title: Premedication with sublingual or oral alprazolam in adults undergoing diagnostic upper gastrointestinal endoscopy.
abstract: OBJECTIVE
  Diagnostic esophagogastroduodenoscopy (EGD) is uncomfortable for most patients. We determined the efficacy of alprazolam, administered orally or sublingually, as premedication for sedation during EGD.
  
  
  METHODS
  Adult EGD candidates were randomly allocated to four groups (n = 55, each group) and received alprazolam (0.5 mg) sublingually or orally, placebo sublingually or orally at 30 minutes before EGD. Main outcome measures included procedure-related anxiety and pain/discomfort (assessed using 11-point numeric scales), patient overall tolerance (assessed using a 4-point Likert scale), need for intravenous sedation, and willingness to repeat the EGD if necessary.
  
  
  RESULTS
  Patients experienced greater reduction in anxiety score after medication with sublingual alprazolam (mean 2.25, standard deviation [SD] 1.73) compared with sublingual placebo (mean 0.10, standard error [SE] 0.15]; P < 0.001) and oral alprazolam (0.63, SE 0.14; P < 0.001). Also, pain/discomfort scores were lower with sublingual alprazolam compared with sublingual placebo (3.29, SE 0.29 vs. 4.16, SD 1.86; P = 0.024), and with oral alprazolam compared with oral placebo (3.48, SD 1.69 vs. 5.13, SD 2.39; P  < 0.001). Patient overall tolerance was better with sublingual alprazolam than with sublingual placebo (P = 0.005) or with oral alprazolam (P = 0.009). Regarding intravenous sedation, there was no difference between sublingual alprazolam and sublingual placebo (10.9 % vs. 10.9 %; P = 0.619) or between oral alprazolam and oral placebo (9.0 % vs. 12.7 %; P = 0.381). Willingness to repeat the procedure was greater with sublingual alprazolam than with sublingual placebo (50.9 % vs. 30.9 %; P = 0.026).
  
  
  CONCLUSIONS
  Sublingual alprazolam is an effective premedication for sedation during EGD. It reduces anxiety and pain/discomfort related to EGD and increases patient tolerance and willingness to repeat the EGD if necessary.
  
  
  BACKGROUND
  NCT01949038 ClinicalTrials.gov.
authors: Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Ahmad
authors: A
authors: Shavakhi
authors: Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Soghry
authors: S
authors: Soleiman
authors: Poursina Hakim Research Institution, Isfahan, Iran.
authors: Ali
authors: A
authors: Gholamrezaei
authors: Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mahsa
authors: M
authors: Khodadoostan
authors: Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Sara
authors: S
authors: Shavakhi
authors: School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran.
authors: Abdolmajid
authors: A
authors: Tahery
authors: Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mohammad
authors: M
authors: Minakari
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000286:Administration, Sublingual; D000328:Adult; D000525:Alprazolam / Q000008:administration & dosage*; D001007:Anxiety / Q000517:prevention & control*; D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care
chemical_list: D006993:Hypnotics and Sedatives; D000525:Alprazolam