Withdrawal Management Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings NCBI Bookshelf

Withdrawal Management Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings NCBI Bookshelf

Adding benzos to the mix only increases the risk factors for a potentially life-threatening outcome. The Drug Abuse Warning Network (DAWN) report of 2014 estimated that mixing benzodiazepines with alcohol or opioids enhanced the potential and predicted risk for a more serious medical outcome between 24 and https://ecosoberhouse.com/ 55 percent. Regular use of BZDs has been shown to cause serious, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. Regular use of BZDs can lead to tolerance, which is the physiologic dependence on the presence of BZDs in the body’s system.

Alprazolam, the generic name for Xanax, was the 13th most prescribed medication in the country in 2012, according to a survey done by IMS Health. BZDs are most commonly used for panic disorder and generalized anxiety disorder (GAD) regarding its indications for anxiety. In terms of anxiety, BZDs are used as a bridge when starting another medication or as abortive therapy for panic attacks. Given concerns for use dependence and withdrawal, SSRIs and antidepressants have been made mainstay therapy for these conditions. However, given their delayed onset of action, BZDs continue to be widely prescribed for these illnesses [12]. A Boxed Warning, the FDA’s most stringent safety warning, exists on all benzodiazepine product information.


Patients may exhibit extreme sedation, cognitive impairment, and ataxia, often accompanied by slurred speech. Respiratory depression represents a critical concern, necessitating benzodiazepine withdrawal prompt medical intervention. Cardiovascular effects, such as hypotension and bradycardia, further underscore the systemic consequences of benzodiazepine toxicity.

  • When these substances are removed suddenly from someone’s bloodstream, respiration can drop to potentially fatal levels and potentially lethal seizures may occur.
  • Benzodiazepines are often coingested with other substances, such as opioids and alcohol, in overdose.
  • One study showed that replacing BZD with a 45 day captodiamine led to a decrease in severity of withdrawal symptoms in patients taking BZD for six months [70].
  • Dependence appears to occur in a similar way to how it does with other addictive drugs.

Additionally, medical supervision allows doctors to respond much more quickly to potential side effects and withdrawal symptoms. During the early stages of withdrawal, the person may notice the symptoms of the condition that the drug was treating start to return, or rebound. For example, symptoms of anxiety or insomnia may come back or get worse without the drugs. Inhalant withdrawal symptoms can begin anywhere between a few hours to a few days after ceasing inhalant use.

Protracted withdrawal syndrome

However, no set schedule for a taper has been validated in the current literature. Agarwal and Landon 2019 stated that the prescription of BZD in outpatient settings significantly increased from 2003 to 2015 [27]. Several studies have examined the relationship between BZD use and mortality. In a systematic review of research, Charlson et al. could not find conclusive evidence supporting increased risk of mortality in BZD users [43]. In their analysis of six retrospective studies, half of them showed no significant relationship between BZD use and mortality.

Withdrawal effects of benzodiazepines

Future research should also further investigate the misuse liability of alprazolam XR, and should attempt to clarify the role of carbamazepine, clonidine, other anticonvulsant drugs, and related compounds in the treatment of the alprazolam withdrawal syndrome. Alprazolam withdrawal syndrome may also feature unique clinical symptoms compared with other benzodiazepine withdrawal syndromes. Interestingly, despite ICU care and administration of beta-blockers and alpha-blockers, the pseudo-pheochromocytoma was only successfully treated by alprazolam re-instatement (Orzack et al., 1988). However, while the available data show that alprazolam monotherapy is as effective as other benzodiazepines for the treatment of anxiety and panic disorders, this must be considered along with its propensity for tolerance, dependence, and rebound anxiety. They’re an important means of treating many conditions, ranging from mental health disorders to brain-related diseases. While these medications can treat many conditions and help millions, they’re not without risks.

Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.

Panic disorder can be a prolonged, chronic disorder, but it is very treatable with medications that lessen symptoms. Behavioral therapy and treatment with the antidepressants such as selective serotonin-reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and/or behavioral therapy are first-line treatments. Benzodiazepines such as diazepam may also be used short-term as a muscle relaxant. These are generally used to relieve acute painful skeletal muscle spasms, such as what might occur with acute lower back muscle spasm. They are added as an adjunct to rest, physical therapy and / or heat and ice.

  • Withdrawal symptoms, ranging from a return of uncomfortable psychological symptoms to physical manifestations such as nausea and diarrhea, may occur when the drugs are removed from the bloodstream.
  • If there is a documented need, low doses and drugs with shorter durations (half-lives) will help to minimize side effects like dizziness, weakness, and falls that may lead to hip fractures.
  • Benzodiazepines are among the most commonly prescribed medications in the country.
  • They are safe when used as directed and often bring quick relief from panic symptoms.
  • The longer the interval between reductions, the more comfortable and safer the withdrawal.

As for management of mild alcohol withdrawal, but patients in severe alcohol withdrawal also require diazepam sedation. This may involve very large amounts of diazepam, many times greater than would be prescribed for patients in moderate alcohol withdrawal. If the protocol in Table 11 does not adequately control alcohol withdrawal symptoms, provide additional diazepam (up to 120mg in 24 hours).

Benzodiazepine Side Effects

Retrospective studies evaluating pregnancy outcomes of women exposed to alprazolam during the first trimester of pregnancy found conflicting results of congenital anomalies (Iqbal et al., 2002). Healthcare professionals can use prescription drug monitoring programs to identify benzodiazepine misuse.[46] Benzodiazepines are DEA-Scheduled IV drugs; flunitrazepam is unique among benzodiazepines, which are under Schedule IV but have Schedule I penalties. The United States Food and Drug Administration (FDA) has approved a few benzodiazepines for the management of anxiety, seizures, and alcohol management, as mentioned below.