Withdrawal, drug/alcohol

Some of these drugp may have additional uses as sedatives, muscle relaxants, anticonvulsants, and in the treatment of alcohol withdrawal. For example, clo-razepate (Tranxene) and diazepam (Valium) are used as anticonvulsants (see Chap. 28). Additional uses of the individual antianxiety drugp are given in the Summary Drug Table Antianxiety Drugp. 

Control of early withdrawal symptoms, which prevents their progression to more serious symptoms, is the indication for which medications are most widely prescribed in the treatment of alcohol dependence. The most commonly used agents to treat alcohol withdrawal are the benzodiazepines, a class of drugs that, by virtue of their agonist activity at the GABA receptor complex, suppress the hyperexcitability associated with alcohol withdrawal. With widespread use of anticonvulsant medications for bipolar disorder and other disorders associated with behavioral disinhibition and CNS hyperexcitability, anticonvulsants have also been examined for use in the treatment of alcohol withdrawal. 

Bailly D, Servant D, Blandin N, et al Effects of beta-blocking drugs in alcohol withdrawal a double-blind comparative study with propranolol and diazepam. Bio-med Pharmacother 46 419—424, 1992... 

Kleber HD, Weissman MM, Rounsaville BJ, et al Imipramine as treatment for depression in addicts. Arch Gen Psychiatry 40 649-633, 1983 Kleber HD, Riordan CE, Rounsaville BJ, et al Clonidine in outpatient detoxification from methadone maintenance. Arch Gen Psychiatry 42 391-394, 1983 Kleber HD, Topazian M, Gaspari J, et al Clonidine and naltrexone in the outpatient treatment of heroin withdrawal. Am J Drug Alcohol Abuse 13 1-17, 1987 Kornetsky C. Brain stimulation reward, morphine-induced stereotypy, and sensitization implications for abuse. Neurosci Biobehav Rev 27 777-786, 2004 Kosten TR, Kleber HD Buprenorphine detoxification from opioid dependence a pilot study. Life Sci 42 633-641, 1988... 

Vorma H, Naukkarinen H, Sarna S, et al Long-term outcome after benzodiazepine withdrawal treatment in subjects with complicated dependence. Drug Alcohol Depend 70 309-314, 2003... 

GHB treatment in mice, tolerance develops to both the hypolocomotion and cataleptic effects of the drug (Itzhak and Ali 2002). There is also preclinical evidence of cross-tolerance and cross-dependence of GHB with alcohol (Colombo et al. 1995 Fadda et al. 1989). As described in the earlier section on clinical pharmacology, GHB and its analogues have been used in humans in the treatment of alcohol withdrawal. Nicholson and Balster (2001) reviewed the evidence for cross-tolerance and cross-dependence of GHB with alcohol. 

Sellers EM, Naranjo CA, Harrison M, et al Diazepam loading simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 34 822-826, 1983 Sharp CW Introduction to inhalant Abuse, in Inhalant Abuse A Volatile Research Agenda (NIDA Research Monograph 129). Edited by Sharp CW, Beuvais F, Spence R. Rockville, MD, National Institute on Drug Abuse, 1992, pp 1-10 Smelson DA, Losonczy MF, Davis CW, et al Risperidone decreases craving and relapses in individuals with schizophrenia and cocaine dependence. Can J Psychiatry 47 671-675, 2002... 

Berlin, I., Spreux-Varoquaux, O., Said, S., Launay, 1. Effects of past history of major depression on smoking characteristics, monoamine oxidase-A and -B activities and withdrawal symptoms in dependent smokers. Drug Alcohol Depend. 45 31, 1997. 

Dissection of the molecular mechanisms underlying tobacco addiction should lead to new and better treatments to achieve nicotine withdrawal. It seems clear that the dopamine D2 receptor is involved in nicotine dependence and drugs that block this receptor, such as tiapride, could be useful in the treatment of tobacco dependence. Tiapride has been shown to be successful in alcohol withdrawal [58] but would represent a new avenue for tobacco addiction therapy. 

Most clinicians agree that the BZs are the drugs of choice in treatment of alcohol withdrawal. 

Alcohol withdrawal seizures do not require anticonvulsant drug treatment unless they progress to status epilepticus. Patients with seizures should be treated supportively. An increase in the dosage and slowing of the tapering schedule of the BZ used for detoxification or a single injection of a BZ may be necessary to prevent further seizure activity. 

For BZ withdrawal, the same drugs and dosages that are used for alcohol withdrawal are used (see Table 73-5). 

Barr, M. et al., Escalating morphine exposures followed by withdrawal in feline immunodeficiency virus-infected cats A model for HIV infection in chronic opiate abusers, Drug Alcohol Depend.., 72, 141, 2005. 

Snyder FR, Davis FC, Henningfield JE. (1989). The tobacco withdrawal syndrome performance decrements assessed on a computerized test battery. Drug Alcohol Depend. 23(3) 259-66. 

Gossop M (1988) Clonidine and the treatment of the opiate withdrawal syndrome. Drug Alcohol Depend 21 253-259... 

Schneider NG, Jarvik ME, Forsythe AB (1984) Nicotine vs, placebo gum in the alleviation of withdrawal during smoking cessation. Addict Behav 9 149-156 Schuh KJ, Schuh LM, Henningfield JE, Stitzer ML (1997) Nicotine nasal spray and vapor inhaler abuse liability assessment. Psychopharmacology 130 352-361 Schuster CR, Henningfield J (2003) Conference on abuse liability assessment of CNS drugs. Drug Alcohol Depend 70 S1-S4... 

In addition to their proven efficacy in the treatment of all types of depression, the SSRIs have been shown to be the drugs of choice in the treatment of panic disorder, obsessive-compulsive disorder, bulimia nervosa, and as an adjunct to the treatment of alcohol withdrawal and relapse prevention, premenstrual dysphoric disorder and post-traumatic stress disorder. The usefulness of these drugs in treating such a diverse group of disorders reflects the primary role of serotonin in the regulation of sleep, mood, impulsivity and food intake. 

Drugs that block j32-receptors generally have a calming effect and are prescribed for anxiety, migraine, esophageal varices, and alcohol withdrawal syndrome, among others. 

Concomitant conditions Use with caution in the following patients exposed to extreme heat or phosphorus insecticides atropine or related drugs because of additive anticholinergic effects those in a state of alcohol withdrawal those with dermatoses or other allergic reactions to phenothiazine derivatives because of the possibility of cross-sensitivity those who have exhibited idiosyncrasy to other centrally acting drugs. 

Visual unformed flashes, shapes, colours formed grotesque faces, animals, people LiUiputian little people, animals - LSD, MDMA, cannabis - anticholinergics, alcohol withdrawal, drug induced deliria and psychotic states. - alcohol withdrawal... 

Gustatory, olfactory - benzodiazepine or alcohol withdrawal, drug-induced psychotic states... 

---