II. Class
III. Preparations: Medical Uses
- See Benzodiazepines
IV. Precautions: Fake Xanax
- Fake Xanax contains Fentanyl and Etizolam (Benzodiazepine analog)
- Presents as opiod Overdose with sedation and respiratory depression (Rhabdomyolysis was also associated)
- Management
- Naloxone 0.4 mg
- Supportive care
- Consult poison control
- References
- Swadron and Nordt in Herbert (2017) EM:Rap 17(2):18
- ThePoisonReview.com
VI. Signs: BenzodiazepineIntoxication
- Cardiopulmonary effects
- Respiratory Depression
- Hypotension
- Rarely lethal alone, but dangerous with Alcohol
- Neurologic effects
- Anterograde Amnesia
- Ataxia
- Confusion
- Slurred Speech
- Miosis
- Spectrum of Decreased Level of Consciousness
- Drowsiness
- Lethargy
- Sedation
- Coma
VII. Differential Diagnosis
- See Unknown Ingestion
- May present in similar fashion to Diabetic Ketoacidosis
VIII. Management: Toxicity
-
Benzodiazepines Overdoses in isolation generally have good outcomes
- CNS Depression (and apnea) increases when combined with other agents (e.g. Opioids)
- Coingestion is common
- Supportive care with airway management for CNS Depression
-
Flumazenil (Romazicon)
- Avoid in patients with chronic use (risks of severe withdrawal including Seizures)
- Most toxicology guidelines do not recommend Flumazenil in Overdose
- Potential harms appear to outweigh benefits in most cases
- Penningo (2016) Basic Clin Pharmacol Toxicol 118(1): 37-44 +PMID:26096314 [PubMed]
- May be indicated for acute Benzodiazepine Overdose (non-chronic use) with cardiopulmonary depression
- Read Flumazenil contraindications carefully
- Avoid in patients with chronic use (risks of severe withdrawal including Seizures)
IX. Management: Taper Schedules
- Calculate Valium to Benzodiazepine Equivalents
- Start at 50% of calculated Valium dose
- Example
-
Valium Protocol
- Days 1-3: 10 mg tid (30 mg/day)
- Days 4-6: 5 mg qid (20 mg/day)
- Days 7-9: 5 mg tid (15 mg/day)
- Days 10-12: 5 mg bid (10 mg/day)
- Days 13-15: 5 mg qd (5 mg/day)
Images: Related links to external sites (from Bing)
Related Studies
Definition (MSH) | A traditional grouping of drugs said to have a soothing or calming effect on mood, thought, or behavior. Included here are the ANTI-ANXIETY AGENTS (minor tranquilizers), ANTIMANIC AGENTS, and the ANTIPSYCHOTIC AGENTS (major tranquilizers). These drugs act by different mechanisms and are used for different therapeutic purposes. |
Definition (CSP) | drug with a calming, soothing effect. |
Concepts | Pharmacologic Substance (T121) |
MSH | D014149 |
SnomedCT | 45604009 |
LNC | LP30812-9, MTHU015319 |
English | Agents, Tranquilizing, Agents, Tranquillizing, Ataractics, Tranquillizing Agents, tranquilizer, Tranquilizing Drugs, Drugs, Tranquilizing, Drugs, Tranquillizing, Tranquillizing Drugs, ataractic, tranquilizers, tranquilizer drug, anxiety reducing drugs, tranquilliser, drugs tranquilizer, anxiolytic drug, tranquillisers, anxiolytic drugs, Tranquilizers, Tranquilizing drugs, Tranquilizer drug, Tranquilizer (substance), Tranquilizer, Tranquilliser drug, Tranquilliser, Tranquilizer drug, NOS, Tranquilizer, NOS, Tranquilizer agent, Tranquilliser agent, Tranquilizing Agents, Anxiety Reducing Drugs, Anxiolytic Drugs, Ataractic Drugs, Ataraxic Drugs |
French | Médicaments tranquillisants, Agents tranquillisants, Tranquillisants |
Swedish | Lugnande medel |
Czech | ataraktika, trankvilizéry |
Finnish | Rauhoittavat lääkkeet |
Italian | Farmaci tranquillanti, Atarassici, Tranquillanti |
Russian | TRANKVILIZATORY, ATARAKTIKI, ATARAKTICHESKIE SREDSTVA, АТАРАКТИКИ, АТАРАКТИЧЕСКИЕ СРЕДСТВА, ТРАНКВИЛИЗАТОРЫ |
Croatian | TRANKVILIZATORI |
Polish | Środki ataraktyczne, Trankwilizatory, Środki kojące |
Japanese | 精神安定剤, 感情抑制薬, トランキライザ, 精神安定薬, 静穏薬, トランキライザー |
Norwegian | Not Translated[Tranquilizing Agents] |
Spanish | Efecto Tranquilizante, ansiolítico, fármaco ansiolítico, fármaco sedante, tranquilizante (sustancia), tranquilizante, Ataraxicos, Tranquilizantes |
Portuguese | Efeito Tranquilizante, Ataráxicos, Tranquilizantes |
German | Ataraktica, Tranquilizer |
Ontology: Benzodiazepine dependence (C0338768)
Concepts | Mental or Behavioral Dysfunction (T048) |
SnomedCT | 154914000, 191823005, 231473004 |
English | benzodiazepine dependence, benzodiazepine dependence (diagnosis), Benzodiazepine dependence, Benzodiazepine dependence (disorder) |
Spanish | dependencia de benzodiazepinas (trastorno), dependencia de benzodiazepinas |