Flunitrazepam Alcohol

Flunitrazepam (Rohypnol) is most commonly ingested orally, frequently in conjunction with alcohol or other drugs. It is often taken with other CNS depressants and has been given to women (without their knowledge) to lower their inhibitions. Thus it has been called a date-rape drug. 

Some abusers mix barbiturates with alcohol or marijuana in order to create a better high. A different kind of abuse occurs when rapists mix another drug, Rohypnol (flunitrazepam), into a woman s drink in order to render her incapable of resisting a sexual assault. The capacity for criminal abuse has led to higher penalties for its possession or use. 

A 69-year-old man developed acute benzodiazepine withdrawal delirium following a short course of flunitrazepam after an acute exacerbation of chronic obstructive pulmonary disease. He was not an alcohol-or drug-abuser and he had not previously taken benzodiazepines. Six days after withdrawal of flunitrazepam he became agitated and confused, and had visual hallucinations, disorganized thinking, insomnia, increased psychomotor activity, disorientation in time and place, and memory impairment. Tachycardia and significant anxiety were also noted. He fulfilled the DSM IV criteria for withdrawal syndrome and delirium, and had spontaneous remission of symptoms within 48 hours. 

Flunitrazepam, especially in combination A/ith alcohol, is claimed to reduce the A/oman s judgment, inhibitions, or physical ability to resist sexual advances, as A/ell as to reduce or eliminate her recall of the events... 

A 37-year-old man who had abused metamfetamine, paint thinner, psychotomimetic drugs, and alcohol for 20 years was given chlorpromazine, haloperidol, and flunitrazepam just before surgery. After spinal anesthesia he was given propofol 5 mg/kg/hour intravenously. However, euphoria and excitement occurred 10 minutes after the start of the infusion and he had excitement, hallucinations, and delirium. His symptoms were suppressed by intravenous haloperidol 5 mg. 

Flunitrazepam (Rohypnol), a potent rapid-onset benzodiazepine with marked amnestic properties, has been used in date rape. Added to alcoholic beverages, chloral hydrate or gamma-hydroxybutyrate (GHB) will render the victim incapable of resisting rape. 

As well as the opioids cocaine and cannabis, polytoxicomane drug abusers also consume bromazepam, diazepam and flunitrazepam in high doses, and fatalities among drug abusers and substitution patients can often be blamed on the consumption of these substances, often in combination with alcohol [48]. Patients who suffer low-dose dependence, in addition to consuming the three above-named substances, also consume therapeutic amounts of dipotassium clorazepate, flurazepam, lorezepam, nitrazepam or oxazepam, sometimes also in combination with amphetamines or antihistamines. 

It is very difficult to assess and compare the results of the very many studies of this interaction because of the differences between the tests, their duration, the dosages of the benzodiazepines and alcohol, whether given chronically or acutely, and a number of other variables. However, the overall picture seems to be that benzodiazepines and related drugs including diazepam, " alprazolam,bromazepam, brotizolam, chlo-rdiazepoxide, " clobazam, dipotassium clorazepate, flunitrazepam, flurazepam, loprazolam, " lorazepam, lormetazepam, medazepam, midazolam, nitrazepam, " " oxazepam, temazepam, " triazolam, and zopiclone enhance the effects of alcohol i.e. cause increased drowsiness, impaired performance and driving skills. 

Some of the benzodiazepines and related drugs that are used primarily to aid sleep, such as flunitrazepam, flurazepam, "" "" nitrazepam, " and temazepam, when taken the night before alcohol or in the evening with alcohol, can still interact with alcohol the next morning. However, midazolam,- loprazolam, lormetazepam, triazolam, Zolpidem, and zopiclone have been reported not to do so. The sedative effects of midazolam alone, and midazolam with fenta-nyl have been shown to have dissipated within 4 hours, and to not be affected by alcohol after this time. However, some patients may metabolise midazolam more slowly and so an interaction could still be possible, especially in older patients or those receiving additional drugs. ... 

The anxiolytic effects of lorazepam and possibly chlordiazepoxide may be opposed by alcohol. Alprazolam and alcohol together may possibly increase behavioural aggression. Similarly, flunitrazepam abuse can cause violent behaviour, impulsive decision-making and anterograde amnesia a report looking at violent crimes committed by abusers of flunitrazepam found that alcohol was almost always also present. Alcoholic drinks also enhance the effects of flunitrazepam when it is used as a date rape drug. ... 

Several studies have reported that alcohol increases plasma levels of diazepam and that alcohol accelerates the absorption of diazepam, but others have suggested that alcohol has no significant effect on diazepam pharmacokinetics. Plasma levels of brotizolam and clobazam may be increased by alcohol. One study reported that the plasma levels of triazolam were increased by alcohol, but other studies have found only a minimal pharmacokinetic interaction. However, an in vitro study demonstrated that alcohol inhibited the metabolism of triazolam by the cytochrome P450 isoenzyme CYP3A. Another in vitro study reported that the formation of flunitrazepam metabolites was weakly inhibited by alcohol, but a pharmacokinetic study suggested that there was no interaction. Alcohol appears to have minimal effects on the pharmacokinetics of alprazolam, and zopiclone. ... 

The pharmacokinetics of alcohol do not appear to be affected to a clinically significant extent by diazepam, flunitrazepam, zolpidem, or zopiclone but alprazolam may increase blood-alcohol levels. 

LiimoUa M, Erwin CW, Biendle A, Lc ue P. Effects of alcohol and flunitrazepam on mood and performance in healthy young metLJC iPho/maco/ (1981)21,430-5. 

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