Benzodiazepine withdrawal - Revision history

Rossdonaldson1: /* Clinical Features */

2023-01-04T18:24:54Z

Clinical Features

← Older revision		Revision as of 18:24, 4 January 2023
Line 4:		Line 4:

	==Clinical Features==		==Clinical Features==
	*Onset usually several days to up to 3 weeks		*Onset usually several days to up to 3 weeks<ref>Marriott S, Tyrer P. Benzodiazepine dependence. Avoidance and withdrawal. Drug Saf. 1993 Aug;9(2):93-103. doi: 10.2165/00002018-199309020-00003. PMID: 8104417.</ref>
	*More likely in patients with high doses or prolonged use		*More likely in patients with high doses or prolonged use
	*Autonomic hyperactivity (e.g., diaphoresis, [[tachycardia]], [[hyperthermia]])		*Autonomic hyperactivity (e.g., diaphoresis, [[tachycardia]], [[hyperthermia]])

Kennybroccoli: /* Clinical Features */

2022-12-14T23:27:58Z

Clinical Features

← Older revision		Revision as of 23:27, 14 December 2022
Line 6:		Line 6:
	*Onset usually several days to up to 3 weeks		*Onset usually several days to up to 3 weeks
	*More likely in patients with high doses or prolonged use		*More likely in patients with high doses or prolonged use
	*Autonomic hyperactivity (e.g., diaphoresis, ~~HR>100~~, hyperthermia)		*Autonomic hyperactivity (e.g., diaphoresis, [[tachycardia]], [[hyperthermia]])
	*[[Nausea/vomiting]]		*[[Nausea/vomiting]]
	*Tremulousness, psychomotor agitation		*Tremulousness, psychomotor agitation
	*Anxiety, insomnia, irritability~~, agitation~~		*[[Anxiety]], [[insomnia]], irritability
	*[[Psychosis]] (more common than in ~~ETOH~~ withdrawal)		*[[Psychosis]] (more common than in [[alcohol withdrawal]])
	*[[Seizure]]		*[[Seizure]]

Kennybroccoli: /* Management */

2022-12-14T23:25:22Z

Management

← Older revision		Revision as of 23:25, 14 December 2022
Line 24:		Line 24:
	*Ensure patient and staff safety, airway protection if acutely agitated or seizing		*Ensure patient and staff safety, airway protection if acutely agitated or seizing
	*[[Benzodiazepines]]		*[[Benzodiazepines]]
	**~~Withdrawal from high~~-~~potency benzodiazepines~~ (e.g. [[~~alprazolam~~]]) ~~may require higher doses of traditional benzos like~~ [[diazepam]] ~~to achieve clinical effect~~		**Mild, can tolerate PO: Long-acting [[benzodiazepine]] (e.g., [[chlordiazepoxide]])
	**Consider substituting shorter half-life drugs with equivalent dose of [[diazepam]]		**Moderate/severe: IV [[diazepam]]
	**Equivalent diazepam dose = [[triazolam]] dose x 20 = [[alprazolam]] dose x 10 = [[lorazepam]] dose x 5		***Consider substituting shorter half-life drugs with equivalent dose of [[diazepam]]
	*After acute symptoms controlled, can prescribe gradual ~~benzo~~ taper		***Equivalent [[diazepam]] dose = [[triazolam]] dose x 20 = [[alprazolam]] dose x 10 = [[lorazepam]] dose x 5
			*After acute symptoms controlled, can prescribe gradual [[benzodiazepine]] taper
	**One taper strategy: decrease dose by 25% for first week, 25% second week, then by 12.5% for subsequent weeks<ref>Chang F: Strategies for benzodiazepine withdrawal in seniors. CPJ 138: 38, 2005.		**One taper strategy: decrease dose by 25% for first week, 25% second week, then by 12.5% for subsequent weeks<ref>Chang F: Strategies for benzodiazepine withdrawal in seniors. CPJ 138: 38, 2005.
	</ref>		</ref>

Kennybroccoli: /* Clinical Features */

2022-12-14T23:19:54Z

Clinical Features

← Older revision		Revision as of 23:19, 14 December 2022
Line 9:		Line 9:
	*[[Nausea/vomiting]]		*[[Nausea/vomiting]]
	*Tremulousness, psychomotor agitation		*Tremulousness, psychomotor agitation
	*Anxiety, insomnia, irritability agitation		*Anxiety, insomnia, irritability, agitation
	*[[Psychosis]] (more common than in ETOH withdrawal)		*[[Psychosis]] (more common than in ETOH withdrawal)
	*[[Seizure]]		*[[Seizure]]

Kennybroccoli: /* Clinical Features */

2022-12-14T23:09:28Z

Clinical Features

← Older revision		Revision as of 23:09, 14 December 2022
Line 4:		Line 4:

	==Clinical Features==		==Clinical Features==
	*Onset usually several days to ~~1 week~~		*Onset usually several days to up to 3 weeks
	*More likely in patients with high doses or prolonged use		*More likely in patients with high doses or prolonged use
	*Autonomic hyperactivity (e.g., diaphoresis, HR>100, hyperthermia)		*Autonomic hyperactivity (e.g., diaphoresis, HR>100, hyperthermia)

Kennybroccoli: /* Background */

2022-12-14T23:08:42Z

Background

← Older revision		Revision as of 23:08, 14 December 2022
Line 1:		Line 1:
	==Background==		==Background==
	*Very similar to [[alcohol withdrawal]]		*Very similar to [[alcohol withdrawal]]
			*Occurs due to chronic use of [[benzodiazepines]], leading to physiologic tolerance<ref>Marriott S, Tyrer P. Benzodiazepine dependence. Avoidance and withdrawal. Drug Saf. 1993 Aug;9(2):93-103. doi: 10.2165/00002018-199309020-00003. PMID: 8104417.</ref>

	==Clinical Features==		==Clinical Features==

Elcatracho: /* Clinical Features */

2021-03-06T10:42:19Z

Clinical Features

← Older revision		Revision as of 10:42, 6 March 2021
Line 10:		Line 10:
	*Anxiety, insomnia, irritability agitation		*Anxiety, insomnia, irritability agitation
	*[[Psychosis]] (more common than in ETOH withdrawal)		*[[Psychosis]] (more common than in ETOH withdrawal)
	*Seizure		*[[Seizure]]

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis: /* Clinical Features */

2016-11-09T21:12:57Z

Clinical Features

← Older revision		Revision as of 21:12, 9 November 2016
Line 7:		Line 7:
	*Autonomic hyperactivity (e.g., diaphoresis, HR>100, hyperthermia)		*Autonomic hyperactivity (e.g., diaphoresis, HR>100, hyperthermia)
	*[[Nausea/vomiting]]		*[[Nausea/vomiting]]
	*Tremulousness, psychomotor [[agitation]]		*Tremulousness, psychomotor agitation
	*Anxiety, insomnia, irritability agitation		*Anxiety, insomnia, irritability agitation
	*[[Psychosis]] (more common than in ETOH withdrawal)		*[[Psychosis]] (more common than in ETOH withdrawal)

ClaireLewis: Created page with "==Background== Very similar to alcohol withdrawal ==Clinical Features== Onset usually several days to 1 week More likely in patients with high doses or prolonged use ..."

2016-11-09T21:10:42Z

Created page with "==Background== *Very similar to alcohol withdrawal ==Clinical Features== *Onset usually several days to 1 week *More likely in patients with high doses or prolonged use *..."

New page

==Background==
*Very similar to [[alcohol withdrawal]]

==Clinical Features==
*Onset usually several days to 1 week
*More likely in patients with high doses or prolonged use
*Autonomic hyperactivity (e.g., diaphoresis, HR>100, hyperthermia)
*[[Nausea/vomiting]]
*Tremulousness, psychomotor [[agitation]]
*Anxiety, insomnia, irritability agitation
*[[Psychosis]] (more common than in ETOH withdrawal)
*Seizure

==Differential Diagnosis==
{{Sedative/hypnotic withdrawal types}}
{{Seizure DDX}}
{{AMS DDX}}

==Evaluation==
*Evaluate for other causes of and complications of symptoms (see evaluation of [[seizure]], [[altered mental status]], [[hypertension]], [[hyperthermia]]

==Management==
*Ensure patient and staff safety, airway protection if acutely agitated or seizing
*[[Benzodiazepines]]
**Withdrawal from high-potency benzodiazepines (e.g. [[alprazolam]]) may require higher doses of traditional benzos like [[diazepam]] to achieve clinical effect
**Consider substituting shorter half-life drugs with equivalent dose of [[diazepam]]
**Equivalent diazepam dose = [[triazolam]] dose x 20 = [[alprazolam]] dose x 10 = [[lorazepam]] dose x 5
*After acute symptoms controlled, can prescribe gradual benzo taper
**One taper strategy: decrease dose by 25% for first week, 25% second week, then by 12.5% for subsequent weeks<ref>Chang F: Strategies for benzodiazepine withdrawal in seniors. CPJ 138: 38, 2005.
</ref>
*Consider neurology consult if patient was using benzos for seizure control (may need further antiepileptic management)

==Disposition==
*Admit if:
**Multiple seizures
**Uncontrolled autonomic hyperstimulation
**Decreased level of consciousness

==See Also==
*[[Benzodiazepines]]
*[[Alcohol withdrawal]]

==External Links==

==References==
<references/>

[[Category:Toxicology]]

Benzodiazepine withdrawal - Revision history

Rossdonaldson1: /* Clinical Features */

Kennybroccoli: /* Clinical Features */

Kennybroccoli: /* Management */

Kennybroccoli: /* Clinical Features */

Kennybroccoli: /* Clinical Features */

Kennybroccoli: /* Background */

Elcatracho: /* Clinical Features */

ClaireLewis: /* Clinical Features */

ClaireLewis: Created page with "==Background== *Very similar to alcohol withdrawal ==Clinical Features== *Onset usually several days to 1 week *More likely in patients with high doses or prolonged use *..."

ClaireLewis: Created page with "==Background== Very similar to alcohol withdrawal ==Clinical Features== Onset usually several days to 1 week More likely in patients with high doses or prolonged use ..."