Withdrawal from seizures caused

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. 

The abrupt withdrawal from barbiturates may cause tremors, restlessness, anxiety, weakness, nausea and vomiting, seizures, delirium, and cardiac arrest. 

Even when taken at recommended dosages, Rohypnol can cause dependence and addiction among frequent users. Some people addicted to Rohypnol experience seizures when they attempt withdrawal from the drug. The U.S. Department of Justice says such seizures may occur among chronic users after as little as one week without Rohypnol. 

Acute barbiturate toxicity is characterized by automatism, or a state of drug-induced confusion, in which patients lose track of how much medication they have taken and take more. Death results from respiratory failure. The treatment of poisoning consists of supporting respiration, prevention of hypotension, as well as diuresis, hemodialysis and, in the event of phenobarbital poisoning, the administration of sodium bicarbonate. Tolerance does not develop from lethal doses. The abrupt withdrawal from barbiturates may cause tremors, restlessness, anxiety, weakness, nausea and vomiting, seizures, delirium, and cardiac arrest. 

Tricyclics modify peripheral sympathetic effects in two ways through blockade of norepinephrine reuptake at neuroeffector junctions and through alpha adrenoceptor blockade. Sedation and atropine-like side effects are common with tricyclics, especially amitriptyline. In contrast to sedative-hypnotics, tricyclics lower the threshold to seizures. The answer is (B). Selective serotonin reuptake inhibitors cause sexual dysfunction in some patients, with changes in libido, erectile dysfunction, and anorgasmia. Tricyclic antidepressants may also decrease libido or prevent ejaculation. Of the heterocyclic antidepressants bupropion is the least likely to affect sexual performance. The drug is also used in withdrawal from nicotine dependence. The answer is (B). 

Visual hallucinations lasting 3 to 4 hours occurred in a 17-year-oid boy who had been taking bupropion 450 mg daiiy for one month and zolpidem 5 to 10 mg daily for about 6 months, when he increased the zolpidem dose to 60 mg. Note that the recommended dose of zolpidem is 10 mg daily and that zolpidem itself can cause psychiatric adverse effects such as hallucinations. Therefore an interaction is not established. Bupropion is contraindicated during abrupt withdrawal from any drug known to be associated with seizures on withdrawal, particularly benzodiazepines and benzodiazepine-like drugs. ... 

Although rare, benzodiazepine toxicity may occur from an overdose of the drug. Benzodiazepine toxicity causes sedation, respiratory depression, and coma. Flumazenil (Romazicon) is an antidote (antagonist) for benzodiazepine toxicity and acts to reverse die sedation, respiratory depression, and coma within 6 to 10 minutes after intravenous administration. The dosage is individualized based on the patient s response, widi most patients responding to doses of 0.6 to 1 mg. However, die drug s action is short, and additional doses may be needed. Adverse reactions of flumazenil include agitation, confusion, seizures, and in some cases, symptoms of benzodiazepine withdrawal. Adverse reactions of flumazenil related to the symptoms of benzodiazepine withdrawal are relieved by die administration of die benzodiazepine. 

Secondary epilepsy A number of reversible disturbances, such as tumors, head injury, hypoglycemia, meningeal infection, or rapid withdrawal of alcohol from an alcoholic, can precipitate seizures. Antiepileptic drugs are given until the primary cause of the seizures can be corrected. Seizures secondary to stroke or trauma may cause irreversible CNS damage. 

It has long been known that intramuscular procaine penicillin can cause some peculiar psychological adverse reactions, and that other penicillin derivatives, such as amoxicillin, can cause psychiatric reactions, such as hallucinations (SEDA-21, 259). In a report from the Netherlands, neuropsychiatric symptoms occurred in six patients who received cefepime for febrile neutropenia (33). The patients, two men and four women, aged 32-75 years, received 6 g/day (n = 5) or 3 g/day (n = 1). The symptoms started 1-5 days after the first dose and varied from nightmares, anxiety, agitation, and visual and auditory hallucinations to coma and seizures. After withdrawal of cefepime, they recovered within 1-5 days. The causality between their neuropsychiatric symptoms and cefepime was considered as probable (WHO criteria) because of the temporal relation, lack of other causal neurological explanations, and positive rechaUenge in five patients. 

Respiratory support with oxygen may be required for respiratory depression associated with Rohypnol ingestion. A benzodiazepine antagonist can reverse respiratory depression and coma caused by overdose but is not routinely recommended because it can precipitate withdrawal symptoms and seizures. There is no antidote to GHB overdose. Ventilator respiratory support, seizure control, and supportive care may be required. Symptoms often resolve within 3-4 h. Abuse of both rohypnol and GHB can cause withdrawal symptoms. Long-term use of Rohypnol can cause seizures, tremors, and anxiety. Long-term abuse of GHB withdrawal can last from days to weeks. GHB withdrawal includes anxiety, tremors, disorientation, hallucinations, and insomnia. 

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... 

A careful haseline physical examination, ECG, and laboratory work-up are essential. Underlying ECG changes (U waves, prolonged QT interval, or flattened T waves) secondary to hypokalemia or bradycardia and atrioventricular block from starvation may be present. AU antidepressants can cause seizures thus a careful risk-benefit assessment is warranted if the patient has predisposing factors such as a personal or family history of seizures, cerebrovascular disease, or alcohol or sedative-hypnotic withdrawal. 

The barbiturates also cause a physical dependence different from the opioid narcotics. In an individual addicted to barbiturates, the barbiturates should not be withdrawn abruptly but, rather, tapered slowly. Sudden withdrawal of the barbiturates can precipitate extreme agitation and grand mal seizures. This can lead to a spasm of the respiratory musculature, producing impaired respiration, cyanosis, and possibly, death (42). As a rule, drug dependence is followed by tolerance, in which increasing doses are required to obtain the same pharmacological effect. Because barbiturates cause tolerance and, often, dependence, their use as a hypnotic rarely is justified. 

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