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Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition And Treatment

March 2017

Abstract

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

Points

  • 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.

Pearl

  • Diazepam and chlordiazepoxide are the preferred agents to treat sedative-hypnotic withdrawal because they are long-acting, with active metabolites.
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Last Modified: 06/28/2017
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