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Tranquilizers

The term "tranquilizers" (from Latin tranquillo-are - to do calm, serene) entered the medical literature in 1957 to refer to psychotropic drugs, used mainly for neuroses, states of mental stress and fear. Unlike neuroleptic substances, most tranquilizers do not have a pronounced antipsychotic effect. "Their action, mainly addressing psychopathological disorders of the neurotic level, unlike neuroleptic drugs, helps to eliminate a wide range of neurotic and neurosis-like disorders, primarily reducing emotional tension, anxiety and fear" (G. Ya. Avrutsky).
In the current literature, the terms "anxiolytic agents" and "antianxiety agents" (antianxiety agents) are also used to refer to preparations of the same group. The term "tranquilizers" remains, however, the most common. It should be borne in mind that the drugs of this group have not only an anxiolytic effect. They have in varying degrees four pharmacodynamic properties: anxiolytic, hypnotic, muscle relaxant and anticonvulsant.
Anxiolytic (antiphobic) and all-calming action is the most important feature of tranquilizers. The hypnotic effect is expressed in facilitating the onset of sleep, increasing the effect of hypnotics; The effect of narcotic and analgesic agents is also increasing. Therefore, tranquilizers are often used in neuroleptanalgesia.
The muscle relaxant effect of tranquilizers is related to the effect on the CNS, and not to the peripheral curare-like action, so they are sometimes called central relaxants. This effect is often a positive factor in the use of tranquilizers to relieve tension, feelings of fear, excitement, but it limits the use of drugs that have a pronounced muscle relaxant property in patients whose work requires a fast, concentrated reaction (transport drivers, etc.).
Clinical aspects of the use of tranquilizers are characterized by the fact that "during the therapy, various emotional disorders are quickly undergoing reduction, and first of all anxiety and fear of neurotic origin arising in the absence of productive psychotic symptoms. In contrast, acute delusional, hallucinatory, affective and other disorders, accompanied by anxiety and fear, are practically not reduced in the appointment of tranquilizers. Due to the tranquilizing effect, only temporarily there may be a temporary decrease in affective tension and a slight decrease in the intensity of delusional hallucinatory and other disturbances >>.
It should be noted that the powerful tranquilizers (in particular, phenazepam) created in recent years are capable of providing therapeutic effect in psychotic and psychopathic conditions.
When choosing a tranquilizer for clinical use, it is necessary to take into account differences in the spectrum of their action. Some drugs have all the properties characteristic of tranquilizers (eg, diazepam), others have more pronounced anxiolytic effect. Some drugs (see Mezapam) have a relatively weak muscle relaxant property, which is why they are more convenient for use in the daytime and are often called daytime tranquilizers. However, in relatively large doses, all tranquilizers can exhibit all the pharmacological properties characteristic of this group of drugs.
By structure, tranquilizers belong to different classes of chemical compounds. The main modern drugs of this group are benzodiazepine derivatives. In addition, the importance of carbamates of propanediol (meprotan, etc.), derivatives of diphenylmethane (amisyl, etc.), representatives of some other chemical groups have been retained.
The mechanisms of action of tranquilizers are still not clear enough. Neurophysiological studies indicate a decrease in the excitability of the subcortical areas of the brain (limbic system, thalamus, hypothalamus) responsible for the implementation of emotional reactions and the inhibition of interaction between these structures and the cerebral cortex under the influence of tranquilizers. Tranquilizers also have a retarding effect on polysynaptic spinal reflexes, thus causing muscle relaxation.
In the neurochemical aspect, different tranquilizers differ in the characteristics of the action. The effect on noradrenergic, dopaminergic, serotonergic systems is expressed in them in a relatively weak degree. At the same time, benzodiazepine tranquilizers actively influence GABAergic systems; Potentiating the central inhibitory effect of y-aminobutyric acid (see Aminalon). In the cells of the central nervous system, specific "benzodiazepine" receptors (and their subgroups) have been found, for which benzodiazepines are exogenous ligands. The nature of the endogenous ligand for these receptors has not been fully elucidated.
There is a close relationship between benzodiazepine and GABA receptors. Benzodiazepines contribute to the release of GABA and its effect on synaptic transmission.
Derivatives of diphenylmethane (amisyl and others) actively influence the cholinergic systems of the brain, in connection with which they are also called central anticholinergics. Derivatives of propanediol (meproton, etc.) have no pronounced effect on benzodiazepine and cholinergic receptors.
Different tranquilizers are effective for various neurotic and neurosis-like conditions. Therefore, they found wide application not only in psychiatric and neurological practice, but also in other areas of practical medicine. Tranquilizers were widely used in outpatient practice. It should be emphasized that, despite the relatively low toxicity of the main tranquilizers (benzodiazepines, propanediol carbamates), they can be used only if there are appropriate indications and under medical supervision. Unreasonable and uncontrolled use of them can cause side effects, mental dependence and other undesirable effects.
Tranquilizers can not be prescribed to receive before and during work drivers of cars and persons of other professions who require rapid mental and motor reactions. In exceptional cases, when increased nervous excitability interferes with successful production activity, it is possible to administer tranquilizers, provided that the drug is individually selected and its dose and careful medical supervision of the patient is made.
It should also be borne in mind that alcohol potentiates the effect of tranquilizers, so you should not consume alcoholic beverages during their use.
In the literature there are single indications that tranquilizers, not only possessing anticholinergic properties (amisyl, etc.), but others, for example meprobamate (meprotan) and especially diazepam (sibazone, seduxen, relanium), can cause an increase in the secretion of watery eyes , The difficulty of its outflow and the increase in intraocular pressure. In this regard, it is recommended to prescribe these drugs to patients with glaucoma with caution and not for a long time.

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Subgroup Psychotropic drugs include drugs: