Uso crônico de benzodiazepínicos na atenção primária à saúde: a visão dos médicos de um município do nordeste
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Jun 3, 2025
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Resumo
Objetivo: Investigar as opiniões de médicos da atenção primária à saúde (APS) sobre o uso crônico de benzodiazepínicos (BZD), suas atitudes e barreiras para mudar a prática. Métodos: Questionário online aplicado a médicos da APS em uma cidade do nordeste. Resultados: Dos 60 médicos da APS do município, 76,6% responderam. 56,5% do sexo feminino; 47,8% abaixo de 30 anos e 63% não especialistas. Quanto às opiniões, 97,7% concordaram que o uso crônico de BZD é um problema de saúde pública, prejudica a cognição e requer informação sobre dependência. 45,6% consideram que insônia/ansiedade descontrolada causam mais danos que o BZD. Nas atitudes, as terapias preferidas foram ISRS (29%), mudanças no estilo de vida (29%) e terapia psicossocial (24,6%). As principais barreiras: insistência do paciente/cuidador (87,2%), falta de acesso a medidas não farmacológicas (80,4%), preocupação com piora do paciente (41,3%) e falta de tempo (34,8%). Conclusão: O estudo destaca a pressão dos pacientes, restrições de acesso a alternativas terapêuticas e para gerenciar a desprescrição como perpetuadores do uso de BZD.
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Como Citar
FernandesM. E. G., TôrresF. J. de O., DuarteK. C. P., & LimaI. V. M. (2025). Uso crônico de benzodiazepínicos na atenção primária à saúde: a visão dos médicos de um município do nordeste. Revista Eletrônica Acervo Saúde, 25(6), e20566. https://doi.org/10.25248/reas.e20566.2025
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Referências
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9. CAVALCANTE CCL, et al. Prevalência da dispensação de benzodiazepínicos em uma farmácia comunitária de Parnamirim-RN. Journal of Medicine and Health Promotion. 2016 v. 1, n. 2, p. 180–188.
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11. DJATCHE L, et al. How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing? Journal of Clinical Pharmacy and Therapeutics. 2018 Apr 22;43(4):550–5.
12. FARIA JSS, et al. Benzodiazepínicos: revendo o uso para o desuso. Revista de Medicina. 2019 Nov 27;98(6):423–6.
13. FEGADOLLI C, et al. Uso e abuso de benzodiazepínicos na atenção primária à saúde: práticas profissionais no Brasil e em Cuba. Cadernos de Saúde Pública. 2019 Jul 4;35.
14. FONSECA AM, et al. Comparison between two household surveys on psychotropic drug use in Brazil: 2001 and 2004. Ciência & Saúde Coletiva. 2010 May;15(3):663–70.
15. GOLDSCHEN-OHM MP. Benzodiazepine Modulation of GABAA Receptors: A Mechanistic Perspective. Biomolecules. 2022 Nov 30;12(12):1784.
16. ISOMURA K, et al. Factors associated with long-term benzodiazepine and Z-drug use across the lifespan and 5-year temporal trajectories among incident users: a Swedish nationwide register-based study. Eur J Clin Pharmacol. 2023;79(8):1091-1105.
17. KATZMAN MA, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1): S1.
18. LEBLANC M, et al. Psychological and health-related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research. 2007 Aug;63(2):157–66.
19. LEE MH, et al. Trends in prescriptions for sedative-hypnotics among Korean adults: a nationwide prescription database study for 2011-2015. Social Psychiatry and Psychiatric Epidemiology. 2019 Apr 1;54(4):477–84.
20. LO SY, et al. Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff. Drugs & Aging. 2021 Jun 25.
21. MADRUGA CS, et al. Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle. Brazilian Journal of Psychiatry. 2018 Oct 11; 41:44–50.
22. MAUST DT, et al. Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatric Services. 2019 Feb;70(2):97–106.
23. MONDAL H, MONDAL S. Social desirability bias: A confounding factor to consider in survey by self-administered questionnaire. Indian Journal of Pharmacology. 2018;50(3):143.
24. NAPPO SA, et al. Prescription of anorectic and benzodiazepine drugs through notification B prescriptions in Natal, Rio Grande do Norte, Brazil. Brazilian Journal of Pharmaceutical Sciences. 2010 Jun;46(2):297–303.
25. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Generalised anxiety disorder and panic disorder in adults: management Clinical guideline. 2020 Jun. Disponível em: https://www.nice.org.uk/guidance/cg113/resources/generalised-anxiety-disorder-and-panic-disorder-in-adults-management-pdf-35109387756997. Acessado em: 23 de julho de 2024.
26. NEVES IT, et al. Physicians’ beliefs and attitudes about Benzodiazepines: a cross-sectional study. BMC Family Practice. 2019 May 25;20(1).
27. OKUDA S, et al. Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database. BMC Psychiatry. 2023 Apr 20;23(1).
28. RIBEIRO NF. Tratamento da Insônia em Atenção Primária à Saúde. Revista Brasileira de Medicina de Família e Comunidade. 2016 Dec 27;11(38):1–14.
29. RIEMANN D, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research. 2023 Nov 28;32(6).
30. SANTIAGO COA, et al. Perfil do Consumo dos Benzodiazepínicos nos anos de 2019 e 2020 no Brasil e Regiões. Revista Ciência Plural. 2023 Aug 31;9(2):1–19.
31. SESAD - Secretaria Municipal de Saúde de Parnamirim [Internet]. sesad.parnamirim.rn.gov.br. Disponível em: http://sesad.parnamirim.rn.gov.br/unidades.html. Acessado em: 12 de novembro de 2023.
32. TAIPALE H, et al. Incidence of and Characteristics Associated with Long-term Benzodiazepine Use in Finland. JAMA Network Open. 2020 Oct 29;3(10): e2019029.
33. TAKESHIMA M, et al. Attitudes and Difficulties Associated with Benzodiazepine Discontinuation. International Journal of Environmental Research and Public Health. 2022 Nov 30;19(23):15990.
34. WELEFF J, et al. An Analysis of Benzodiazepine Prescribing to Primary Care Patients in a Large Healthcare System from 2019-2020. Journal of psychoactive drugs. 2023 Mar 20;1–12.
35. WICK JY. The history of benzodiazepines. The Consultant Pharmacist: The Journal of the American Society of Consultant Pharmacists. 2013 Sep 28;28(9):538–48.
2. BALDAÇARA L, et al. Brazilian Psychiatric Association guidelines for the treatment of generalized anxiety disorder (GAD). Perspectives on Pharmacological and Psychotherapy approach. Braz J Psychiatry. 2024;46: e20233235.
3. BARDIN, L. Análise de Conteúdo. 3ª reimpressão da 1ª Edição de 2016. São Paulo: Edições 70, 2016.
4. BIGAL, AL, NAPPO, SA. Prescrição de benzodiazepínicos em Unidades Básicas de Saúde em uma comunidade com alta vulnerabilidade social. Saúde em Debate. 2024 Jun 1;48(141).
5. BRANDT J, et al. Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review. EClinical Medicine. 2024 Apr 1; 70:102507–7.
6. BUŽANČIĆ I, ORTNER HADŽIABDIĆ M. Development and Validation of Comprehensive Healthcare Providers’ Opinions, Preferences, and Attitudes towards Deprescribing (CHOPPED Questionnaire). Pharmacy. 2022 Jul 1;10(4):76.
7. BUŽANČIĆ I, ORTNER HADŽIABDIĆ M. Differences in Factors Influencing Deprescribing between Primary Care Providers: Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2023 Mar 11;20(6):4957.
8. CAMARGO BM de O, et al. Uso de benzodiazepínicos na Atenção Primária à Saúde (APS). Revista de Medicina. 2023 Feb 6;102(esp):e–203871.
9. CAVALCANTE CCL, et al. Prevalência da dispensação de benzodiazepínicos em uma farmácia comunitária de Parnamirim-RN. Journal of Medicine and Health Promotion. 2016 v. 1, n. 2, p. 180–188.
10. DELAŠ AŽDAJIĆ M, et al. Prescription pattern and prevalence of benzodiazepine use among elderly patients. Asian Journal of Psychiatry. 2021 Jan; 55:102514.
11. DJATCHE L, et al. How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing? Journal of Clinical Pharmacy and Therapeutics. 2018 Apr 22;43(4):550–5.
12. FARIA JSS, et al. Benzodiazepínicos: revendo o uso para o desuso. Revista de Medicina. 2019 Nov 27;98(6):423–6.
13. FEGADOLLI C, et al. Uso e abuso de benzodiazepínicos na atenção primária à saúde: práticas profissionais no Brasil e em Cuba. Cadernos de Saúde Pública. 2019 Jul 4;35.
14. FONSECA AM, et al. Comparison between two household surveys on psychotropic drug use in Brazil: 2001 and 2004. Ciência & Saúde Coletiva. 2010 May;15(3):663–70.
15. GOLDSCHEN-OHM MP. Benzodiazepine Modulation of GABAA Receptors: A Mechanistic Perspective. Biomolecules. 2022 Nov 30;12(12):1784.
16. ISOMURA K, et al. Factors associated with long-term benzodiazepine and Z-drug use across the lifespan and 5-year temporal trajectories among incident users: a Swedish nationwide register-based study. Eur J Clin Pharmacol. 2023;79(8):1091-1105.
17. KATZMAN MA, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1): S1.
18. LEBLANC M, et al. Psychological and health-related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research. 2007 Aug;63(2):157–66.
19. LEE MH, et al. Trends in prescriptions for sedative-hypnotics among Korean adults: a nationwide prescription database study for 2011-2015. Social Psychiatry and Psychiatric Epidemiology. 2019 Apr 1;54(4):477–84.
20. LO SY, et al. Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff. Drugs & Aging. 2021 Jun 25.
21. MADRUGA CS, et al. Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle. Brazilian Journal of Psychiatry. 2018 Oct 11; 41:44–50.
22. MAUST DT, et al. Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatric Services. 2019 Feb;70(2):97–106.
23. MONDAL H, MONDAL S. Social desirability bias: A confounding factor to consider in survey by self-administered questionnaire. Indian Journal of Pharmacology. 2018;50(3):143.
24. NAPPO SA, et al. Prescription of anorectic and benzodiazepine drugs through notification B prescriptions in Natal, Rio Grande do Norte, Brazil. Brazilian Journal of Pharmaceutical Sciences. 2010 Jun;46(2):297–303.
25. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Generalised anxiety disorder and panic disorder in adults: management Clinical guideline. 2020 Jun. Disponível em: https://www.nice.org.uk/guidance/cg113/resources/generalised-anxiety-disorder-and-panic-disorder-in-adults-management-pdf-35109387756997. Acessado em: 23 de julho de 2024.
26. NEVES IT, et al. Physicians’ beliefs and attitudes about Benzodiazepines: a cross-sectional study. BMC Family Practice. 2019 May 25;20(1).
27. OKUDA S, et al. Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database. BMC Psychiatry. 2023 Apr 20;23(1).
28. RIBEIRO NF. Tratamento da Insônia em Atenção Primária à Saúde. Revista Brasileira de Medicina de Família e Comunidade. 2016 Dec 27;11(38):1–14.
29. RIEMANN D, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research. 2023 Nov 28;32(6).
30. SANTIAGO COA, et al. Perfil do Consumo dos Benzodiazepínicos nos anos de 2019 e 2020 no Brasil e Regiões. Revista Ciência Plural. 2023 Aug 31;9(2):1–19.
31. SESAD - Secretaria Municipal de Saúde de Parnamirim [Internet]. sesad.parnamirim.rn.gov.br. Disponível em: http://sesad.parnamirim.rn.gov.br/unidades.html. Acessado em: 12 de novembro de 2023.
32. TAIPALE H, et al. Incidence of and Characteristics Associated with Long-term Benzodiazepine Use in Finland. JAMA Network Open. 2020 Oct 29;3(10): e2019029.
33. TAKESHIMA M, et al. Attitudes and Difficulties Associated with Benzodiazepine Discontinuation. International Journal of Environmental Research and Public Health. 2022 Nov 30;19(23):15990.
34. WELEFF J, et al. An Analysis of Benzodiazepine Prescribing to Primary Care Patients in a Large Healthcare System from 2019-2020. Journal of psychoactive drugs. 2023 Mar 20;1–12.
35. WICK JY. The history of benzodiazepines. The Consultant Pharmacist: The Journal of the American Society of Consultant Pharmacists. 2013 Sep 28;28(9):538–48.