Lormetazepam Addiction

This chapter focuses on lormetazepam addiction. Lormetazepam is a BDZ mainly used as sedative-hypnotic, has some specific pharmacological properties that differentiate it from other BDZs. In Italy, lormetazepam is the most commonly used BDZ, followed by lorazepam and alprazolam. However, it is very difficult to determine the use deriving from abuse, dependence, and addiction from consumption data only. Furthermore, these data do not take into consideration under-the-counter use. Despite guidelines recommending to limit the use of BDZs, lormetazepam included, to a few weeks, their consumption is often chronic and many people take these drugs for many years. Patients often take these drugs for a long period, because they are generally well tolerated and safe. Lormetazepam abuse, dependence, and addiction may appear after prolonged treatment. A drug-induced alteration in the GABA inhibitory regulation of DA neurons has been implicated for the neural basis of BDZ addiction. Some authors proposed that BDZs increase DA level through disinhibition. This disinhibition is dependent on the BDZ binding site on alpha1-containing GABAA receptors in the VTA. To our knowledge, there is limited evidence of specific addictive properties of lormetazepam in the scientific literature. In our experience, lormetazepam addiction is an increasingly common occurrence in Italy and its abuse concerns almost exclusively the drop formulation (84% of abusers). Some special features (such as the presence of 95% alcohol in the dropformulation) seem to facilitate its abuse. l Reports of lormetazepam abuse/dependence/addiction sent to the Italian pharmacovigilance system account for about 50% of the total BDZ abuse/dependence/addiction reports.The lack of data about lormetazepam addiction in the literature is probably because drop solution exists only in Italy and Spain. Research shows that combining medications for addiction treatment (e.g., flumazenil) with behavioral therapy is the best way to ensure success for most patients.