Ver el código de «Benzodiazepine withdrawal»

==Background==
*Very similar to [[alcohol withdrawal]]
*Occurs due to chronic use of [[benzodiazepines]], leading to physiologic tolerance<ref>Marriott S, Tyrer P. Benzodiazepine dependence. Avoidance and withdrawal. Drug Saf. 1993 Aug;9(2):93-103. doi: 10.2165/00002018-199309020-00003. PMID: 8104417.</ref>

==Clinical Features==
*Onset usually several days to up to 3 weeks<ref>Marriott S, Tyrer P. Benzodiazepine dependence. Avoidance and withdrawal. Drug Saf. 1993 Aug;9(2):93-103. doi: 10.2165/00002018-199309020-00003. PMID: 8104417.</ref>
*More likely in patients with high doses or prolonged use
*Autonomic hyperactivity (e.g., diaphoresis, [[tachycardia]], [[hyperthermia]])
*[[Nausea/vomiting]]
*Tremulousness, psychomotor agitation
*[[Anxiety]], [[insomnia]], irritability
*[[Psychosis]] (more common than in [[alcohol withdrawal]])
*[[Seizure]]

==Differential Diagnosis==
{{Sedative/hypnotic withdrawal types}}
{{Seizure DDX}}
{{AMS DDX}}

==Evaluation==
*Evaluate for other causes of and complications of symptoms (see evaluation of [[seizure]], [[altered mental status]], [[hypertension]], [[hyperthermia]]

==Management==
*Ensure patient and staff safety, airway protection if acutely agitated or seizing
*[[Benzodiazepines]]
**Mild, can tolerate PO: Long-acting [[benzodiazepine]] (e.g., [[chlordiazepoxide]])
**Moderate/severe: IV [[diazepam]]
***Consider substituting shorter half-life drugs with equivalent dose of [[diazepam]]
***Equivalent [[diazepam]] dose = [[triazolam]] dose x 20 = [[alprazolam]] dose x 10 = [[lorazepam]] dose x 5
*After acute symptoms controlled, can prescribe gradual [[benzodiazepine]] taper
**One taper strategy: decrease dose by 25% for first week, 25% second week, then by 12.5% for subsequent weeks<ref>Chang  F: Strategies for benzodiazepine withdrawal in seniors. CPJ 138: 38, 2005.
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*Consider neurology consult if patient was using benzos for seizure control (may need further antiepileptic management)

==Disposition==
*Admit if:
**Multiple seizures
**Uncontrolled autonomic hyperstimulation
**Decreased level of consciousness

==See Also==
*[[Benzodiazepines]]
*[[Alcohol withdrawal]]

==External Links==

==References==
<references/>

[[Category:Toxicology]]