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Effects of anxiolytics on driving

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Drugs, Driving and Traffic Safety

Abstract

Most of the currently used anxiolytic agents act via GABA or serotonin. The latter include drugs traditionally classified as antidepressants, which are reviewed in the next chapter. This chapter reviews the results of ten experimental studies investigating the effects of anxiolytics on driving performance using over-the-road tests. Results show that only the serotonergic drugs (buspirone, ondansetron and ritanserin) had a low potential for impairment. All GABA-agonists (diazepam, lorazepam, oxazepam, clorazepate, alprazolam, alpidem, suriclone) had moderate to severely impairing effects on driving in the doses studied. Impairment was clearly dose dependent, and increased on average with increasing blood concentrations. However, most studies analyzing correlations between drug concentrations in plasma and effects on driving performance found low and non-significant correlations, indicating that prediction of impairment from blood concentrations is problematic.

Furthermore, tolerance was found to develop only very slowly, and impairing effects did not seem to be counteracted by improvement in anxiety symptoms. Finally, subjects seemed relatively unaware of the effects of the drugs. Awareness of these effects was only seen with severe objective impairment, indicating that patients should be warned explicitly about the risks associated with using these drugs by their physicians or pharmacists.

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References

  1. Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, den Boer JA, Fineberg NA, Knapp M, Scott J et al (2005) Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 19: 567–596

    Article  PubMed  CAS  Google Scholar 

  2. Nash JR, Nutt DJ (2007) Pharmacotherapy of anxiety: Handbook of contemporary neuropharmacology. Wiley Berlin, 59–91

    Google Scholar 

  3. Vermeeren A (2004) Residual effects of hypnotics: epidemiology and clinical implications. CNS Drugs 18: 1–37

    Article  Google Scholar 

  4. Ray WA, Fought RL, Decker MD (1992) Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am J Epidemiol 136: 873–883

    Article  PubMed  CAS  Google Scholar 

  5. Neutel CI (1995) Risk of traffic accident injury after a prescription for a benzodiazepine. Ann Epidemiol 5: 239–244

    Article  PubMed  CAS  Google Scholar 

  6. Hemmelgarn B, Suissa S, Huang A, Boivin JF, Pinard G (1997) Benzodiazepine use and the risk of motor vehicle crash in the elderly. Jama 278: 27–31.

    Article  PubMed  CAS  Google Scholar 

  7. Neutel I (1998) Benzodiazepine-related traffic accidents in young and elderly drivers. Hum Psychopharmacol 13: S115–S123

    Article  Google Scholar 

  8. Barbone F, McMahon AD, Davey PG, Morris AD, Reid IC, McDevitt DG, MacDonald TM (1998) Association of road-traffic accidents with benzodiazepine use. Lancet 352: 1331–1336

    Article  PubMed  CAS  Google Scholar 

  9. Mura P, Kintz P, Ludes B, Gaulier JM, Marquet P, Martin-Dupont S, Vincent F, Kaddour A, Goulle JP, Nouveau J et al (2003) Comparison of the prevalence of alcohol, cannabis and other drugs between 900 injured drivers and 900 control subjects: results of a French collaborative study. Forensic Sci Int 133: 79–85

    Article  PubMed  CAS  Google Scholar 

  10. Engeland A, Skurtveit S, Morland J (2007) Risk of road traffic accidents associated with the prescription of drugs: a registry-based cohort study. Ann Epidemiol 17: 597–602

    Article  PubMed  Google Scholar 

  11. O’Hanlon JF, Haak TW, Blaauw GJ, Riemersma JB (1982) Diazepam impairs lateral position control in highway driving. Science 217: 79–81

    Article  PubMed  Google Scholar 

  12. Volkerts ER, Brookhuis KA, O’Hanlon JF (1987) The effects of treatment with buspirone, diazepam, and lorazepam on driving performance in real traffic. In: PC Noordzij, R Roszbach (eds): International Congres on Alcohol, Drugs and Traffic Safety, T86. Excerpta Medica, Amsterdam

    Google Scholar 

  13. Volkerts ER, Brookhuis KA, O’Hanlon JF (1987) Comparison of the effects of buspirone 5 mg and 10 mg, diazepam 5 mg, and lorazepam 1 mg (t.i.d.) upon actual driving performance (VK 87-02). Traffic Research Centre, Haren, 1–46

    Google Scholar 

  14. Brookhuis KA, Borgman AE (1988) The effects of some anxiolytics on driving performance. J Drugther Res 13: 228–231

    Google Scholar 

  15. Brookhuis KA, Borgman AE, Roos EPM, De Vries G, Broekhuis J (1987) The effects of clorazepate 5 mg, oxazepam 10 mg, and lorazepam 0.5 mg on aspects of driving and driving related skills (VK 87-10). Traffic Research Centre, University of Groningen, Groningen, 1–50

    Google Scholar 

  16. Volkerts ER, Abbink F, Van Laar MW, Plomp TA, Maes RAA (1988) Comparison of the effects of ritanserin 5 mg b.i.d. and lorazepam 1.5 mg b.i.d. upon driving performance in an over-the-road driving test. NIDDR, Utrecht, 1–33

    Google Scholar 

  17. Van Laar MW, Volkerts ER, Verbaten MN (2001) Subchronic effects of the GABA-agonist lorazepam and the 5-HT2a/2c antagonist ritanserin on driving performance, slow wave sleep and daytime sleepiness in healthy volunteers. Psychopharmacol 154: 189–197

    Article  Google Scholar 

  18. Van Laar MW, Volkerts ER, Van Willigenburg AP (1992) Therapeutic effects and effects on actual driving performance of chronically administered buspirone and diazepam in anxious outpatients. J Clin Psychopharmacol 12: 86–95

    PubMed  Google Scholar 

  19. Van Veggel L, O’Hanlon JF (1993) Effects of ondansetron and diazepam on driving and psychometric performance in healthy volunteers (IGVG-P26). Institute for Human Psychopharmacology, Maastricht, 1–21

    Google Scholar 

  20. Uiterwijk MM, O’Hanlon JF (1994) Acute and subchronic effects of suriclone on actual driving performance, psychometric test parameters and subjective feelings versus those of lorazepam and placebo in healthy volunteers (IGVG 93-29). Institute for Human Psychopharmacology, Maastricht, 1–24

    Google Scholar 

  21. Vermeeren A, Swijgman HF, J.F. OH (1994) Acute and subchronic effects of alpidem, lorazepam, and placebo on anxiety, psychometric test performance and actual driving in anxious patients (IGVG 93-19). Institute for Human Psychopharmacology, Maastricht, 1–34

    Google Scholar 

  22. O’Hanlon JF, Vermeeren A, Uiterwijk MM, van Veggel LM, Swijgman HF (1995) Anxiolytics’ effects on the actual driving performance of patients and healthy volunteers in a standardized test. An integration of three studies. Neuropsychobiology 31: 81–88

    Article  PubMed  Google Scholar 

  23. Verster JC, Volkerts ER, Verbaten MN (2002) Effects of alprazolam on driving ability, memory functioning and psychomotor performance: a randomized, placebo-controlled study. Neuropsychopharmacol 27: 260–269

    Article  CAS  Google Scholar 

  24. Leufkens TR, Vermeeren A, Smink BE, van Ruitenbeek P, Ramaekers JG (2007) Cognitive, psychomotor and actual driving performance in healthy volunteers after immediate and extended release formulations of alprazolam 1 mg. Psychopharmacol 191: 951–959

    Article  CAS  Google Scholar 

  25. O’Hanlon JF (1984) Driving performance under the influence of drugs: rationale for, and application of, a new test. Br J Clin Pharmacol 18 Suppl 1: 121s–129s

    PubMed  Google Scholar 

  26. O’Hanlon JF, Brookhuis KA, Louwerens JW, Volkerts ER (1986) Performance testing as a part of drug registration. In: JF O’Hanlon, JJ De Gier (eds): Drugs and driving. Taylor & Francis

    Google Scholar 

  27. Verster JC, Veldhuijzen DS, Volkerts ER (2005) Is it safe to drive a car when treated with anxiolytics? Evidence from on-the-road driving studies during normal traffic. Cur Psychiat Rev 1: 215–225

    Article  CAS  Google Scholar 

  28. Verster JC, Volkerts ER (2004) Antihistamines and driving ability: evidence from on-theroad driving studies during normal traffic. Ann Allergy Asthma Immunol 92: 294–303; quiz 303–295, 355

    Article  PubMed  CAS  Google Scholar 

  29. Verster JC, Veldhuijzen DS, Volkerts ER (2004) Residual effects of sleep medication on driving ability. Sleep Med Rev 8: 309–325

    Article  PubMed  Google Scholar 

  30. Ramaekers JG (2003) Antidepressants and driver impairment: empirical evidence from a standard on-the-road test. J Clin Psychiatry 64: 20–29

    PubMed  Google Scholar 

  31. Louwerens JW, Gloerich ABM, De Vries G, Brookhuis KA, J.F. OH (1987) The relationship between drivers’ blood alcohol concentration (BAC) and actual driving performance during high speed travel. In: PC Noordzij, R Roszbach (eds): International Congres on Alcohol, Drugs and Traffic Safety, T86. Exerpta Medica, Amsterdam, 183–186

    Google Scholar 

  32. Borkenstein RF (1964) The role of the drinking driver in traffic accidents, the Grand Rapids Study. Blutalkohol 11

    Google Scholar 

  33. Brookhuis KA, de Waard D, Mulder B (1994) Measuring driving performance by car-following in traffic. Ergonomics 37: 427–434

    Article  Google Scholar 

  34. Ramaekers JG, O’Hanlon JF (1994) Acrivastine, terfenadine and diphenhydramine effects on driving performance as a function of dose and time after dosing. Eur J Clin Pharmacol 47: 261–266

    Article  PubMed  CAS  Google Scholar 

  35. Couper FJ, Logan BK (2004) Drugs and Human Performance Fact Sheets. In: NHTSA (ed). National Highway Traffic Safety Administration, Washington DC

    Google Scholar 

  36. Greenblatt DJ, Schillings RT, Kyriakopoulos AA, Shader RI, Sisenwine SF, Knowles JA, Ruelius HW (1976) Clinical pharmacokinetics of lorazepam. I. Absorption and disposition of oral 14C-lorazepam. Clin Pharmacol Ther 20: 329–341

    PubMed  CAS  Google Scholar 

  37. Baselt RC (2001) Drug effects on psychomotor performance. Biomedical Publications, Foster City CA

    Google Scholar 

  38. Volkerts ER, Van Laar MW, Van Willigenburg AP, Plomp TA, et al. (1992) A comparative study of on-the-road and simulated driving performance after nocturnal treatment with lormetazepam 1 mg and oxazepam 50 mg. Hum Psychopharmacol 7: 297–309

    Article  CAS  Google Scholar 

  39. Glue P, Fang A, Gandelman K, Klee B (2006) Pharmacokinetics of an extended release formulation of alprazolam (Xanax XR) in healthy normal adolescent and adult volunteers. Am J Ther 13: 418–422

    Article  PubMed  Google Scholar 

  40. Ciraulo DA, Barnhill JG, Boxenbaum HG, Greenblatt DJ, Smith RB (1986) Pharmacokinetics and clinical effects of alprazolam following single and multiple oral doses in patients with panic disorder. J Clin Pharmacol 26: 292–298

    PubMed  CAS  Google Scholar 

  41. Verster JC, Volkerts ER (2004) Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. CNS Drug Rev 10: 45–76

    PubMed  CAS  Google Scholar 

  42. Fujita M, Woods SW, Verhoeff NP, Abi-Dargham A, Baldwin RM, Zoghbi SS, Soares JC, Jatlow PA, Krystal JH, Rajeevan N et al (1999) Changes of benzodiazepine receptors during chronic benzodiazepine administration in humans. Eur J Pharmacol 368: 161–172

    Article  PubMed  CAS  Google Scholar 

  43. O’Hanlon JF (1991) Review of buspirone’s effects on human performance and related variables. Eur Neuropsychopharmacol 1: 489–501

    Article  PubMed  Google Scholar 

  44. Rickels K, Khalid-Khan S, Ruynn M (2003) Buspirone in the treatment of anxiety disorders. In: DJ Nutt, JC Ballenger (eds): Anxiety disorders. Blackwell, Oxford, 381–397

    Google Scholar 

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Author information

Authors and Affiliations

  1. Neuropsychology and Psychopharmacology Section, Faculty of Psychology and Neuroscience, Maastricht University, 6200 MD, Maastricht, The Netherlands

    Annemiek Vermeeren & Tim R.M. Leufkens

  2. Psychopharmacology Section, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3508 TB, Utrecht, The Netherlands

    Joris C. Verster

Authors
  1. Annemiek Vermeeren
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  2. Tim R.M. Leufkens
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  3. Joris C. Verster
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Editor information

Editors and Affiliations

  1. Utrecht University Faculty of Science Section Psychopharmacology, Utrecht Institute for Pharmaceutical Sciences, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands

    Joris C. Verster

  2. Somnogen Inc., 8790 112th Street, New York, NY, 11418, USA

    S. R. Pandi-Perumal

  3. Experimental Psychopharmacology Unit, Department of Neuropsychology & Psychopharmacology Faculty of Psychology and Neurosciences, Maastricht University, 6200 MD, Maastricht, The Netherlands

    Johannes G. Ramaekers

  4. Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands

    Johan J. de Gier

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© 2009 Birkhäuser Verlag/Switzerland

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Vermeeren, A., Leufkens, T.R., Verster, J.C. (2009). Effects of anxiolytics on driving. In: Verster, J.C., Pandi-Perumal, S.R., Ramaekers, J.G., de Gier, J.J. (eds) Drugs, Driving and Traffic Safety. Birkhäuser Basel. https://doi.org/10.1007/978-3-7643-9923-8_17

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