Benzodiazepine (BZD) withdrawal: clinical findings and complications

Benzodiazepine (BZD) withdrawal: clinical findings and complications
Abrupt cessation of chronic ingestion of BZDs
Administration of BZD antagonist (flumazenil) on patients who have developed -* tolerance/dependence to BZD
Withdrawal Seizure
Negative physiological reactions BZD intake inhibition a mygd to f, • of a la Withdrawal symptoms Benzodiazepine Withdrawal GABA receptor activity (less inhibition alleviated by ingesting BZD Tolerance GABA BZD intake Conformational changes in the GABA receptor 1, receptor’s Withdrawal Insomnia Pro-excitatory 4— state of excitatory neurotransmitters) 4— to the agent activity affinity for the agent
Activation of ACC and OFC
Feelings of fear
Activation of PAG
Behavioural response of fight or flight
Legend: Pathophysiology Mechanism
Activation of hypothalamus ‘1` Cortisol CAD, T2DM, Stroke
Sign/Symptom/Lab Finding
Activation of PBN
t RR, SOB, Asthma, or a sense of being smothered
Activation of LC
t Sympathetic Activity
t BP, t HR variability, tremor, and diaphoresis
Authors: Usama Malik Reviewers: Sina Marzoughi Aaron Mackie* * MD at time of publication
Notes: • The onset of withdrawal can vary according to the half-life of the BZD involved. Symptoms may be delayed up to three weeks in BZDs with long half-lives, but may appear as early as 24 to 48 hours after cessation of BZDs with short half-lives.
Abbreviations: • ACC: Anterior Cingulate Cortex • BP: Blood Pressure • CAD: Coronary Artery Disease • HR: Heart Rate • LC: Locus Coeruleus • MI: Myocardial Infarction • OFC: Orbitofrontal Cortex • PAG: Periaqueductal Gray • PBN: Parabrachial Nucleus • RR: Respiratory Rate • SOB: Shortness of Breath • T2DM: Type 2 Diabetes
I` atherosclerosis, cardiac ischemia, MI, or sudden death