eISSN: 2720-5371
ISSN: 1230-2813
Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii
Current issue Archive Manuscripts accepted About the journal Scientific board Abstracting and indexing Subscription Contact Instructions for authors Publication charge Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
4/2019
vol. 28
 
Share:
Share:
abstract:
Case report

Steering the pharmacological treatment along different metabolic pathways in response to outlying complicated benzodiazepine withdrawal – a case study

Urszula Cieślak
1
,
Anna Basińska-Szafrańska
2

1.
I Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
2.
Department of Prevention and Treatment of Addictions, Institute of Psychiatry and Neurology, Warsaw, Poland
Adv Psychiatry Neurol 2019; 28 (4): 283-290
Online publish date: 2019/12/30
View full text Get citation
 
PlumX metrics:
Purpose
In benzodiazepine (BZD)-addicted patients, as in alcohol-dependent ones, the complicated withdrawal syndrome may be efficiently treated with accumulated long-acting benzodiazepine. The following work presents an alternative that can be used when the procedure fails.

Case description
A midazolam-dependent patient (1500 mg/d) was admitted to the hospital due to a withdrawal-induced status epilepticus. After treatment with barbiturates and megadoses of diazepam, the seizures subsided, but during the continuation of BZD (diazepam, clorazepate), consciousness disorders gradually developed culminating in a full loss of contact with the patient. The breakthrough occurred when lorazepam was used instead of previously administered substitute BZDs.

Comment
Extreme midazolam abuse (with a possible contribution of barbiturates at emergency admission) induced hydroxylating liver enzymes. This meant a rapid conversion of nominally long-acting substitutes, as those are similarly metabolized. This extremely facilitated elimination hindered their accumulation to the needed satiation level. Lorazepam, short-acting but bypassing the accelerated metabolic pathway, at sufficient doses provided the satiation necessary to stabilize the patient.

keywords:

metabolism, midazolam, benzodiazepine, withdrawal syndrome, lorazepam

Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.