Source: Doering PL. Substance-Related
Disorders: Overview and Depressants, Stimulants, and Hallucinogens.
In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM,
eds. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7987346.
Accessed June 9, 2012.
- Substance-related disorders include disorders of:
- Intoxication is maladaptive behavior during waking state after
recent ingestion and presence in body of substance that causes central
nervous system (CNS) effects.
- Substance dependenceis continued
pattern of substance use in spite of repeated adverse consequences
related to repeated use.
- Physical dependence is state of adaptation manifested by withdrawal
- Rapid dose reduction
- Decreasing blood levels
- Administration of antagonist
- Withdrawalis development of
substance-specific syndrome after cessation or reduced intake of
substance that had been used regularly.
- Emergency department (ED) visits involving benzodiazepines
outnumber those of other psychotherapeutic agents.
- In 2006, approximately 195,625 ED visits involved nonmedical
use of benzodiazepines.
- Alprazolam and clonazepam implicated more frequently than
diazepam and lorazepam.
- Benzodiazepine intoxication
- Slurred speech
- Poor coordination
- Does not generally result in life-threatening respiratory
- Table 1: Characteristics of dependence on benzodiazepines
- Benzodiazepine withdrawal
- Presents similarly
to alcohol withdrawal, with:
- Muscle pain
- Cardiovascular collapse
- Onset of withdrawal from short-acting benzodiazepines (oxazepam,
lorazepam, alprazolam) within 12–24
hours of last dose.
- Withdrawal from long-acting benzodiazepines (diazepam, chlordiazepoxide, clorazepate) may
be delayed for several days after discontinuation.
- Patients in withdrawal may be in acute distress
and should be treated with benzodiazepine taper to prevent seizures.
Table 1. Characteristics
of Benzodiazepine Dependence |Favorite Table|Download (.pdf)
Table 1. Characteristics
of Benzodiazepine Dependence
|Generic Name||Common Trade Names||Oral Sedating Dose (mg)||Physical Dependence Daily Dose and Time Needed to Produce Dependence||Time Before Onset of Withdrawal (hr)||Peak Withdrawal Symptoms (days)|
|Alprazolam||Xanax||0.25–8||8–16 mg × 42 days (est.)||8–24||2–3|
|Clorazepate||Tranxene||7.5–15||45–180 mg × 42–120 days (est.)||12–24||5–8|
|Diazepam||Valium||5–10||40–100 mg × 42–120 days||12–24||5–8|
|Flunitrazepam||Rohypnol||1–2||8–10 mg × 42 days (est.)||24–36||2–3|
- When toxicology screens necessary, blood or urine should
be collected immediately when patient presents for treatment.
- Qualitative testing useful to confirm presence of benzodiazepines
for diagnostic purposes.
- Quantitative plasma concentrations not usually helpful.
- Intoxication: Ingestion of other sedative-hypnotics or
- Withdrawal from other sedatives
- Cocaine intoxication
- Delirium due to medical illness
- Hepatic encephalopathy
- Thiamine deficiency
- Anxiety disorder
- Hallucinosis from other causes
- Seizure from other causes
- Cessation of use of drug
- Termination of drug-seeking behaviors
- Return to normal functioning
- Goals of treatment for withdrawal
progression of withdrawal to life-threatening severity.
- Enable patient participation in treatment program.
- Likelihood and severity of ...