Drug Withdrawal: Recognition and Treatment
Frank Lynn Iber in Alcohol and Drug Abuse as Encountered in Office Practice, 2020
A variety of agents are advocated for the treatment of alcohol withdrawal, but several are superior in my experience. Use of a single agent in a unit leads to far superior withdrawal treatment than use of multiple agents. For 95% of sedative and opiate withdrawals, the very-long-acting agents diazepam and chlordiazepoxide are heavily preferred. The long action makes everyone’s efforts easier, for when adequate sedation is attained (see treatment curve in Figure 12) so that withdrawal signs are decreasing, no further dosing is required. In a consecutive series of 100 patients adequately treated for withdrawal using chlordiazepoxide, the average patient required a total of 5.7 doses for the entire withdrawal. The mean dose in the first 24 h was 312 mg, and the mean in the second 24 h was 97 mg. In a subsequent study of 100 similar patients treated with diazepam, 6.3 doses were required (not significantly greater), with 43 mg used in the first 24 h and 28 mg used in the subsequent 24-h period. The very prolonged duration of action is desirable in uncomplicated withdrawal but may be less desirable when there is a question of serious head injury or impending surgery. The inability to give these two agents i.m. is their major disadvantage. Chlordiazepoxide has almost no anticonvulsant effect. An evaluation of withdrawal treated with a single 20-mg dose of diazepam has appeared.9
Military Chemical Casualty Treatment
Brian J. Lukey, James A. Romano, Salem Harry in Chemical Warfare Agents, 2019
Diazepam is an anticonvulsant drug used to decrease convulsive activity and reduce the brain damage caused by prolonged seizure activity. Without the use of pyridostigmine pretreatment with soman, experimental animals died quickly after lethal doses of nerve agents despite conventional therapy. With pyridostigmine pretreatment (followed by conventional therapy), animals survived lethal doses of soman but had prolonged periods of seizure activity before recovery. They later had performance decrements and anatomic lesions in their brains. The administration of diazepam with standard therapy and pretreatment with pyridostigmine reduced the seizure activity and its sequelae. Current military doctrine is to administer diazepam with other therapy (three ATNAAs) at the onset of severe effects from a nerve agent, whether or not seizure activity is among those effects. Each warfighter carries one autoinjector containing 10 mg of diazepam for administration by a buddy or medic. Medical personnel should administer more diazepam (three or four CANAs) to a casualty with seizures or flaccid paralysis. Additional CANA should be titrated to need should seizures fail to stop or return. Medically, the dosage of diazepam is whatever it takes to stop seizures. However, the larger the diazepam dosage, the more likely it is that longer respiratory support will be required.
Postconcussive syndrome
Brian Sindelar, Julian E. Bailes in Sports-Related Concussion, 2017
Conservative measures can be instituted acutely and continued with chronically symptomatic athletes, but persistent symptoms warrant escalation to pharmacological agents. Due to the limited research on pharmaceutical interventions specifically for concussive injury, these are only recommendations based on the limited data from concussion and moderate to severe TBI literature. Medications that have been suggested for use in cognition and arousal following a concussion/TBI are neurostimulants (i.e. amantadine, dextroamphetamine, modafinal, methylphenidate, atomoxetine), selective serotonin reuptake inhibitors (i.e sertraline, fluoxetine), and acetylcholinesterase inhibitors (i.e donepezil, rivastigmine, galantamine)175,184,186,215,217–227 (refer to Table 5.3).175 In patients whose complaints appear to be more sleep-related, the use of both nonbenzodiazepine sedatives and herbal remedies are advocated (Table 5.4).175 Benzodiazepines, such as lorazepam, clonazepam, and diazepam, are highly addictive and alter the normal sleep architecture and therefore are not recommended for routine use.184,186,228 Nonbenzodiazepine derivatives, such as zolpidem, are good short-term, first line agents to aid those with sleep difficulties because they decrease sleep latency and nocturnal awakenings.11,175,184,228 Caution should be exercised when used in the elderly due to potential side effects of confusion and altered mental status.228
Sinisan ameliorates colonic injury induced by water immersion restraint stress by enhancing intestinal barrier function and the gut microbiota structure
Published in Pharmaceutical Biology, 2023
Xiaoying Xu, Huimei Hu, Haizhou Zeng, Boyi Li, Qiuxiong Yin, Yupeng Jiang, Linquan Zang, Changlin Zhao, Guoqiang Qian
SNS was prepared from the following ingredients: Bupleurum chinense DC. (Apiaceae), Paeonia lactiflora Pall. (Paeoniaceae), Citrus aurantium L. (Aurantioideae), and Glycyrrhiza uralensis Fisch. (Fabaceae), with a dose proportion of 1:1:1:1 (shown in Table 1). Our team obtained and verified the herbs from Beijing Tongrentang (Guangzhou, China). Four Chinese medicinal herbs (12 g each) were soaked for 1 h and then decocted twice for 1 h each. Two filtrates were combined and concentrated to 1 g/mL. The SNS solution was stored in a refrigerator at 4 °C. By diluting 1 g/mL SNS with ultrapure water, the low-, medium-, and high-dose concentrations of SNS were 0156, 0.324, and 0.624 g/mL, respectively. The medium dose was considered to be the therapeutic comparable dose for humans. Reference standards of saikosaponin A (CAS No. 20736-09-8, purity ≥ 98%), paeoniflorin (CAS No. 23180-57-6, purity ≥ 98%), naringin (CAS No. 10236-47-2, purity ≥ 98%), and glycyrrhizic acid (CAS No. 1405-86-3, purity ≥ 98%) were all purchased from Shanghai Macklin Biochemical Co., Ltd. (Shanghai, China). Diazepam tablets were manufactured by Shandong Xinyi Pharmaceutical Co., Ltd. (Lot number: NO.210504, national medicine permission number: H37023039). Diazepam was diluted with ultrapure water to a concentration of 0.25 mg/mL. The clinical adult dose recommended in the medication instructions served as the basis for the diazepam dose used in our study.
Current and emerging treatment options for Angelman syndrome
Published in Expert Review of Neurotherapeutics, 2023
Christopher J. Keary, Christopher J. McDougle
Special considerations in the treatment of epilepsy in AS include the treatment of status epilepticus and episodes of NEM. There is a high risk for seizures being refractory to single-agent treatment, so patients with AS who have had their first seizure should have a seizure rescue medication prescribed. Intranasal or buccal midazolam and rectal or intranasal diazepam are recommended. A retrospective chart review of 13 patients with AS with 25 separate episodes of NCSE showed resolution with courses of diazepam 80% of the time [26]. Diazepam courses in the study used twice or three times a day dosing ranging from 0.18 to 0.57 mg/kg/day over a range of 4–12 days. Multiple patients required two or even three consecutive treatment courses. Side effects included fatigue and nasal congestion. A separate two patient case series described effective usage of ethosuximide added to valproic acid to treat atypical absence status epilepticus [33]. When it comes to the treatment of NEM, a chart review study found that some patients improved with trials of levetiracetam, clobazam, or clonazepam and as needed dosing of lorazepam or diazepam was often helpful [25]. Finally, a four patient case series described the usage of the antiepileptic drug perampanel for NEM [34]. All subjects had reductions in the rate of myoclonus from 66% to 100% with dose-dependent dizziness the only experienced side effect.
Acute organophosphate and carbamate pesticide poisonings – a five-year survey from the National Poison Control Center Of Serbia
Published in Drug and Chemical Toxicology, 2023
Žana M. Maksimović, Jasmina Jović-Stošić, Slavica Vučinić, Nataša Perković-Vukčević, Gordana Vuković-Ercegović, Ranko Škrbić, Miloš P. Stojiljković
With energetic supportive measures (securing a breathing line), poison removal and detoxification (gastric lavage until obtaining clear lavage liquid, application of activated charcoal) and symptomatic therapy, specific treatment of OPP poisoning include administration of antidotes (atropine, oximes, diazepam) (Vanova et al.2018, Eddleston 2019, Jokanović et al.2020). Atropine, which has a 100 times stronger affinity for cholinergic receptors than ACh, alleviates the muscarinic effects but has no impact on the nicotinic ones. It is given for as long as there are signs of acute cholinergic crisis, that is until the signs of atropinization occur (Henretig et al.2019). Oximes, AChE reactivators, bind to OPP already bound to AChE, which leads to the reactivation of AChE. The affinity of oximes for different organophosphorus compounds (OPCs) varies significantly. Globally, pralidoxime (PAM-2) is the oxime most frequently used for the treatment of OPP poisoning. Apart from that, in practice, obidoxime (LüH-6) is also used and it is considered the most effective oxime against OPP poisonings (Worek et al.2020, Maksimović et al.2021). Diazepam inhibits the excitability of the neurons in the CNS; by increasing the effect of GABA, it increases cAMP, decreases the level of cGMP, leading to the cessation of convulsions (Lundy and Magor 1978).
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