• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Journal of Medical Case Reports >Withdrawal-induced delirium associated with a benzodiazepine switch: a case report
【24h】

Withdrawal-induced delirium associated with a benzodiazepine switch: a case report

机译：苯二氮卓类药物引起的戒断引起的ir妄：一例病例报告

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Introduction Introduced in the early 1960s, diazepam remains among the most frequently prescribed benzodiazepine-type sedatives and hypnotics. Patients with chronic use of short-acting benzodiazepines are frequently switched to diazepam because the accumulating, long-acting metabolite, N-desmethyl-diazepam, prevents benzodiazepine-associated withdrawal symptoms, which can occur during trough plasma levels of short-acting benzodiazepines. Although mild to moderate withdrawal symptoms are frequently observed during benzodiazepine switching to diazepam, severe medical complications associated with this treatment approach have thus far not been reported. Case presentation A 64-year-old female Caucasian with major depression, alcohol dependence and benzodiazepine dependence was successfully treated for depression and, after lorazepam-assisted alcohol detoxification, was switched from lorazepam to diazepam to facilitate benzodiazepine discontinuation. Subsequent to the benzodiazepine switch, our patient unexpectedly developed an acute delirious state, which quickly remitted after re-administration of lorazepam. A newly diagnosed early form of mixed dementia, combining both vascular and Alzheimer-type lesions, was found as a likely contributing factor for the observed vulnerability to benzodiazepine-induced withdrawal symptoms. Conclusion Chronic use of benzodiazepines is common in the elderly and a switch to diazepam often precedes benzodiazepine discontinuation trials. However, contrary to common clinical practice, benzodiazepine switching to diazepam may require cross-titration with slow tapering of the first benzodiazepine to allow for the build-up of N-desmethyl-diazepam, in order to safely prevent severe withdrawal symptoms. Alternatively, long-term treatment with low doses of benzodiazepines may be considered, especially in elderly patients with chronic use of benzodiazepines and proven vulnerability to benzodiazepine-associated withdrawal symptoms.
机译：简介地西epa于1960年代初问世，至今仍是处方最频繁的苯二氮卓类镇静剂和催眠药。长期使用短效苯二氮卓类药物的患者经常会改用地西epa，因为蓄积的长效代谢物N-去甲基二氮卓可预防苯二氮卓相关的戒断症状，​​这种症状可在短效苯二氮卓类药物的低谷浓度期间发生。尽管在苯二氮卓类药物转换为地西epa期间经常观察到轻度至中度的戒断症状，​​但迄今为止尚未报道与该治疗方法相关的严重医学并发症。病例介绍一位患有严重抑郁，酒精依赖和苯二氮卓依赖的64岁女性高加索人成功地治疗了抑郁症，劳拉西m辅助的酒精解毒后，从劳拉西epa改用地西az以促进苯二氮卓的停用。苯二氮卓类药物转换后，我们的患者出乎意料地出现了急性精神错乱状态，劳拉西m重新给药后迅速缓解。发现一种新诊断的混合型痴呆的早期形式，包括血管性病变和阿尔茨海默氏型病变，是观察到的易受苯二氮卓类药物引起的戒断症状影响的可能因素。结论苯二氮卓类药物在老年人中经常使用，在苯二氮卓类中止试验之前，通常先改用地西epa。但是，与通常的临床实践相反，苯二氮卓改用地西epa可能需要交叉滴定，并逐渐减慢第一个苯并二氮卓的含量，以使N-去甲基二氮卓堆积，从而安全地预防严重的戒断症状。或者，可以考虑长期服用低剂量的苯二氮卓类药物，尤其是在长期使用苯二氮卓类药物且已证明对苯二氮卓类药物相关的戒断症状具有脆弱性的老年患者中。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号