Perils in Benzodiazepine Withdrawal: Case Report
Article Main Content
The discovery that clonazepam prescribed for the treatment of migraines caused obstructive sleep apnea led to a rapid taper of clonazepam and substitution of lorazepam. Lack of accurate knowledge about the different pharmacokinetics and actions of different benzodiazepines at GABA-A receptors and the risks associated with rapid benzodiazepine withdrawal resulted in the development of the benzodiazepine protracted withdrawal syndrome. Moderately severe disability continued after 2 years. Insufficient knowledge about benzodiazepines and their withdrawal is a serious problem as doctors across the world are under extreme pressure to stop prescribing them but do not have an understanding of the potential perils involved. The pathophysiology of protracted withdrawal syndrome remains poorly understood and there is no recognised treatment. Information about appropriate management of withdrawal and the protracted withdrawal syndrome are available on Professor Ashton’s website at www.benzo.org.uk.
References
-
M. Lader, “Benzodiazepines revisited-will we ever learn?” Addiction, vol 106, pp. 2086-2109, 2011. doi 10 1111/j 1360-0443 2011 03563 x.
DOI |
Google Scholar
1
-
K. Pottie, W. Thompson, S. Davies, J. Grenner, C. A. Sadowski, V. Welch, et al, “Deprescribing benzodiazepine receptor agonists; Evidence-based clinical practice guidelines”, Can Fam Physician, vol 264, pp. 339-351, 2018.
Google Scholar
2
-
D. L. Longo, Ed., M. Soyka, “Treatment of benzodiazepine dependence”, NEJM, vol 376, pp. 1147-1157, 2017.
DOI |
Google Scholar
3
-
M. Lader, “Benzodiazepine harm: how can it be reduced?”, Br J Clin Pharmacol., vol 77 pp. 295-301, 2014. doi: 10.1111/j.1365-2125.2012.04418.x.
DOI |
Google Scholar
4
-
H. C. Ashton, “Protracted Withdrawal Symptoms From Benzodiazepines” www.benzo.org.uk, Revised August 2002 (accessed 2/2018). “Benzodiazepines: How They Work and How to Withdraw”, “Chapter II Slow Withdrawal Schedules” and “Chapter III Benzodiazepine Withdrawal Symptoms, Acute and Protracted”.
Google Scholar
5
-
D. Nutt, “GABAa receptors: subtypes, regional distribution, and function” J Clin Sleep Med, vol 2, pp. S7-S11, 2006.
Google Scholar
6
-
M. Chebib and A. R. Johnston, “The ‘ABC’ of GABA receptors: a brief review”, Clin Exp Pharmacol Physiol, vol 26, pp. 937-940, 1999.
DOI |
Google Scholar
7
-
C. E. Griffin III, A. M. Kaye, F. R. Bueno, A. D. Kaye, “Benzodiazepine pharmacology and central nervous system-mediated effects”, Ochsner J, vol 13, pp. 214-223, 2013.
Google Scholar
8
-
“National Institute for Health Care Excellence: Guidelines for Benzodiazepine Withdrawal”, www.nice.org.uk, 2013.
Google Scholar
9
-
C. Ford, F. Law, “Guidance for the use and reduction of misuse of benzodiazepines and other hypnotics and anxiolytics in general practice”. http://www.emcdda.europa.eu/attachements.cfm/att_248926_EN_UK59_benzos.pdf (accessed 2/2018).
Google Scholar
10