊^[37]
• 胸痛^[37]
• 人格解體^[38]
• 抑鬱（可能嚴重），^[39]甚至有自殺念頭^[2][3]
• 失實症^[40]
• 瞳孔放大^[22]
• 頭暈^[37]
• 口乾^[37]
• 煩躁^[41][42]
• 血壓升高，^[43]或高血壓^[44]
• 疲勞、虛弱^[37]
• 胃腸功能紊亂（包括噁心、腹瀉、嘔吐等）^{[45][46][46][47]}
• 聽覺障礙^[37]
• 頭痛^[1]
• 潮熱、發冷^[37]
• 嗅覺過敏（英語：Hyperosmia）^[48]
• 入睡前幻覺（英語：Hypnagogia）^[17]
• 疑病症^[37]
• 觸覺敏感度增強^[40]
• 排尿頻率增加^[37]
• 失眠^[45]
• 記憶力和專注力受損^[1][37]
• 食欲不振、體重下降^[49]
• 輕微至中度失語症^[48]
• 情緒波動^[37]
• 肌肉痙攣、抽筋、不適或肌束震顫（英語：fasciculation）^[50]
• 夢魘^[45]
• 強迫症^[51][52]
• 感覺異常（英語：Paraesthesia）^{[37][40][48][5][53]}
• 偏執^[48]
• 出汗^[1]
• 畏光^[48]
• 姿位性低血壓^[45]
• 快速動眼期睡眠反彈（英語：REM sleep rebound）^[54]
• 不寧腿症候群^[24]
• 關節僵硬^[37]
• 味覺和嗅覺障礙^[37]
• 心跳過速^[55]
• 耳鳴^[56]
• 顫抖^[57][58]
• 視覺障礙^[40]

迅速停藥可能會引發更嚴重的症狀：

• 緊張性抑鬱障礙，可能致死^[59][60][61]
• 意識錯亂（英語：Confusion）^[25]
• 癲癇發作，^[25]可能致死^[62][63]
• 昏迷^[64]（罕見）
• 震顫性譫妄^[65][66][66]
• 高熱^[45]
• 狂躁^[67][68]
• 抗精神藥物惡性症候群（英語：Neuroleptic malignant syndrome）類似表現^[69][70]（罕見）
• 器質性腦病症候群（英語：Organic brain syndrome）^[71]
• 創傷後壓力症候群^[24]
• 思覺失調^[72][73]
• 自殺意念（英語：Suicidal ideation）^[74]或自殺^[2][3]
• 暴力、攻擊行為^[37][75]

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