Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition And Treatment
Sedative-hypnotic drugs include gamma-Aminobutyric acid (GABA)ergic agents such as benzodiazepines, barbiturates, gamma-Hydroxybutyric acid [GHB], gamma-Butyrolactone [GBL], baclofen, and ethanol. Chronic use of these substances can cause tolerance, and abrupt cessation or a reduction in the quantity of the drug can precipitate a life-threatening withdrawal syndrome. Benzodiazepines, phenobarbital, propofol, and other GABA agonists or analogues can effectively control symptoms of withdrawal from GABAergic agents. Managing withdrawal symptoms requires a patient-specific approach that takes into account the physiological pathways of the particular drugs used, as well as the patient's age and comorbidities. Adjunctive therapies include alpha-2 agonists, beta blockers, anticonvulsants, and antipsychotics. Newer pharmacological therapies offer promise in managing withdrawal symptoms.
Key words: sedative-hypnotic, withdrawal, GABA, GABAergic, benzodiazepine, barbiturate, baclofen, GHB, GBL, ethanol, alprazolam, chlordiazepoxide, lorazepam, propofol, dexmedetomidine, phenobarbital, haloperidol, sympathomimetic, hyperthermia
- Sedative-hypnotic agents are the second most frequent drug class to cause an emergency department (ED) visit. This category includes benzodiazepines, barbiturates, baclofen, GHB (gamma-hydroxybutyric acid) and GBL (gamma-butyrolactone).
- Cessation of sedative-hypnotic agents leads to decreased GABA-mediated inhibitory tone and increased NMDA-mediated excitatory tone. This results in autonomic stimulation (tachycardia, hypertension, hyperthermia, diaphoresis), tremors, hallucinations, and seizures.
- Diazepam and chlordiazepoxide are the preferred agents to treat sedative-hypnotic withdrawal because they are long-acting, with active metabolites.
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- » Introduction
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- » Pathophysiology
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- » Risk Management Pitfalls For Sedative-Hypnotic Drug Withdrawal
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- » Clinical Pathway For Managing Sedative-Hypnotic Drug Withdrawal In The Emergency Department
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- » Alcohol Withdrawal Syndrome: Improving Outcomes Through Early Identification And Aggressive Treatment Strategies (Critical Care Issue) Emergency Medicine Practice - June 2015