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Clonazepam and Nitrazepam
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
CZP is well absorbed, achieving a peak plasma level within 1 to 3 hours after oral administration (for rectal administration, see Chapter 73). It is 47% protein bound. CZP distribution is rapid because of its high lipid solubility. The elimination half-life of the drug varies from 20 to 40 hours and is excreted primarily as oxazepam after liver metabolism (4,3). The relationship between the serum levels and dosage is more or less linear, children having a considerably lower mean ratio of plasma levels to oral dose and a higher clearance value than adults (6). Most authors recommend serum levels between 13 and 70 ng/ml (1,6). However, there is no clear correlation between this “therapeutic range” and either effective seizure control or toxicity (7). CZP seems not to alter the steady-state serum level of phenobarbital (PB), phenytoin (PHT), or carbamazepine (CBZ). On the other hand, the addition of PHT, CBZ, or barbiturates may lower the steady-state concentration of CZP (4).
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
In alcohol dependent patients with hepatic impairment, oxazepam is the treatment of choice. As described in Chapter 7, this benzodiazepine is eliminated from the body by Type II conjugating enzymes to a glucuronoconjugate, which is then eliminated in the urine by the kidney. In contrast, most other benzodiazepines are eliminated by hepatic oxidation through the CYP450 system. In patients with hepatic impairment, oxazepam is the most appropriate benzodiazepine to provide predictable plasma levels without the need for dose titration or drug monitoring.
Homicide
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
Burkhard Madea, Musshoff Frank, Schmidt Peter
Toxicological analysis of the blood demonstrated therapeutic concentrations of oxazepam. The assays for cyanide yielded the following levels: blood 42.5 mg/L, brain 2.54 mg/l, gastric contents 1.2 g/l. The white granular powder taken by the woman was proved to be sodium cyanide.
Designer benzodiazepines versus prescription benzodiazepines: can structural relation predict the next step?
Published in Critical Reviews in Toxicology, 2021
Raneem E. Moustafa, Fuad Tarbah, Huda Sulaiman Saeed, Suleiman I. Sharif
Similarly, diazepam is metabolized into three active metabolites, nordiazepam with a half-life of up to 100 h, temazepam with a half-life of 10 h, and oxazepam with a half-life of 6–25 h (Alván and Odar-Cederlöf 1978; Rouini et al. 2008; Luk et al. 2014). This imposes the same issue discussed in diclazepam as a thorough investigation is needed to determine the parent drug and its metabolites taking into consideration the possibility of any of the four drugs being an individual cause of abuse/death (Hastedt 2015; Moosmann and Auwärter 2018). It is worth noting that a study in 2013 analyzed benzodiazepines and their metabolites including diazepam and metabolites of diclazepam by different immunoassay screenings and LC-MS\MS to differentiate between the parent drug and its metabolites (Bertol et al. 2013).
Domiciliary alcohol detoxification outcomes: a study from Goa, India
Published in Journal of Addictive Diseases, 2020
Saumitra Nemlekar, Pooja Gaonkar, Anil Rane
The socio-demographic details of our all male sample of 100 are given in the following table (Table 1). The age of start of alcohol was from as early as 12 years to as late as 40 years of age. The daily use of alcohol was in the range of 3–30 units/day. Five patients were prescribed oxazepam and rest was detoxified with lorazepam. Converting the dosages to a single benzodiazepine, the average daily dose (at day one of presentation) used was 5.85 mg lorazepam equivalence.10 Other psychiatric comorbidities were nicotine use (n = 75), mood, anxiety, personality disorders (26% each), psychosis (6%) and cannabis use (3%).53% did not have any medical co-morbidities. Hypertension (15%), liver impairment (19%), CNS related (14%), symptoms due to portal hypertension (8%) and diabetes mellitus (2%) were seen in the others either individually or in combination.
Longitudinal gut microbiome changes in alcohol use disorder are influenced by abstinence and drinking quantity
Published in Gut Microbes, 2020
Nancy J. Ames, Jennifer J. Barb, Kornel Schuebel, Sarah Mudra, Brianna K. Meeks, Ralph Thadeus S. Tuason, Alyssa T. Brooks, Narjis Kazmi, Shanna Yang, Kelly Ratteree, Nancy Diazgranados, Michael Krumlauf, Gwenyth R. Wallen, David Goldman
During inpatient treatment, 18/22 participants required benzodiazepines, primarily oxazepam, to assist with withdrawal. For those who used benzodiazepines, the mean number of days was 4.17 (± 3.37) and use extended from 1 d to a maximum of 11 d. Seven received topical steroids for skin conditions. Seven participants were taking acamprosate or naltrexone for AUD. Two were on systemic antibiotics to treat underlying infections, while one participant received ophthalmic antibiotic drops for prophylaxis after an eye procedure performed before inpatient admission. Three participants were given proton-pump inhibitors, one was taking an H2 blocker, ranitidine and two received antacids (prescribed as needed) for heartburn symptoms during study participation. Nine participants were placed on smoking cessation therapies (varenicline, nicotine patch/gum, or bupropion). Ten participants were taking psychotropic drugs. Fourteen participants were taking analgesics as needed for pain. Last, but not least, every study participant was taking multivitamin tablets, and thiamine for nutritional support which is standard clinical management for AUD. For a list of administered medications, see Supplemental Material (Table S1).