Withdrawal state benzodiazepine

Drug withdrawal states (alcohol, ctj-adrenergic agonists, antidepressants, barbiturates, benzodiazepines, opiates)... 

Benzodiazepines are also used for several other conditions that are related to, but not actually termed, anxiety. For example, benzodiazepines are commonly given as soporific or hypnotic drugs (drugs that help people sleep). One of the benzodiazepines, flurazepam, is the most frequently prescribed hypnotic drug in the United States. Benzodiazepines also are administered as muscle relaxants, and can even reduce the occurrence of seizures or convulsions. Another common use of benzodiazepines is in alcohol withdrawal. Someone who is trying to stop drinking alcohol is usually given a heavy dose of... 

Pharmacological treatments were used by nearly half of the 149 services which offered any treatment, with a wide range of medications directed at various features of cocaine usage. Fluoxetine and desipramine were the most frequently prescribed antidepressants, with benzodiazepines used to aid sleep and reduce distress in withdrawal states. Sedative antipsychotics were used, apparently in states of severe agitation as well as more directly for psychotic complications. 

Benzodiazepines (BZDs) may be given to patients with moderate agitation. These agents also are the treatment of choice in alcohol withdrawal states, characterized by agitation, tremors, or change in vital signs (see also the section The Alcoholic Patient in Chapter 14) (156). 

Uses. Benzodiazepines are used for insomnia, anxiety, alcohol withdrawal states, muscle spasm due to a variety of causes, including tetanus and cerebral spasticity, epilepsy (clonazepam, see p. 421), anaesthesia and sedation for endoscopies and cardioversion. 

Six cases of complications loosely related to the use of naltrexone pellet implantation during the highly controversial rapid and ultra-rapid opioid detoxification procedures have been reported (22). These included pulmonary edema, prolonged opioid withdrawal states, drug toxicity, withdrawal from cross-dependence to alcohol and benzodiazepines, aspiration pneumonia, and death. The risk of these controversial procedures and of naltrexone in this novel delivery system are high a robust scientifically validated program of research is needed to justify such treatment packages. 

Lader, M. (1983). Benzodiazepine withdrawal states. In M. R. Trimble (F,d.), Benzodiazepines divided A multidisciplinary rei iew(pp. 17-32). New York John Wiley. 

Other uses Thiopental is commonly used for the induction of anesthesia, and certain benzodiazepines (eg, diazepam, midazolam) are used as components of anesthesia protocols. Special uses include the management of seizure disorders (eg, clonazepam, phenobarbital) and muscle spasticity (diazepam). Longer-acting dmgs (eg, chlordiazepoxide, diazepam) are used in the management of withdrawal states in persons physiologically dependent on ethanol and other sedative-hypnotics. 

B. Rapid reversal of benzodiazepine effect in patients with benzodiazepine addiction or high tolerance may result in an acute withdrawal state, including hyperexcitability, tachycardia, and seizures (rarely reported). 

Auditory unformed tinnitns, whistles formed voices, often insulting or accusatory - benzodiazepine withdrawal - cocaine, amphetamine, alcoholic hallucinosis, drug induced deliria and psychotic states... 

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

The problem of tautomeric equilibriums in annelated 1,5-diazepines was studied in [68] by means of NMR spectroscopy, X-ray analysis and quantum-chemical calculations. It was shown that the electron-withdrawing rings (e.g., pyrimidine moiety) fused with the diazepine cycle increase the stability of the antiaromatic enamine tautomeric forms A and C, while in the case of benzodiazepine, a diimine tautomer B was found to be the most stable. Ab initio quantum-chemical calculations and NMR spectroscopic data showed that solvation of seven-membered heterocycles with polar solvents contributes considerably to the stabilization of the enamine forms A and C. This assumption was also proven by X-ray analysis, which showed that in the solid state these diazepines exist in the diimine form B. 

It must be emphasized that the relationship between tolerance, physical dependence and compulsive drug use is complex and depends both on the category of drug and the personality of the abuser. For example, it appears that the majority of patients prescribed benzodiazepines for periods of many months experience relatively minor withdrawal symptoms when the drugs are abruptly stopped. Others, however, experience severe anxiety states and have extreme difficulty in stopping the drug. 

It is often difficult to distinguish withdrawal symptoms from the reappearance of the underlying anxiety state for which the benzodiazepine was originally prescribed. Furthermore, some patients may increase the dose of the drug over time, particularly if they are taking the drugs for the... 

Patients who have been on the medications for some time need to be advised against abrupt discontinuation, which can lead to a severe withdrawal syndrome and possible convulsions. A reduction in dose is likely to lead to a reemergence of the anxiety symptoms for which the person is being treated, such as panic attacks. If this is due only to drug withdrawal, the symptoms usually subside within two weeks. For this reason, as stated above, it is best to taper off benzodiazepine dosage very slowly after prolonged use. 

The benzodiazepines are used to treat anxiety states and sleep disorders. Dose-dependent CNS depression does occur but can be reversed by flumazenil. Chronic use can lead to tolerance and dependency with rebound effects upon withdrawal. Table IV-1-1 summarizes the uses and characteristics of various benzodiazepines. 

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