Inhalants withdrawal

The objective in treating inhalant withdrawal is the relief of discomfort, prevention or treatment of complications, reduction of urges to use inhalants, and preparation for rehabilitation. Successful management of inhalant with-... 

Chronic use of inhalants can lead to the body s physical need for a drug, which is called dependence. Addiction is a psychological and physical disease, and dependence is a physical manifestation of the disease. The body adapts to the presence of the drug, and heavy users experience withdrawal if they stop using inhalants abruptly. Withdrawal symptoms indicate an abuser is physically dependent on inhalants. These symptoms have been reported to occur in approximately 50% to 60% of inhalant users. When they quit inhaling, withdrawal symptoms appear. The body has... 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Despite the paucity of systematic studies in humans, the available evidence suggests that, like drugs such as alcohol, sedatives, and stimulants, inhalant drugs (i.e., solvents, general anesthetics, and nitrites) exert reinforcing effects and increase motor activity. Furthermore, with continuous use, these drugs appear to induce both tolerance and symptoms of withdrawal. 

There are similarities between the biological actions of inhalants and those of alcohol and barbiturates (Bowen et al. 1996b). For example, acute administration of inhalants affects motor coordination (Moser and Balster 1981) and induces anxiolysis, whereas chronic administration is associated with physical dependence and withdrawal (Bowen et al. 1996a Evans and Balster 1991, 1993). In addition, some inhalant drugs have anticonvulsant properties (Wood et al. 1984). Like other CNS-depressant agents, inhalants have biphasic effects on spontaneous locomotor activity in rodents, with increased activity seen at lower doses and diminished locomotion seen at higher doses (Cause et al. 1985 Kjellstrand et al. 1985). 

Diagnostic criteria for inhalant use disorders in DSM-IV-TR are similar to those in the International Classification of Diseases, Tenth Revision (ICD-10) (World Health Organization 1992). These criteria include biological, cognitive, and behavioral dimensions. The DSM-IV-TR diagnosis of inhalant dependence is given when three or more of the seven criteria are present (see Table 8-2). The first criteria to be considered here are tolerance and withdrawal. These phenomena are considered to be forms of adaptation to chronic administration of these compounds and were discussed extensively earlier in this chapter. 

Evans EB, Balster RL Inhaled 1,1,1-trichloroethane-produced physical dependence in mice effects of drugs and vapors on withdrawal. J Pharmacol Exp Ther 264 ... 

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... 

Valerian extracts show sedative and anxiolytic effects. Whereas passionflower and chamomile have relatively specific anxiolytic effects, valerian shows more general sedative effects, but all effects occur in a dose-dependent manner (Della Logia et al. 1981 Leuschner et al. 1993). The sedative effects of valerian extract are moderate when compared to diazepam and the neuroleptic chlorpromazine (Leuschner et al. 1993). However, valepotriates reverse the anxiogenic effects of diazepam withdrawal in rats in the elevated plus maze. This effect is dose dependent, effective at 12 mg/kg but not 6 mg/kg. Interestingly, the fragrant valerian compound bornyl acetate has sedative effects in mice, but only when inhaled (Buchbauer et al. 1992). 

Adverse reproductive effects are supported by animal studies. However, in some of the oral and inhalation studies in animals, chemical toxicity and/or neoplasia made it difficult to ascribe testicular lesions to direct toxicity. In other studies, antispermatogenic effects of 1,2-dibromoethane were documented directly in bovines exposed via feed these effects were reversible after chemical withdrawal (Amir and Ben-David 1973 Amir and Volcani 1965). Effects were more severe in adult bulls compared to young bulls (Amir 1975). 

Molander L, LuneU E, Andersson SB, Kuylenstiema F (1996) Dose released and absolute bioavaU-abUity of nicotine from a nicotine vapor inhaler. CUn Pharmacol Ther 59 394 00 Murphy JK, Edwards NB, Downs AD, Ackerman BJ, Rosenthal TL (1990) Effects of doxepin on withdrawal symptoms in smoking cessation. Am J Psychiatry 147 1353-1357 Nabi Biopharmaceuticals (2007). Nabi biopharmaceuticals announces positive results of phase Ilb trial of NicVAX. Medical News Today, 3 May 2007. See http //www.medicalnewstoday.com/ articles/69666.php, accessed October 11, 2007... 

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... 

During the initial evaluation, providing for the safety of the patient is of paramount importance. The severity of intoxication and potential for withdrawal must be quickly and accurately determined. Extreme alcohol intoxication can be fatal either by the production of cardiac arrhythmias, aspiration (the inhalation of stomach contents that are vomited), or other causes. We have all seen reports of college students dying from alcohol poisoning. Likewise, up to 10% of patients in severe alcohol withdrawal can die without treatment. Fortunately, most patients do not experience the most severe forms of alcohol withdrawal such as the DTs. Mild withdrawal can be managed in the outpatient setting with appropriate support and patient adherence, but severe withdrawal requires an inpatient hospitalization. See Section 6.5 for further discussion of the initial evaluation. 

Up to 70% of inhaled methoxyflu-rane is converted to metabolites that may cause nephrotoxicity, a problem that has led to the withdrawal of the drug. 

During withdrawal, some patients may experience symptoms of steroid withdrawal (eg, joint or muscular pain, lassitude, depression) despite maintenance or even improvement of respiratory function. Encourage continuance with the inhaler, but observe for objective signs of adrenal insufficiency (eg, fatigue, lassitude, weakness, nausea and vomiting, hypotension). If adrenal insufficiency occurs, increase the systemic steroid dose temporarily and continue further withdrawal more slowly. During periods of stress or severe asthma attack, transfer patients will require supplementary systemic steroids. 

Nicotine Nasal Spray (Nicolrol NS) [Smoking Deterrent/ Cholinergic] Uses Aid to smoking cessation, relieve nicotine withdrawal Action Systemic delivery of nicotine Dose 0.5 mg/actuation 1-2 sprays/h, 10 sprays/h max Caution [D, M] Contra Life-threatening arrhythmias, unstable angina Disp Nasal inhaler SE Local irritation, tach, HA, taste p v sion Interactions T Effects W/ cimetidine, black cohosh t effects OF catecholamines, cortisol T hemodynamic AV blocking effects OF adenosine EMS See Nicotine Gum OD See Nicotine Gum... 

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