Withdrawal symptoms from benzodiazepines

Rebound may be contrasted with a withdrawal reaction in which stopping the hypnotic is followed by the emergence of new symptoms, not previously experienced by the patient. Muscle tension and pain, loss of appetite and weight, and perceptual changes such as hyperacusis are cardinal features of withdrawal reactions from benzodiazepine-type depressants. 

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... 

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. 

The clinician must be cautious in interpreting some of these symptoms (especially anxiety) in patients withdrawing from benzodiazepines. Anxiety fearfulness, and dysphoria may represent symptoms that were treated by the benzodiazepine and unmasked on withdrawal. 

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... 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Withdrawal from long-term high-dose use of alcohol or sedative-hypnotic drugs can be life threatening if physical dependence is present. Benzodiazepines, such as chlordiazepoxide Librium) and diazepam Valium), are sometimes used to lessen the intensity of the withdrawal symptoms when alcohol or sedative-hypnotic drug use is discontinued. Benzodiazepines are also employed to help relieve the anxiety and other behavioral symptoms that may occur during rehabilitation. 

Buspirone has been shown to be as effective as benzodiazepines for the treatment of GAD. However, it appears to take several weeks for this drug to be effective. The big advantage of using buspirone instead of benzodiazepines is that buspirone does not have the sedative effect, physical dependence, and withdrawal symptoms often seen with benzodiazepines. Buspirone does, however, cause stomach upset in some patients that may discourage patients from taking the drug. 

Although benzodiazepine dependence is very common, cases that fulfill all the diagnostic criteria for addiction are rare. Withdrawal from benzodiazepines occurs within days of stopping the medication and varies as a function of the half-life of elimination. Symptoms include irritability, insomnia, phono- and photophobia, depression, muscle cramps, and even seizures. Typically, these symptoms taper off within 1-2 weeks. 

Significant progress has been made in establishing safe and effective medications for alcohol withdrawal. Pharmacotherapy with a benzodiazepine is the treatment of choice for the prevention and treatment of the signs and symptoms of alcohol withdrawal. Many patients detoxify from alcohol without specific treatment or medications. However, it is difficult to determine accurately which patients require medication for alcohol withdrawal. Patients in good physical condition with uncomplicated, mild to moderate alcohol withdrawal symptoms usually can be treated as outpatients. 

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... 

Withdrawal reactions are more problematical. Hypnotics, by and large, are benzodiazepine like in their pharmacology, receptor binding, etc. The main differences relate to duration of action and to putative selectivity of binding. The benzodiazepine withdrawal reaction has been described many times, and rating scales have been developed to measure the symptoms. Withdrawal reactions from hypnotics would be expected to display similar symptomatic patterns and to follow time-courses dictated by the pharmacokinetic properties of the drug. 

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