Dependence liability of lormetazepam: are all benzodiazepines equal? The case of the new i.v. lormetazepam for anesthetic procedures

• Published in: Journal of Neural Transmission 2020-08, Vol.127 (8), p.1107-1115
• Main Author: Horowski, Reinhard
• Format: Article
• Language: English
• Subjects: Anesthetics; Anti-Anxiety Agents; Benzodiazepines - adverse effects; Humans; Lorazepam - analogs & derivatives; Male; Medicine; Medicine & Public Health; Neurology; Neurosciences; Psychiatry; Psychiatry and Preclinical Psychiatric Studies - Review; Psychiatry and Preclinical Psychiatric Studies - Review Article
• ISSN: 0300-9564; 1435-1463
• DOI: 10.1007/s00702-020-02209-8

There are contradictory publications and reports regarding the dependence liability of the 3-hydroxy-benzo-1,4-diazepine derivative lormetazepam, one of the most often prescribed hypnotic benzodiazepines which is now also available as an intravenous (i.v.) product for anesthetists. The author was involved in the preclinical and subsequently in the clinical development and post-marketing surveillance of lormetazepam. Here, he reviews the published and unpublished data about lormetazepam dependence and proposes explanations for contradictory views from other authors. On this basis and in contrast to class labeling from regulatory bodies and WHO, the author comes to the conclusion that use of lormetazepam definitely carries a lower risk of inducing dependence and causing abuse than most other benzodiazepines. This applies as well to Sedalam ® , the new i.v. application form of lormetazepam, which is much better tolerated than propofol. Because of its pharmacokinetic properties and because all its effects can be fully antagonized with the benzodiazepine antagonist flumazenil, this innovative intravenous application form of lormetazepam provides an excellent method for premedication, symptomatic treatment of excitation and anxiety in the context of surgical or diagnostic procedures including outpatient interventions and for basic sedation during anesthesia.