Psychotropics, sedation and driving advice

Meet the patient

A 34-year-old project manager, three nights into zopiclone 7.5 mg nocte for shift-related insomnia, drifts across a lane on the morning commute and only registers the kerb when it vibrates under the wheels. He walks into clinic holding the packet and asks the question every registrar dreads: "It's not a benzodiazepine, so it's safe to drive, right?"^[5][6]

Across the corridor, an 82-year-old widow on long-half-life diazepam and a recently added SSRI mentions, almost as an afterthought, that she has "clipped the gate" twice this month. She is the stem Fournier built a paper around.^[3][11]

Both patients are asking the same question, and both expect a yes or a no. The fellowship answer is neither. It is a structured judgment of illness, drug, substances and licence class — written down, with a review date.^[1][9][13]

References14ShowHide

1. [1]Verster JC, Mets MA. Psychoactive medication and traffic safety Int J Environ Res Public Health, 2009.PMID 19440432
2. [2]Thomas RE. Benzodiazepine use and motor vehicle accidents. Systematic review of reported association Can Fam Physician, 1998.PMID 9585853
3. [3]Hemmelgarn B, Suissa S, Huang A, et al. Benzodiazepine use and the risk of motor vehicle crash in the elderly JAMA, 1997.PMID 9207334
4. [4]Barbone F, McMahon AD, Davey PG, et al. Association of road-traffic accidents with benzodiazepine use Lancet, 1998.PMID 9802269
5. [5]Verster JC, Veldhuijzen DS, Volkerts ER. Residual effects of sleep medication on driving ability Sleep Med Rev, 2004.PMID 15233958
6. [6]Gustavsen I, Bramness JG, Skurtveit S, et al. Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam Sleep Med, 2008.PMID 18226959
7. [7]Ramaekers JG. Antidepressants and driver impairment: empirical evidence from a standard on-the-road test Hum Psychopharmacol, 2003.PMID 12590619
8. [8]Wingen M, Ramaekers JG, Schmitt JA. Driving impairment in depressed patients receiving long-term antidepressant treatment Psychopharmacology (Berl), 2006.PMID 16865389
9. [9]Dassanayake T, Michie P, Carter G, et al. Effects of benzodiazepines, antidepressants and opioids on driving: a systematic review and meta-analysis of epidemiological and experimental evidence Drug Saf, 2011.PMID 21247221
10. [10]Rudisill TM, Zhu M, Kelley GA, et al. Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review Accid Anal Prev, 2016.PMID 27569655
11. [11]Fournier JP, Wilchesky M, Patenaude V, et al. Concurrent Use of Benzodiazepines and Antidepressants and the Risk of Motor Vehicle Accident in Older Drivers: A Nested Case-Control Study CNS Drugs, 2015.PMID 26847674
12. [12]Verster JC, Roth T. Methylphenidate significantly reduces lapses of attention during on-road highway driving in patients with ADHD J Psychopharmacol, 2014.PMID 24978156
13. [13]Brunnauer A, Herpich F, Zwanzger P, et al. Driving Performance Under Treatment of Most Frequently Prescribed Drugs for Mental Disorders: A Systematic Review of Patient Studies Int J Neuropsychopharmacol, 2021.PMID 34038545
14. [14]Orriols L, Salmi LR, Philip P, et al. The impact of medicinal drugs on traffic safety: a systematic review of epidemiological studies Pharmacoepidemiol Drug Saf, 2009.PMID 19418468