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Benzodiazepine Abuse
Aka: Benzodiazepine Abuse, Benzodiazepine Dependence, Tranquilizer, Benzodiazepine Withdrawal, Benzodiazepine Overdose, Benzodiazepine Toxicity, Fake Xanax
- See Also
- Chemical Dependency
- Substance Abuse Evaluation
- Benzodiazepine
- Class
- Sedative-Hypnotic
- Preparations: Medical Uses
- See Benzodiazepines
- 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
- http://www.thepoisonreview.com/2016/08/24/case-series-8-patients-exposed-to-phony-alprazolam-xanax-containing-fentanyl-andor-etizolam/
- Symptoms: Benzodiazepine Withdrawal
- Anxiety
- Insomnia
- Myalgias
- Tremors
- Seizures
- 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
- Differential Diagnosis
- See Unknown Ingestion
- May present in similar fashion to Diabetic Ketoacidosis
- 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
- Management: Taper Schedules
- Calculate Valium to Benzodiazepine Equivalents
- Start at 50% of calculated Valium dose
- Example
- Xanax 6 mg is equivalent to 60 mg Diazepam
- Xanax 10 mg is equivalent to 100 mg Diazepam
- Start taper at 50% or 50 mg Valium per day
- Decrease dosing per Valium taper below
- 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)