scholarly journals Critical Review of Alcohol, Alcoholism and the Withdrawal Symptoms I. Mechanisms of Addiction and Withdrawal Syndrome

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
K Singh Ashok
Keyword(s):  
Critical Review ◽  
Withdrawal Syndrome ◽  
Withdrawal Symptoms

scholarly journals Continuous Infusion of Flumazenil in the Management of Benzodiazepines Detoxification

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna Benini ◽  
Rossella Gottardo ◽  
Cristiano Chiamulera ◽  
Anna Bertoldi ◽  
Lorenzo Zamboni ◽  
...  
Keyword(s):  
Plasma Level ◽  
Hospital Admission ◽  
Continuous Infusion ◽  
Clinical Setting ◽  
Withdrawal Syndrome ◽  
Withdrawal Symptoms ◽  
High Dose ◽  
End Of Treatment ◽  
Before And After ◽  
Treatment Changes

An effective approach in the treatment of benzodiazepine (BZD) overdosing and detoxification is flumazenil (FLU). Studies in chronic users who discontinued BZD in a clinical setting suggested that multiple slow bolus infusions of FLU reduce BZD withdrawal symptoms. The aim of this study was to confirm FLU efficacy for reducing BZD withdrawal syndrome by means of continuous elastomeric infusion, correlated to drugs plasma level and patients' compliance.Methods: Seven-day FLU 1 mg/day subcutaneously injected through an elastomeric pump and BZDs lormetazepam, clonazepam, and lorazepam were assessed by HPLC-MS/MS in serum of patients before and after 4 and 7 days of FLU continuous infusion treatment. Changes in withdrawal severity were assessed by using the BZD Withdrawal Scale (BWS).Results: Fourteen patients (mean age ± SD 42.5 ± 8.0 years, 5 male and 9 female), admitted to the hospital for high-dose BZD detoxification, were enrolled in the study. Serum FLU concentrations significantly decreased from 0.54 ± 0.33 ng/ml (mean ± SD) after 4 days of treatment to 0.1 ± 0.2 ng/ml at the end of infusion. Lormetazepam concentrations were 502.5 ± 610.0 ng/ml at hospital admission, 26.2 ± 26.8 ng/ml after 4 days, and 0 at the end of treatment. BWS values decreased during FLU treatment temporal period. FLU was well-tolerated by patients.Conclusions: Elastomeric FLU infusion for BZD detoxification is a feasible administration device to maintain adequate, constant, and tolerated FLU concentrations for reducing BZD withdrawal symptoms.

Withdrawal Reactions Associated with Venlafaxine

1998 ◽  
Vol 32 (2) ◽  
pp. 291-294 ◽  
Author(s):  
Gordon Parker ◽  
Jenny Blennerhassett
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Clinical Picture ◽  
Withdrawal Syndrome ◽  
Withdrawal Symptoms ◽  
Selective Serotonin ◽  
Short Acting ◽  
Severe Withdrawal ◽  
Uptake Inhibitors

Objective: The aim of this paper is to describe discontinuation syndromes associated with abrupt and tapered withdrawal of venlafaxine, and to document that withdrawal symptoms may occur after missing a single dose. Clinical picture: We report on two patients prescribed venlafaxine. One developed a broad range of serious side effects after reaching a dose of 300 mg a day, and a severe withdrawal syndrome (including hallucinations) during a slow taper regime. The second had severe discontinuation symptoms during and aborting a slow taper regime, and described withdrawal responses after missing a single dose of venlafaxine. Conclusions: As for the short-acting selective serotonin re-uptake inhibitors, severe discontinuation reactions may occur with venlafaxine, seemingly marked most distinctly by headache, nausea, fatigue, dizziness and dysphoria, and may make cessation of the drug extremely difficult. Two strategies for addressing the concern are considered.

Phenobarbital Overdose: A Kinetic Approach

1982 ◽  
Vol 16 (7-8) ◽  
pp. 613-614 ◽  
Author(s):  
Todd J. Brown ◽  
Larry A. Bauer ◽  
H. Richard Miyoshi
Keyword(s):  
At Risk ◽  
Drug Use ◽  
Half Life ◽  
Withdrawal Syndrome ◽  
Elimination Rate ◽  
Withdrawal Symptoms ◽  
Kinetic Approach ◽  
Patients At Risk ◽  
Phenobarbital Overdose ◽  
Pharmacokinetic Approach

A case that utilizes a pharmacokinetic approach to evaluate the need for withdrawal prophylaxis after a phenobarbital overdose is presented. To date, the practitioner has had to rely on an accurate drug-use history to predict which patients may be at risk for withdrawal symptoms. Since this information is often difficult to obtain, some other means of identifying potential withdrawal-syndrome patients would be useful. This case describes the successful use of kinetically determined parameters, the elimination rate constant and half-life, in predicting withdrawal potential. This easily used kinetic approach may provide practitioners with a useful tool for predicting those patients at risk for withdrawal symptoms following phenobarbital overdose.

scholarly journals Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Justin Jek-Kahn Koh ◽  
Madeline Malczewska ◽  
Mary M. Doyle ◽  
Jessica Moe
Keyword(s):  
Emergency Department ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Observational Studies ◽  
Alcohol Withdrawal Syndrome ◽  
Withdrawal Symptoms ◽  
Rapid Review ◽  
Controlled Trials ◽  
Seizure Recurrence ◽  
Outpatient Settings

Abstract Background Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19 pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome in the ED. Methods We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. Results We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. Conclusions Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings should be evaluated in the ED setting before routine use.

The Influence of Psychological Factors on the Opiate Withdrawal Syndrome

1986 ◽  
Vol 149 (2) ◽  
pp. 235-238 ◽  
Author(s):  
Grania T. Phillips ◽  
Michael Gossop ◽  
Brendan Bradley
Keyword(s):  
Drug Dependence ◽  
Symptom Severity ◽  
Psychological Factors ◽  
Withdrawal Syndrome ◽  
Drug Dose ◽  
Withdrawal Symptoms ◽  
Opiate Withdrawal ◽  
Opiate Withdrawal Syndrome

Psychological and drug-related variables and their effect on the severity of withdrawal symptoms were examined in a group of addicts being withdrawn from opiates on an in-patient drug dependence unit. Two psychological factors—neuroticism and the degree of distress expected by the patient—were related to subsequent severity of symptoms. Both are anxiety-related, and may serve to amplify withdrawal symptoms. Surprisingly, drug dose was unrelated to symptom severity.

scholarly journals Phenibut (β-Phenyl-γ-aminobutyric Acid) Dependence and Management of Withdrawal: Emerging Nootropics of Abuse

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Tania Ahuja ◽  
Ofole Mgbako ◽  
Caroline Katzman ◽  
Allison Grossman
Keyword(s):  
Case Report ◽  
Withdrawal Syndrome ◽  
Aminobutyric Acid ◽  
Receptor Type ◽  
Withdrawal Symptoms ◽  
Gamma Aminobutyric Acid ◽  
Type B ◽  
Acid Receptor ◽  
Online Retailers ◽  
Acid Dependence

This case report describes the development of withdrawal from phenibut, a gamma-aminobutyric acid-receptor type B agonist. Although phenibut is not an FDA-approved medication, it is available through online retailers as a nootropic supplement. There are reports of dependence in patients that misuse phenibut. We report a case in which a patient experienced withdrawal symptoms from phenibut and was successfully treated with a baclofen taper. This case report highlights the development of phenibut use disorder with coingestion of alcohol and potential management for phenibut withdrawal. We believe clinicians must be aware of how phenibut dependence may present and how to manage the withdrawal syndrome.

Severe Withdrawal Syndrome after Substitution of a Short-Acting Benzodiazepine for a Long-Acting Benzodiazepine

1985 ◽  
Vol 19 (10) ◽  
pp. 742-744 ◽  
Author(s):  
William S. Bond ◽  
Neil J. Berwish ◽  
Brian Swift
Keyword(s):  
Withdrawal Syndrome ◽  
Active Metabolite ◽  
Withdrawal Symptoms ◽  
Short Acting ◽  
Severe Withdrawal ◽  
Symptom Remission ◽  
Rate Of Decline ◽  
Long Acting ◽  
Chronic Use

A severe withdrawal syndrome occurred in a patient after oxazepam 10 mg bid was substituted for diazepam 5 mg bid. The onset of symptoms was consistent with the rate of decline of diazepam and its active metabolite, desmethyldiazepam. Reintroduction of diazepam produced prompt symptom remission. This report and others suggest the need for caution when substituting a short-acting drug for a long-acting one, even when usual doses of each are used. The chronic use of benzodiazepines for eight months or longer prior to substitution or withdrawal appears to place the patient at a higher risk of incurring withdrawal phenomena. Slow and careful tapering of drug is required in such patients to reduce the risk of withdrawal symptoms.

scholarly journals Characterization of the GHB Withdrawal Syndrome

2021 ◽  
Vol 10 (11) ◽  
pp. 2333
Author(s):  
Casper J. H. Wolf ◽  
Harmen Beurmanjer ◽  
Boukje A. G. Dijkstra ◽  
Alexander C. Geerlings ◽  
Marcia Spoelder ◽  
...  
Keyword(s):  
Sex Differences ◽  
Withdrawal Syndrome ◽  
Vital Signs ◽  
Withdrawal Symptoms ◽  
Hydroxybutyric Acid ◽  
Personalized Approach ◽  
Withdrawal Syndromes ◽  
Sedative Drugs ◽  
Over Time

The gamma-hydroxybutyric acid (GHB) withdrawal syndrome can have a fulminant course, complicated by severe complications such as delirium or seizures. Detoxification by tapering with pharmaceutical GHB is a safe way to manage GHB withdrawal. However, a detailed description of the course of the GHB withdrawal syndrome is currently lacking. This study aimed to (1) describe the course of GHB withdrawal symptoms over time, (2) assess the association between vital signs and withdrawal symptoms, and (3) explore sex differences in GHB withdrawal. In this observational multicenter study, patients with GHB use disorder (n = 285) were tapered off with pharmaceutical GHB. The most reported subjective withdrawal symptoms (SWS) were related to cravings, fatigue, insomnia, sweating and feeling gloomy. The most prevalent objective withdrawal symptoms (OWS) were related to cravings, fatigue, tremors, sweating, and sudden cold/warm feelings. No association between vital signs and SWS/OWS was found. Sex differences were observed in the severity and prevalence of specific withdrawal symptoms. Our results suggest that the GHB withdrawal syndrome under pharmaceutical GHB tapering does not strongly differ from withdrawal syndromes of other sedative drugs. The lack of association between vital signs and other withdrawal symptoms, and the relative stability of vitals over time suggest that vitals are not suitable for withdrawal monitoring. The reported sex differences highlight the importance of a personalized approach in GHB detoxification.

scholarly journals Addiction withdrawal syndrome: Needs medications, education, counselling & support

2021 ◽  
Vol 12 (2) ◽  
pp. 143-150
Author(s):  
Tapan Kumar Mahato ◽  
Sunil Kumar Ojha ◽  
Vishwakarma Singh ◽  
Surendra Pratap Singh Parihar
Keyword(s):  
Drug Abuse ◽  
Withdrawal Syndrome ◽  
Physical Dependence ◽  
The Body ◽  
Withdrawal Symptoms ◽  
Rehabilitation Centers ◽  
Long Time ◽  
Harmful Effects ◽  
Over Time

Addiction is a feel good or euphoria like condition which is commonly associated with drug abuse (opioid & non-opioid), alcohol and nicotine intake. There are many reasons behind a man gets addicted to these substances such as recreation purpose, drugs used for long time for treatment of any disorder and gets addicted, unemployment, stress, emotions, professional pressure and social status. It provides enjoyable feelings which results in creating a strong urge to use the substances again and again. These drugs can cause physical dependence or psychological dependence or both. Over time, drug tolerance is produced which means to get the same effect more quantity of the drug is needed. These substances are very harmful physically, mentally, financially and socially too. If someone suddenly terminates using these substances after heavy or long term use, the body needs time to recover and number of withdrawal symptoms arises. These withdrawal symptoms can’t be treated by medications only but it needs counselling and support as well. This article reviews i. the drug abuse (opioid & non-opioid), alcohol and nicotine addictions with their withdrawal symptoms and medications used to treat these symptoms ii. Rehabilitation centers running and other steps taken by Government of India to aware people especially the youths of the country about the harmful effects of these substances.

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