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Benzodiazepines: Anticonvulsant and other clinical uses
Published in Adam Doble, Ian L Martin, David Nutt, Calming the Brain: Benzodiazepines and related drugs from laboratory to clinic, 2020
Adam Doble, Ian L Martin, David Nutt
Benzodiazepine overdose is a frequent form of self-poisoning encountered in suicide attempts (Hojer et al, 1989). Due to the very low acute toxicity of these compounds death rarely results, but the individual falls asleep and enters a comatose state that may last for many hours. Respiratory depression is also sometimes observed, which may be dangerous. Many studies have demonstrated that individuals can be aroused from their comatose state by IV administration of flumazenil (eg O’Sullivan and Wade, 1987; Spivey et al, 1993). A problem associated with the use of flumazenil in benzodiazepine overdose is its short half-life, which may lead to relapse once its effects have worn off, and thus requires multiple treatments. The use of flumazenil in concomitant overdose with benzodiazepine and tricyclic antidepressants can be dangerous in that relief by flumazenil of the anticonvulsant effects of benzodiazepines may unveil the convulsant effects of tricyclic antidepressants, and several examples of this leading to death have been reported.
Central nervous system depressants
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Although benzodiazepines are much safer in overdose than barbiturates, they can still cause problems (Gaudreault et al., 1991). Drug poisoning deaths in England showed that benzodiazepines caused 3.8 per cent of all deaths from a single drug (Charlson et al., 2009), and benzodiazepines were present in toxicology tests in 9.4 per cent of adolescents included in the Toxicology Investigators Consortium (ToxIC) Case Registry (Finkelstein et al., 2017). Different benzodiazepines differ in their toxicity; temazepam appears to be more toxic in overdose, especially when combined with other drugs (Serfaty and Masterton, 1993; Buckley et al., 1995) and flurazepam, now rarely prescribed, has the highest fatal toxicity index of any benzodiazepine (Buckley et al., 1995). Symptoms of benzodiazepine overdose may include drowsiness, slurred speech, nystagmus, hypotension, ataxia, coma, respiratory depression and cardiorespiratory arrest. Combining benzodiazepines with alcohol, opiates or tricyclic antidepressants markedly raises their toxicity (White and Irvine, 1999).
Disorders
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Benzodiazepine misuse and withdrawal are covered in depth on p. 288, refer ‘Stopping’ in ‘Sleep Disorders and Agitation’ section of this chapter]. For benzodiazepine overdose, see p. 382, refer ‘Benzodiazepine Overdose’ heading in ‘Emergencies’ chapter.
Trends in intentional abuse or misuse of benzodiazepines and opioid analgesics and the associated mortality reported to poison centers across the United States from 2000 to 2014
Published in Clinical Toxicology, 2018
S. L. Calcaterra, S. G. Severtson, G. E. Bau, Z. R. Margolin, B. Bucher-Bartelson, J. L. Green, R. C. Dart
One unexpected finding of this study was the greater number of benzodiazepine-exposures compared to opioid analgesic exposures. There were 60% more benzodiazepine exposures (n = 103,825) than opioid analgesic exposures (n = 62,967). Despite the national increase in benzodiazepine prescribing over the study period [15], opioid analgesics were prescribed in greater quantities in the United States [49] making them readily available for diversion and illicit use. A possible explanation for this unexpected finding may be related to the safety profile of benzodiazepines as compared to opioid analgesics. Benzodiazepine overdose can cause sedation, dizziness, slurred speech and blurry vision [50], but rarely cause death, which is more commonly associated with opioid overdose [51]. Our findings may reflect that people who abused or misused benzodiazepines were more likely to call a poison center for concerning physical symptoms. In contrast, people who abused or misused opioid analgesics (or both opioid analgesics and benzodiazepines) may have been too incapacitated to call for assistance, to call 911 or may have used naloxone to reverse the opioid effect. These scenarios would result in fewer reports to poison centers despite the abuse and misuse of opioid analgesics.
Mandatory use of prescription drug monitoring program and benzodiazepine prescribing among U.S. Medicaid enrollees
Published in Substance Abuse, 2021
Di Liang, Huiying Guo, Yuyan Shi
The problem of benzodiazepines has been a long-standing public health concern in the U.S.7 The number of adults filling a benzodiazepine prescription increased from 8.1 million to 13.5 million in 1996–2013 and the quantity of filled benzodiazepines tripled from 1.1 kg to 3.6 kg lorazepam-equivalents per 100,000 adults during the same period.8 Parallel with the increasing trend of benzodiazepine prescribing, benzodiazepine overdose mortality more than quintupled.8 In 2016, 10,684 people in the U.S. died of an overdose involving benzodiazepines, which accounted for 16.8% of all drug overdose deaths.9
Association of prescription drug monitoring programs with benzodiazepine prescription dispensation and overdose in adolescents and young adults
Published in Clinical Toxicology, 2023
Michael S. Toce, Kenneth A. Michelson, Joel D. Hudgins, Karen L. Olson, Michael C. Monuteaux, Florence T. Bourgeois
Benzodiazepine overdoses occurred among 1,569 (0.04%) and 3,202 (0.05%) adolescents and young adults, respectively. The number of males and females experiencing at least one overdose was similar (females n = 2,545, 0.1%; males n = 2,199, 0.1%). Annual overdose prevalence peaked in 2016 at 2.6 (95% CI, 2.1–3.1) and 4.0 (95% CI, 3.6–4.5) per 100,000 adolescents and young adults, respectively, before declining to 1.6 (95% CI, 1.3–1.9) and 2.3 (95% CI, 2.0–2.6) per 100,000 adolescents and young adults, respectively, in 2019.