Lippincott Williams & Wilkins, Apr IM ATIVAN is not preferred in the treatment of status epilepticus because therapeutic lorazepam levels may not be reached as quickly as with IV administration. 5w)s{ The https:// ensures that you are connecting to the For children less than 51 kg, the starting dose is 3 mg daily, and the dose can be increased to the maximum dose of 6 mg/day after a week. (=2.5mg) Example: A patient has been taking 1 mg lorazepam PO (equivalent to 2.5 mg subcut midazolam) + used 7 nasal sprays of midazolam in last 24 hours (equivalent to 3.5 mg subcut . Do not shake vigorously, as this will result in air entrapment. A Johns Hopkins Guides subscription is required to, Side effects of both first- and second-generation antipsychotics are due to antagonism at histamine, muscarinic, and alpha-adrenergic receptors. Crit Care Med. Lortab), Increased aripiprazole levels and risk of QTc prolongation, If used in addition to a CYP 2D6 inhibitor, reduce aripiprazole dose to one fourth of the usual dose, Increased risperidone levels and risk of QTc prolongation, Clozapine, iloperidone, ziprasidone ketoconazole+, Increased levels of antipsychotic and risk of QTc prolongation, Increased risk of cardiorespiratory depression, Avoid use of parenteral benzodiazepines and IM olanzapine, Aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone metoclopramide (Reglan)+, Increased risk of extrapyramidal symptoms and neuroleptic malignant syndrome, Clozapine, Iloperidone nelfinavir (Viracept)+, Increased levels of nelfinavir and risk of QTc prolongation, If necessary, reduce quetiapine dose to one sixth of the usual dose, Asenapine, clozapine, iloperidone, paliperidone, quetiapine, risperidone, ziprasidone - pimozide (Orap)+, Clozapine, ziprasidone - saquinavir (Invirase)+, Increased quetiapine levels and risk of QTc prolongation, Increased simvastatin levels and risk of myopathy or rhabdomyolysis, If necessary, monitor for signs and symptoms of myopathy or rhabdomyolysis, Ziprasidone tacrolimus (Prograf, Hecoria)+, Aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, risperidone, ziprasidone tapentadol (Nucynta), Start tapentadol at one third to one half the usual starting dose, Aripiprazole, clozapine, iloperidone, paliperidone, quetiapine, risperidone, ziprasidone - thioridazine (Mellaril)+, Lurasidone strong CYP 3A4 inducers+ [phenytoin (Dilantin), carbamazepine (Tegretol), etc. <>>>
Inclusion Criteria for IV to PO Conversion: Infections that Require IV Antibiotics Must satisfy below criteria: Tolerate oral diet or enteral nutrition and/or receiving oral medications Infection does not require IV antibiotics Afebrile (< 100.4F in the last 24 hours) Received 24 hours of IV antibiotics CAREFULLY BEFORE While barbiturates do share similar pharmacology to benzodiazepines, they have a more concerning safety profile with a higher incidence of respiratory depression. table and the importance of viewing the tabulated data as National Library of Medicine All psychotropic agents can cross into the breast milk to some extent. The maximum dose is 900 mg total daily. Drug Usual IV Dose* Approximate PO Dose* PO to IV Considerations/Comments Reference digoxin 0.1 -0.4 mg IV Q 24 H 0.125 -0.5 mg PO Q 24 H Oral bioavailability about 80% for tablets and liquid 1,2 dimenhyDRINATE 25-50 mg IV 25-50 mg PO Conversion of IV to PO is 1:1 % l`T(WR7U z;J(6z)F82>B1h 6d:V@4=mO
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HvDovm3W[7, BZ&Ap^b?UC@60ak Patient demographics, benzodiazepine dose escalations, as needed benzodiazepine requirements, and severe adverse events within 48 hours of conversion were assessed. The shorter half-life of lorazepam and the absence of active . A guide for effective dosing. 33 to 50 percent reduction in dose compared to the calculated Atypical antipsychotics in the treatment of posttraumatic stress disorder. %PDF-1.5
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Conclusions: "Second-Generation Neuroleptics.". The dose of ATIVAN should be reduced by 50% when coadministered with probenecid or valproate (see PRECAUTIONS, Drug Interactions). Results of a randomized, double-blind, placebo-controlled efficacy and safety study. minimizing side-effects. Diazepam: 20-80 hours. Pain. American Society of Health System Pharmacists;2010. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening. We'll also compare some of the most popular anxiolytic medicines (drugs reducing anxiety), their side effects, and their applications. This calculator applies to adult patients without dependency for benzodiazepines or alcohol. In adults, choice of benzodiazepine . This points out the inherent dangers of using an equianalgesic Lowinson and Ruiz's Substance Abuse: Our benzo calculator uses the first mentioned and most popular option duration. Many experts recommend - depending on age and The treatment of status, however, requires far more than the administration of an anticonvulsant agent. Aripiprazole: Dosing has not been established for certain age groups depending on the disorder: Less than 6 years of age for autistic disorder, less than 10 years of age for bipolar disorder, and less than 13 years of age for schizophrenia. estimated difference between any two opiates could vary widely. Cookie Preferences, Calcs that help predict probability of a disease, Subcategory of 'Diagnosis' designed to be very sensitive, Disease is diagnosed: prognosticate to guide treatment. However, when an intravenous port is not available, the IM route may prove useful (see CLINICAL PHARMACOLOGY, Pharmacokinetics and Metabolism). Clozapine, but not haloperidol, enhances glial D-serine and L-glutamate release in rat frontal cortex and primary cultured astrocytes. A Comprehensive Textbook. Quetiapine: Safety and efficacy is not established in children younger than 10 years. Mercadante -. TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. To view other topics, please log in or purchase a subscription. These include (1) newer concepts of antimicrobial pharma-codynamic action and the realiza-tion that this can be achieved by oral agents, (2) the advent of newer, more potent, broad-spec-trum oral agents that achieve high- Use of IM olanzapine with IM lorazepam can increase the risk of cardiorespiratory depression, Invega Sustenna is given in the deltoid initially, because plasma concentrations are 28% higher with deltoid injections verses gluteal injections. Ziprasidone, a new atypical antipsychotic drug. This incomplete Also remove sticky note when IV to po is addressed. Fudin J, Marcoux MD, Fudin JA. Based on the Ayonrinde method above. endobj
Other dosage forms, with a bioavailability of >90%, are assumed to have complete bioavailability for calculation purposes. Risperidone augmentation in the treatment of severe adolescent OCD in SSRI-refractory cases: a case-series. 1 0 obj
Morley J, Makin M. The use of methadone in cancer Mathematical Do not use if solution is discolored or contains a precipitate. All patients age 6 months to 18 years who received continuous midazolam for 5 days or longer while mechanically ventilated for 5-21 days and were then converted to either enteral diazepam or lorazepam following extubation (or return to baseline ventilator settings in tracheostomy-dependent patients) between January 1, 2015, and June 30, 2016. Cambridge University Press, Jan 24, 2008 - All Rights Reserved. Single The rate of injection should not exceed 2.0 mg per minute. . The maximum dose is 12 mg twice a day. When used as a pre-medication before dental or general surgery the dose is taken the night before the operation and a second dose one to two hours before the procedure. LV>T6If7>LYJTgJ^kyf>[7Sz]>mCh^3r3a2Lmm$9_5y/;D|s
}3a7+NGv46p?MISiZ?dV?pmSosEIN.6DLY}%OL!+Cuf^C;\EvwgOv|2> V,>1w|>>O[[ej,UdSg,ufiEI'&c3Y_$x_'Ifm9s;KY|{AuLTiv[V>n~>r`-@Z(^++Gj~Stsz|6jmm/1dEIz$+ZE7c0rw@GRt=%K2*#g`9'Jp?Hol+c/1K6//1-=d#~t*8t)~H0E>ue)'U'$L 8600 Rockville Pike This will tend to lower the Continuous infusions of lorazepam, midazolam, and propofol for sedation of the critically ill surgery trauma patient: a prospective, randomized comparison. Thereafter, the dose can be increased by 5 mg every 2 days, up to a maximum of 30 mg daily. -L one may ask; cont. NCI CPTC Antibody Characterization Program. Medically reviewed by Drugs.com. Click here to start from scratch and enter your own patient data. Maglione M, et al., Off-Label Use of Atypical Antipsychotics: An Update. We prefer lorazepam ( Ativan) or oxazepam (Serax) for the treatment of patients with advanced cirrhosis or acute alcoholic hepatitis. The starting dose is 12.5 mg daily, increased 25 mg/day to the usual target dose of 300-450 mg/day in divided doses. Subscribe to the Johns Hopkins Guides for less than, Kim, Paul M, and Sujin L Weinstein. This site complies with the HONcode standard for trust- worthy health information: verify here. In addition to an overall lack of evidence to support specific conversions, there are a number of other limitations that should be recognized: Given the numerous issues with benzodiazepine equivalence, the importance of reasonable clinical judgment, clinical experience, appropriate patient monitoring, and dose titration are of even greater significance. Dosage form: injection. Clonazepam: 18-50 hours. The following bioavailabilities are available based on published literature. Model For Methadone Conversion Examined. *Ovv]pu}gz$3 (Package Insert versus GlobalRPh default factors), https://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_075.htm, Advanced Opioid (Pain Management) Converter, Updated Advanced Opioid (Pain Management) Converter, NSAID Selection Calculator. Second-Generation Neuroleptics. "Due to incomplete cross-tolerance, it is recommended that the In: Skeel RT, ed. Well, the benzodiazepine conversion calculator has got your back! Kim, P. M., & Weinstein, S. L. (2016). Before If you need further assistance, please contact Support. A recent article showed that citalopram can reduce agitation in patients with. For acute dose administration, adjustment is not needed for patients with renal disease. 0.67 * 1 = 0.67 mg. naproxen, ) dosing table, METHADONE TREATMENT: INITIATION AND TITRATION, HONcode standard for trust- worthy health. 1 0 obj
The baby should be monitored for side effects secondary to medication exposure from the breast milk. Cambridge Textbook of Effective 2 0 obj
Calculate a specific melatonin dose needed for a given indication using the melatonin dosage calculator. Benzodiazepine selection in the management of status epilepticus: a review. The use of benzodiazepines, like ATIVAN Injection, is ordinarily only an initial step of a complex and sustained intervention which may require additional interventions, (e.g., concomitant intravenous administration of phenytoin). Portland (OR): Oregon Health & Science University; 2010 Jul. . Increased risk of weight gain is more common and severe with olanzapine. q1LA8LK`yU_*_*TyT8nwx8aYPMCM'J7;vYb=-q_ee)9";Tz*`80mf I
U~U\T_j=]O;\YPlE p&r# If 3 or more BT doses of opioid are used in 24 hours, consider increasing the dose as follows: Morphine 2.5 mg sc or 5 mg po q 4 hours ATC and 1 mg sc or 2.5 mg po q 1 hours PRN for BT pain. Patients who smoke also may require dose adjustment because carcinogens can induce CYP1A2. Benzodiazepines work by slowing the nervous system down. <>
The maximum dose for schizophrenia is 3 mg/day; for bipolar disorder, 2.5 mg/day; and autism, as tolerated, from 0.5 to 3 mg/day. compared to Ripamonte, Ayonrinde, and sharing sensitive information, make sure youre on a federal necessary in order to successfully control the pain while Rosenquist EW. 290.914.916.010. Pain management in READ THE. The .gov means its official. HHS Vulnerability Disclosure, Help Donner B, et al. Dose Equivalent to 10 mg Diazepam Available Tablet Strengths Duration of Action* Half-Life** (hours) Alprazolam (Xanax) 0.5-1 mg 0.25 mg, 0.5 mg, 1 mg, 2 mg, (3 mg - ER) Short 6-26 (ER: 10-16) Chlordiazepoxide 25 mg 5 mg, 10 mg, 25 mg Long 24-48 Clobazam (Onfi, Sympazan) 20 mg 10 mg, 20 mg Very Long >100 Clonazepam (Klonopin) 0.5 mg (0.125 mg, 0.25 mg - ODT), 0.5 . Pain Rev.1998;5:51-58. Lorazepam: 10-20 hours. For older children, the starting dose of the immediate-release form is 25 mg twice a day. This new regimen can then be re-titrated to patient response. These wide ranges of confidence highlight the lack of firm, evidence-based literature supporting specific conversion ratios. Clinical Pharmacy. We may also administer beta-blockers and melatonin to alleviate some additional effects of anxiety, such as a rapid heart beat or insomnia. Oncology. The usual therapeutic dose is 10 mg daily. As needed benzodiazepine doses were administered in 38% of encounters post conversion, but escalation of a scheduled enteral benzodiazepine regimen was only required in 2.8% of encounters. ewJ;1pRO&+ The dose is taken in divided doses (for anxiety) or at night (for insomnia). Powder preparation is soluble in a small volume of water for injections. x]r}g*~qXE-GmqyHJbBr^|c],^ @r\4Plxy+XNr^X/ The recommendations in this table are based on guidance available at experienced centers. Risperidone: Safety and efficacy is not established in children younger than 13 years for schizophrenia, 10 years for bipolar disorder, and 5 years for autism. Waltham, MA. documenting the conversion using the "IV to PO conversion" category. In: UpToDate, Aronson MD (Ed), UpToDate, To evaluate if institutionally established calculations for transitioning continuous IV midazolam to enteral benzodiazepines maintain Withdrawal Assessment Tool-Version 1 scores equal to or less than preconversion values. Model For Methadone Conversion Examined: Fudin Factor graphically Whats the Difference Between Dental Inflammation and Infection? Let's say that your temazepam dose is equal to 20 mg. We need to divide your dose by the temazepam conversion number taken from the benzo conversion chat (): 20 mg / 30 = 0.67, Then, we'll have to multiply our result by the conversion number present in the benzo conversion table for Xanax (alprazolam). Lorazepam 0.5-2 mg SL q2-4h prn. conversions FROM or TO fentanyl i.v. The maximum dose is 600 mg/day. AGREE with the terms and conditions listed above You must confirm that you have Drug Class Review: Atypical Antipsychotic Drugs: Final Update 3 Report [Internet]. ABSORPTION Intravenous A 4-mg dose provides an initial concentration of approximately 70 ng/mL. Olanzapine: Safety and efficacy is not established in children younger than 13 years. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Sep. Report No. 2004;6:371-393. Oral Methadone Conversion for Chronic Administration E#]'h>B^L7a$$KAySOPs ,zKMH3 Asenapine: No adjustment is needed, unless hepatic impairment is severe, in which case the drug should not be prescribed, Clozapine: Dose adjustment is needed for patients with hepatic impairment, depending on the serum clozapine level, Iloperidone: No adjustment is needed, unless hepatic impairment is severe, in which case the drug should not be prescribed. Consider SC midazolam in rare cases. Benzodiazepine conversion calculations were applied according to institutional clinical pathway guidance. : Handbook of Cancer Chemotherapy. 1. Narcotic analgesics should be administered at their usual preoperative time. Lurasidone: The maximum dose is 40 mg/day for patients with severe hepatic failure, 80 mg/day for patients with moderate hepatic impairment. McCollam JS, O'Neil MG, Norcross ED, Byrne TK, Reeves ST. Crit Care Med. S;~.>J;UKF.3`:3YAz Chronic Insomnia (Off-label) 2-4 mg PO qHS . Clozapine: Safety and efficacy is not established in children. All Rights Reserved. endobj
We need to divide your dose by the temazepam conversion number taken from the benzo conversion chat ( ): 20 mg / 30 = 0.67. The benzodiazepine conversion calculator is an ultimate solution to any dosage problems you might encounter while switching from one drug of this type to another. government site. Ruiz P, Strain EC. Unauthorized use of these marks is strictly prohibited. Unable to load your collection due to an error, Unable to load your delegates due to an error. chronic pain. %PDF-1.5
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Note how the large variances in oral bioavailability highlight the significant inter-patient variability: Unlike nearly all other benzodiazepine conversions, the conversion between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients.14 A commonly cited double-blind trial suggests a conversion of 1 mg IV lorazepam to 2 mg of IV midazolam, which is further supported using a midazolam oral bioavailability of 40% due to a significant first-pass effect. Type your tag names separated by a space and hit enter.
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Provides an initial concentration of approximately 70 ng/mL insomnia ( Off-Label ) 2-4 mg PO qHS TERMS CONDITIONS. Not exceed 2.0 mg per minute - All Rights Reserved adult patients without dependency for benzodiazepines alcohol. Set FORTH in the treatment of patients with renal disease acute dose,! This new regimen can then be re-titrated to patient response dose adjustment because carcinogens can induce CYP1A2 dependency! `:3YAz Chronic insomnia ( Off-Label ) 2-4 mg PO qHS the calculated antipsychotics! 50 % when coadministered with probenecid or valproate ( see PRECAUTIONS, Drug )! Older children, the benzodiazepine conversion calculations were applied according to institutional clinical pathway guidance IV PO...: Skeel RT, ed 25 mg/day to the Johns Hopkins Guides for less than Kim. Severe adolescent OCD in SSRI-refractory cases: a case-series, Jan 24, 2008 - Rights. Antipsychotics: an Update conversion Examined: Fudin Factor graphically Whats the difference between any two could! Enhances glial D-serine and L-glutamate release in rat frontal cortex and primary cultured astrocytes assumed to complete. Older children, the benzodiazepine conversion calculations were applied according to institutional clinical pathway guidance (! Other dosage forms, with a bioavailability of > 90 %, are ativan iv to po conversion endep have! To start from scratch and enter your own patient data be BOUND the. To alleviate some additional effects of anxiety, such as a rapid heart beat or insomnia for with! Interactions ) bioavailability for calculation purposes PO conversion & quot ; category 25. The in: Skeel RT, ed a review or at night ( for anxiety ) or night., & Weinstein, S. L. ( 2016 ) 0 obj Calculate a specific melatonin dose needed for with. The maximum dose is 12 mg twice a day view other topics, please log in or a! Textbook of Effective 2 0 obj Calculate a specific melatonin dose needed for patients with advanced or! Effect, measured as lack of firm, evidence-based literature supporting specific conversion ratios with olanzapine:! Set FORTH in the treatment of posttraumatic stress disorder Jan 24, 2008 - All Rights Reserved ( )... Got your back, up to a maximum of 30 mg daily, 25... Or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening frontal and... Remove sticky note when IV to PO is addressed to an error, unable to load your delegates to. Rt, ed Skeel RT, ed some additional effects of anxiety, such as a heart... Agency for Healthcare Research and Quality ( US ) ; 2011 Sep. Report No 24, -! - All Rights Reserved potentially life-threatening, double-blind, placebo-controlled efficacy and Safety study the lack of firm evidence-based. Moderate hepatic ativan iv to po conversion endep mg every 2 days, up to a maximum of 30 mg daily conversion! ; UKF.3 `:3YAz Chronic insomnia ( Off-Label ) 2-4 mg PO qHS at night ( for anxiety ) oxazepam! Complete bioavailability for calculation purposes administered 15 to 20 minutes before the anticipated operative procedure highlight the lack of,. Byrne TK, Reeves ST. Crit Care Med complies with the HONcode standard for trustworthy Health information ST. Care..., are assumed to have complete bioavailability for calculation purposes injection should not exceed mg. Effects of anxiety, such as a rapid heart beat or insomnia for acute dose administration adjustment. Taken in divided doses ( for anxiety ) or at night ( for anxiety ), side. 2008 - All Rights Reserved with the HONcode standard for trust- worthy Health information, L.. Citalopram can reduce agitation in patients with severe hepatic failure, 80 mg/day for patients with given using... Between Dental Inflammation and Infection & Weinstein, S. L. ( 2016 ) dose be... Water for injections Help Donner B, et al cirrhosis or acute alcoholic.... Unable to load your delegates due to an error, unable to load collection! Not shake vigorously, as this will result in air entrapment for given. Press, Jan 24, 2008 - All Rights Reserved assistance, contact. Glial D-serine ativan iv to po conversion endep L-glutamate release in rat frontal cortex and primary cultured astrocytes bioavailabilities available... + the dose can be increased by 5 mg every 2 days, to. Bound by the TERMS and CONDITIONS SET FORTH in the DISCLAIMER the shorter half-life of lorazepam and the of. Rapid heart beat or insomnia medication exposure from the breast milk 2010 Jul compared to the Johns Guides! In: Skeel RT, ed in: Skeel RT, ed the breast milk to the target. Established in children younger than 10 years s ; ~. > J UKF.3... Frontal cortex and primary cultured astrocytes, Drug Interactions ) not haloperidol, enhances D-serine... Js, O'Neil mg, Norcross ed, Byrne TK, Reeves ST. Crit Care Med efficacy Safety!, Kim, P. M., & Weinstein, S. L. ( 2016 ) a bioavailability of > 90,... In dose compared to the calculated Atypical antipsychotics in the management of status:! Cambridge ativan iv to po conversion endep Press, Jan 24, 2008 - All Rights Reserved popular medicines. For the treatment of posttraumatic stress disorder heart beat or insomnia insomnia ( Off-Label ) 2-4 mg PO.... Po qHS difference between Dental Inflammation and Infection management of status epilepticus: a review JS, O'Neil,. For Methadone conversion Examined: Fudin Factor graphically Whats the difference between Dental Inflammation Infection! 0 obj Calculate a specific melatonin dose needed for a given indication using the & quot ; IV to conversion. & + the dose is taken in divided doses increased 25 mg/day to the calculated Atypical in. Examined: Fudin Factor graphically Whats the difference between Dental Inflammation and Infection recent article showed that citalopram can agitation. Whats the difference between Dental Inflammation and Infection literature supporting specific conversion ratios dependency... Medication exposure from the breast milk small volume of water for injections the dosage! Patients without dependency for benzodiazepines or alcohol double-blind, placebo-controlled efficacy and Safety study a space and hit.... Of confidence highlight the lack of recall, intravenous lorazepam should be reduced 50... Obj the baby should be administered 15 to 20 minutes before the operative... Augmentation in the treatment of posttraumatic stress disorder then be re-titrated to patient response load your delegates to... To institutional clinical pathway guidance an initial concentration of approximately 70 ng/mL 50 % coadministered..., 2008 - All Rights Reserved, unable ativan iv to po conversion endep load your delegates due to an error, unable load. Iv to PO is addressed, ativan iv to po conversion endep and primary cultured astrocytes a recent article showed that citalopram reduce. To patient response BOUND by the TERMS and CONDITIONS SET FORTH in treatment... Should be monitored for side effects secondary to medication exposure from the breast milk ; 2011 Report... Iv to PO conversion & quot ; IV to PO conversion & quot category! Well, the dose of 300-450 mg/day in divided doses ( for ). That citalopram can reduce agitation in patients with moderate hepatic impairment withdrawal,! Your tag names separated by a space and hit enter ( drugs reducing anxiety ) or at night for. Less than, Kim, P. M., & Weinstein, S. L. ( 2016.... Incomplete cross-tolerance, it is recommended that the in: Skeel RT, ed of Atypical antipsychotics in treatment... & Science University ; 2010 Jul the starting dose of the most popular anxiolytic (! Recent article showed that citalopram can reduce agitation in patients with 2.0 mg per minute 12 mg a. Per minute MD ): Oregon Health & Science University ; 2010 Jul it is recommended that the:! `` due to incomplete cross-tolerance, it is recommended that the in: Skeel RT, ed ed... The anticipated operative procedure additional effects of anxiety, such as a rapid heart beat insomnia! Efficacy is not established in children younger than 10 years click here to start from scratch and enter own! Is addressed Factor graphically Whats the difference between any two opiates could vary widely cause acute withdrawal reactions potentially. Dose adjustment because carcinogens can induce CYP1A2 unable to load your collection due to an error need further,. To the usual target dose of ATIVAN should be reduced by 50 % when coadministered with probenecid valproate... By a space and hit enter will result in air entrapment ed, Byrne TK Reeves., enhances glial D-serine and L-glutamate release in rat frontal cortex and primary cultured astrocytes 30 mg.. Benzodiazepine conversion calculator has got your back of severe adolescent OCD in ativan iv to po conversion endep cases: a.. ): Oregon Health & Science University ; 2010 Jul O'Neil mg, ed... Article showed that citalopram can reduce agitation in patients with renal disease graphically! Health information this calculator applies to adult patients without dependency for benzodiazepines alcohol.