Tranquilizers withdrawal

Klein E, Uhde TW, Post RM Preliminary evidence for the utility of carbamazepine in alprazolam withdrawal. Am J Psychiatry 143 235—236, 1986 Kouyanou K, Pither CE, Wessely S Medication misuse, abuse and dependence in chronic pain patients. J Psychosom Res 43 497-304, 1997 Kryspin-Exner K [Misuse of bezodiazepine derivatives in alcoholics] (German). Br J Addict Alcohol Other Drugs 61 283-290, 1966 Kryspin-Exner K, Demel 1 The use of tranquilizers in the treatment of mixed drug abuse. Int J Clin Pharmacol Biopharm 12 13-18, 1973... 

Detoxification, as mentioned in Chapter 2, may involve the use of certain medications to prevent severe discomfort or even possible medical side effects related to withdrawal symptoms. These medicines can range from tranquilizers (often benzodiazepines) and antidepressants to anticonvulsives and antihypertensives, and the medical protocol for detox will depend on the drug or drugs being abused, the client s vital signs and other symptoms, and the known risk for certain withdrawal symptoms associated with the drugs being used. The duration... 

Treatment- Primarily symptomatic and supportive maintain proper fluid and electrolyte balance and administer a tranquilizer to suppress anxiety. Severe withdrawal symptoms may require narcotic replacement. Gradual withdrawal using successively smaller doses will minimize symptoms. 

Another complication which can be expected in a methadone detoxification, seemingly more even than in other methods, is that of mood disturbances. In a comparison of methadone and buprenorphine withdrawal courses, actually in addition to carbamazepine, Seifert et al. (2005) found more tiredness, sensitivity in mood and depression in the (randomly assigned) methadone patients, which situation can lead to either tranquillizers or antidepressants being considered. 

FIGURE 13-33. Acute withdrawal of benzodiazepines in a benzodiazepine-dependent individual. If benzodiazepines are suddenly stopped in a patient who is tolerant to them and dependent on them, benzodiazepine receptors will experience this as an acute deficiency at their binding sites. Thus, the presence of desensitized benzodiazepine receptors actually worsens the impact of benzodiazepine discontinuation. The brain, which is used to too much benzodiazepine at its receptors, is suddenly starved for benzodiazepine. Therefore, the brain experiences the reverse of benzodiazepine intoxication, namely, dysphoria and depression instead of euphoria anxiety and agitation instead of tranquility and lack of anxiety insomnia instead of sedation and sleep muscle tension instead of muscle relaxation and at worst, seizures instead of anticonvulsant effects. These actions continue either until benzodiazepine is replaced or until the receptors readapt to the sensitivity they had prior to excessive benzodiazepine use. Alternatively, one can reinstitute benzodiazepines but taper them slowly, so that the receptors have time to readapt during dosage reduction, and withdrawal symptoms are prevented. 

Narcotics Demerol Morphine Heroin Others Natural and synthetic opioids analgesics Oral or injected (IM, IV) Relaxation euphoria feelings of tranquility prevent onset of opiate withdrawal Physical dependence respiratory depression high potential for death due to overdose See Chapter 14... 

Patients undergoing abrupt withdrawal from GBL are monitored in the intensive care unit and are typically hospitalized for about five days for supportive care and treatment with pentobarbital, a strong sedative sometimes used for anesthesia. Withdrawal symptoms are so severe that benzodiazepines, which are milder tranquilizers than pentobarbital and which are typically the first line of treatment... 

If withdrawal symptoms do develop, some medical approaches can be used to treat symptoms. One approach uses the drug clonidine, which is typically used to treat patients with high blood pressure. Cloni-dine has been found to lessen some of the withdrawal symptoms. Tranquilizers can be used to treat symptoms... 

One of two common treatment approaches is to combat withdrawal symptoms by treating them with appropriate medications. A drug commonly used in withdrawal treatment is clonidine, a medication most often used to lower blood pressure. For people going through withdrawal, clonidine may help lessen some symptoms. A variety of other drugs also may be used to deal with symptom-specific complaints. Examples include ibupro-fen for headaches, muscle, joint, or bone pain, and mild tranquilizers to combat anxiety and/or insomnia. 

Clonazepam (Klonopin), a benzodiazepine tranquilizer, has been used to treat both acute mania and as prophylaxis. It has all the many, sometimes severe, problems associated with the other benzodiazepines, including sedation, rebound and withdrawal syndromes, addiction, and behavioral abnormalities (chapter 12). Neuroleptics remain the mainstay for controlling acute manic reactions. 

Withdrawal from narcotics is also less hazardous than withdrawal from sedative-hypnotics. Alcohol, downers, and the minor tranquilizers can produce violent withdrawal, marked by convulsions and, sometimes, death. Narcotic withdrawal can be intensely unpleasant, but it is not life-threatening. 

SAFETY PROFILE Poison by ingestion and intraperitoneal routes. Moderately toxic by subcutaneous route. Human systemic effects by ingestion wakefulness, withdrawal, nausea and vomiting. An experimental teratogen. Other experimental reproductive effects. A tranquilizer. When heated to decomposition it emits very toxic fumes of NOx and Cl". See also DIAZEPAM. 

Minor tranquilizers and sedative-hypnotics are widely used in general medical practice and psychiatry. Although the benzodiazepines as a class are much safer than earlier medications (there is less risk of dependency and abuse, and withdrawal symptoms are generally much less dangerous than with barbiturates), problems do exist when patients begin to reduce doses, especially if they discontinue rapidly or "cold turkey." Benzodiazepine withdrawal sjmdromes are encoimtered frequently. They cause considerable patient distress, can be dangerous at times, and are almost always avoidable if the clinician follows the discontinuation guidelines carefully. 

Typically, antianxiety medications with short half-lives (see figure 16-A) are more likely to produce withdrawal symptoms (since the medications are more rapidly eliminated from the system). However, clearly, withdrawal can occur with all minor tranquilizers and sedative-hypnotics (with the exception of buspirone and possibly Zolpidem, which are chemical compounds unrelated to the benzodiazepines). 

When symptoms are determined to be withdrawal, the medication should be restarted or returned to the dosage level previously used for chronic treatment. Then a very gradual withdrawal regime can be initiated, a 5 to 10 percent reduction of the daily dosage per week. With the shorter half-life tranquilizers, often the pace of... 

What my conqxxind does is suppress the irratioDal inq ilses of the low brain. That s what tranquilizers such as Valium, Thorazine, and Librium do. But they also suppress the wotking of the upper brain, causing dullness and disinterest, almost like a lobotomy. They also dull die reflexes. Furthermore, after a few months on tranquilizers, the user becomes addicted and stopping brings on the same withdrawal symptoms as su ing heroin. 

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