Propylene glycol toxicity: a severe iatrogenic illness in ICU patients receiving IV benzodiazepines: a case series and prospective, observational pilot study. Wilson KC, Reardon C, Theodore AC, Farber HW. Respiratory depression by midazolam and diazepam. 14:77-79.įorster A, Gardaz JP, Suter PM, Gemperle M.
A Retrospective Review of Morbidity and Mortality Associated with Acute Benzodiazepine Withdrawal at a Midwestern Academic Medical Center. Thornton SL, Whitacre J, Pallo N, Roberts N, Oller L. In the announcement, the FDA concluded that prescribing information did not provide adequate warnings about the serious risks and harms associated with these drugs, thus increasing the risk of adverse effects, especially when BZDs are used with some other medicines and substances. In 2020, the US Food and Drug Administration (FDA) updated the required boxed warnings and package inserts for all BZDs to include information on the potential for abuse, addiction, and other serious risks. Treatment of BZD withdrawal is typically with a long-acting BZD (eg, clonazepam), but sucessful use of antiseizure drugs (eg, valproate, carbamazepine) has also been reported. Alprazolam (Xanax) withdrawal syndrome may be especially severe, with associated delirium, psychosis, and hyperadrenergic states. Clinical hand findings are shown (Figure A).In long-term users who have developed dependence, cessation of BZDs can result in a withdrawal syndrome, with manifestations including anxiety, irritability, confusion, seizures, and sleep disorders. On physical examination, he appears diaphoretic, anxious, and has scleral icterus. His temperature is 100.2☏ (37.9☌), blood pressure is 150/90 mmHg, pulse is 130/min, and respirations are 22/min. However, the recent death of his brother motivated him to stop drinking. He has a 35 pack-year smoking history and drinks multiple alcoholic beverages a day. His past medical history is notable for multiple prior hospitalization for acute pancreatitis. Within the past few hours he developed severe nausea and vomited twice. He also states that he hears his recently deceased brother speaking to him. He reports that he began developing tremors, irritability, and severe anxiety approximately 18 hours prior to presentation. Spongiform Encephalopathy / Creutzfeldt-Jakob DiseaseĪ 61-year-old man presents to the emergency department due to severe malaise.
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