Sedative/hypnotic withdrawal: Difference between revisions
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==Background== | ==Background== | ||
Sedative/hypnotics, including benzodiazepines, barbiturates, and non-benzodiazepine "Z-drugs" (e.g., zolpidem, eszopiclone), are commonly prescribed for anxiety, insomnia, and seizure disorders. While effective in the short term, these agents carry a significant risk for tolerance, physical dependence, and withdrawal upon abrupt discontinuation. The underlying pathophysiology of withdrawal stems from chronic modulation of gamma-aminobutyric acid (GABA) receptors, resulting in a state of central nervous system hyperexcitability when the inhibitory effect is suddenly removed [2]. Sedative/hypnotic withdrawal remains underrecognized in clinical practice despite its potentially life-threatening complications, such as seizures and delirium [5]. | |||
==Clinical Features== | ==Clinical Features== | ||
For short-acting agents like alprazolam or zolpidem, withdrawal can begin within 6–24 hours after the last dose. Long-acting agents like diazepam may produce symptoms after several days. | |||
Common features include: | |||
Mild: anxiety, insomnia, restlessness, tremors, diaphoresis | |||
Moderate: palpitations, nausea, myoclonus, perceptual disturbances | |||
Severe: hallucinations, psychosis, seizures, and delirium tremens-like presentations | |||
Symptoms typically peak within 48–72 hours but can persist for weeks, especially with long-term use [2]. A clinical feature distinguishing sedative/hypnotic withdrawal from alcohol withdrawal is the potential for prolonged symptoms due to the long half-life of some agents. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 15:41, 5 May 2025
Background
Sedative/hypnotics, including benzodiazepines, barbiturates, and non-benzodiazepine "Z-drugs" (e.g., zolpidem, eszopiclone), are commonly prescribed for anxiety, insomnia, and seizure disorders. While effective in the short term, these agents carry a significant risk for tolerance, physical dependence, and withdrawal upon abrupt discontinuation. The underlying pathophysiology of withdrawal stems from chronic modulation of gamma-aminobutyric acid (GABA) receptors, resulting in a state of central nervous system hyperexcitability when the inhibitory effect is suddenly removed [2]. Sedative/hypnotic withdrawal remains underrecognized in clinical practice despite its potentially life-threatening complications, such as seizures and delirium [5].
Clinical Features
For short-acting agents like alprazolam or zolpidem, withdrawal can begin within 6–24 hours after the last dose. Long-acting agents like diazepam may produce symptoms after several days.
Common features include:
Mild: anxiety, insomnia, restlessness, tremors, diaphoresis
Moderate: palpitations, nausea, myoclonus, perceptual disturbances
Severe: hallucinations, psychosis, seizures, and delirium tremens-like presentations
Symptoms typically peak within 48–72 hours but can persist for weeks, especially with long-term use [2]. A clinical feature distinguishing sedative/hypnotic withdrawal from alcohol withdrawal is the potential for prolonged symptoms due to the long half-life of some agents.
Differential Diagnosis
Sedative/hypnotic withdrawal
- Toxic alcohols
- Benzodiazepines
- Flunitrazepam (Rohypnol)
- Gamma hydroxybutyrate (GHB)
- Baclofen
- Barbiturates
- Opioids
- Chloral hydrate