Diazepam withdrawal from

Signs and symptoms of BZ withdrawal are similar to those of alcohol withdrawal, including muscle pain, anxiety, restlessness, confusion, irritability, hallucinations, delirium, seizures, and cardiovascular collapse. Withdrawal from short-acting BZs (e.g., oxazepam, lorazepani, alprazolam) has an onset within 12 to 24 hours of the last dose. Diazepam, chlordiazep-oxide, and clorazepate have elimination half-lives (or active metabolites with elimination half-lives) of 24 to greater than 100 hours. So, withdrawal may be delayed for several days after their discontinuation. 

Jonkman S, Markou A (2006) Blockade of nicotinic acetylcholine or dopamine D 1-fike receptors in the central nucleus of the amygdala or the bed nucleus of the stria terminads does not precipitate nicotine withdrawal in nicotine-dependent rats, Neurosci Lett 400 140-145 Katsura M, Shuto K, Mohri Y, Tsujimura A, Ohkuma S (2001) Withdrawal from nicotine facilitates diazepam binding inhibitor mRNA expression in mouse cerebral cortex. Brain Res Mol Brain Res 97 194-218... 

Withdrawal from long-term high-dose use of alcohol or sedative-hypnotic drugs can be life threatening if physical dependence is present. Benzodiazepines, such as chlordiazepoxide Librium) and diazepam Valium), are sometimes used to lessen the intensity of the withdrawal symptoms when alcohol or sedative-hypnotic drug use is discontinued. Benzodiazepines are also employed to help relieve the anxiety and other behavioral symptoms that may occur during rehabilitation. 

Ondansetron. The S-HTj antagonist ondansetron has been reported to be effective in the treatment of generalized anxiety disorder, with efficacy comparable to that of diazepam [Lader 1991). Sedation and rebound anxiety during withdrawal from ondansetron were not observed [Lader 1991). Ondansetron has been considered for phase 111 clinical trials for the treatment of social phobia and panic disorder. 

Long-acting drugs such as chlordiazepoxide and diazepam and, to a lesser extent, phenobarbital are administered in progressively decreasing doses to patients during withdrawal from physiologic dependence on ethanol or other sedative-hypnotics. Parenteral lorazepam is used to suppress the symptoms of delirium tremens. 

Baclofen is at least as effective as diazepam in reducing spasticity and causes less sedation. In addition, baclofen does not reduce overall muscle strength as much as dantrolene. It is rapidly and completely absorbed after oral administration and has a plasma half-life of 3-4 hours. Dosage is started at 15 mg twice daily, increasing as tolerated to 100 mg daily. Adverse effects of this drug include drowsiness however, patients become tolerant to the sedative effect with chronic administration. Increased seizure activity has been reported in epileptic patients. Therefore, withdrawal from baclofen must be done very slowly. 

Suriclone, a cyclopyrrolone analogue of zopiclone, has similar pharmacology to the benzodiazepines, binding close to the same site of the GABA receptor-chloride channel complex. It is effective as an anxiolytic and has the notable advantages of minimal sedation and cognitive toxicity, and milder withdrawal effects than those of diazepam or lorazepam (1). Its withdrawal from further development is a mystery. 

During acute withdrawal from alcohol, the intravenous administration of diazepam is recommended, usually followed by chlordiazepoxide given orally. 

Alcohol, barbiturates, and narcotics—such as diphenhydramine (Benadryl), amobarbital (Amytal), diazepam (Valium), codeine, heroin, methadone, morphine, propoxyphene (Darvon)—that are used during pregnancy can lead to harmful effects on the newborn. Use of these dmgs during pregnancy can create an addiction in the newborn. The baby will go into withdrawal from the drug when they are born. This can result in hyperactivity, crying, irritability, seizures and even sudden death. 

The withdrawal syndrome from ethanol includes anxiety, insomnia, possibly convulsions and visual hallucinations (delirium tremens - the Dts). It is treated or better still prevented by a calm environment, adequate (but not excessive) hydration, and careful monitoring, with the added use of anticon-vulsive/sedative agents, mainly benzodiazepines to prevent or treat convulsions. The preventive effects of benzodiazepines on withdrawal morbidity has been clearly demonstrated. There do not seem to be major differences between benzodiazepines, such as chlordiazepoxide or diazepam or others. Because of the abuse potential in these highly susceptible patients, these should be rapidly weaned, and proper prevention of relapse instituted. Other drugs such as meprobamate and clomethiazole (Hemineurin) are commonly used in some countries. The effectiveness... 

There is no evidence from randomized trials that general strategies to prevent delirium are successful. Benzodiazepines are significantly better than placebo in preventing delirium and seizures due to alcohol withdrawal, and long-acting benzodiazepines (such as diazepam) are more effective than... 

Residential treatment appeared the most likely way of making an impact on Carl s crack cocaine use, and plans were made for an admission. This could not happen immediately, and in the meantime Carl was prescribed fluoxetine 20mg per day, and diazepam 20-30mg per day. He was keen to try to withdraw himself from crack without going into hospital, and he and his mother were instructed about his use of the two medications. They were advised that diazepam would reduce anxiety and agitation, and might help relieve craving for crack. 

Patients receiving long-term diazepam treatment who complain of episodes of anxiety may be suffering from intermittent withdrawal symptoms. 

A 23-year-old military officer on active duty took diazepam 5 mg tds and ibuprofen for back spasms. Three days later he was found sitting in a church, having assumed a previous role from his past life. He identified the date as 14 months before and his memory before that time was intact. However, he had no memory of events during the previous 14 months. There were no symptoms suggesting a schizophrenic disorder and his mental function was normal. His symptoms resolved within 24 hours of withdrawal of diazepam, except for amnesia of the event. He assumed his correct identity and was aware of the correct date. He had taken ibuprofen in the past with no adverse effects and this was his first exposure to a benzodiazepine. No other medications were involved and a full medical review found no cause for his symptoms other than diazepam use. 

One means of treatment for alcoholism is to give the addict a sedative/ relaxant drug such as diazepam for about seven days. After this time the worst of the unpleasant withdrawal symptoms will have receded. The patient still has to be kept away from alcohol and weaned off it, but the drug helps to reduce the craving. There are other newer drugs that also do this by increasing the substance GABA (see box above), they inhibit the activity of nerves in the brain that would otherwise increase when there is no alcohol present. 

Diazepam Use in palliative care, treatment of initial or acute withdrawal symptoms caused by the withdrawal of alcohol from persons habituated to it, tonic-clonic seizures Oral, parenteral or rectal... 

---