Poisoning by Drugs, Medicaments and Biological Substances Codexery

Benzodiazepine overdose

Benzodiazepine overdose: CNS depression, supportive care, controversial antidote.

Ingesting a benzodiazepine drug in an amount exceeding the recommended or typical dosage constitutes a benzodiazepine overdose.[1] Central nervous system depression, balance difficulties, ataxia, and slurred speech are frequently observed symptoms of overdose.[1] The primary treatment approach involves supportive care, while flumazenil serves as an antidote, though its administration remains debated.[1]

Key facts and history

Symptoms of overdose typically develop within 4 hours and include intoxication, somnolence, diplopia, and anterograde amnesia.[2][3] Severe symptoms such as coma, respiratory depression, and cardiac arrest are rare with benzodiazepines alone but increase significantly with co-ingestants.[4] Flumazenil is a competitive benzodiazepine receptor antagonist but is contraindicated in many patients due to risks including seizures and death.[5] Fatalities resulting from overdoses involving only a single benzodiazepine are uncommon, particularly once a patient has been admitted to a hospital.[6]

Mixing elevated doses of benzodiazepines with alcohol, barbiturates, opioids, or tricyclic antidepressants creates especially hazardous situations that may result in coma or death.[6] A black box warning concerning the simultaneous use of benzodiazepines and opioids was mandated by the US Food and Drug Administration.[7]

What the cited sources add

The National Records of Scotland report for 2018 implicated 548 deaths from 'street' etizolam, which was 45% of all drug-related deaths in Scotland that year.[8] A 2006 textbook reports that merely 10% of individuals who arrive at a hospital with a benzodiazepine overdose meet the criteria for flumazenil treatment.[9][10] The 2006 textbook further notes that flumazenil's effects typically last under one hour, which may necessitate repeated dosing.[9][10]

References

  1. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: "Flumazenil--treatment or toxin", Journal of Toxicology. Clinical Toxicology, 2004, p. 209–16 (original not read by us) en.wikipedia.org
  2. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: "Pediatric benzodiazepine ingestion resulting in hospitalization", Journal of Toxicology. Clinical Toxicology, 1998, p. 227–31 (original not read by us) en.wikipedia.org
  3. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: "Pediatric benzodiazepine ingestion resulting in hospitalization", Journal of Toxicology. Clinical Toxicology, 1998, p. 227–31; "Benzodiazepine poisoning. Clinical and pharmacological considerations and treatment", Drug Safety, 1991, p. 247–65; "[Agitation and hallucinations during acute lorazepam poisoning in children. Apropos of 65 personal cases]", Annales de Pédiatrie, April 1984, p. 286–9; "Benzodiazepine poisoning. Clinical and pharmacological considerations and treatment", Drug Safety, 1991, p. 247–65 (original not read b en.wikipedia.org
  4. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: "Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14-year period", Journal of Internal Medicine, August 1989, p. 117–22; "Pediatric benzodiazepine ingestion resulting in hospitalization", Journal of Toxicology. Clinical Toxicology, 1998, p. 227–31; "Cardiac arrest caused by oral diazepam intoxication", Clinical Pediatrics, September 1975, p. 842–4; "Clonazepam overdose resulting in cyclic coma", Clinical Toxicology, 1977, p. 433–6; "Benzodiazepine-associated emergencies in Toronto", The A en.wikipedia.org
  5. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: "Flumazenil--treatment or toxin", Journal of Toxicology. Clinical Toxicology, 2004, p. 209–16; Nelson, "Goldfrank's toxicologic emergencies", McGraw-Hill, 2006, p. 1112–7; "Flumazenil and seizures: analysis of 43 cases", Clinical Therapeutics, 1992, p. 292–305; "Flumazenil causing convulsions and ventricular tachycardia", BMJ, July 2025, p. 860; "Death after flumazepil", BMJ, June 1989, p. 1713; "Flumazenil--treatment or toxin", Journal of Toxicology. Clinical Toxicology, 2004, p. 209–16; Whyte, "Medical toxicology", Williams & en.wikipedia.org
  6. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: Dart, "Medical Toxicology", Lippincott Williams & Wilkins, 1 December 2003, p. 811; "Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14-year period", Journal of Internal Medicine, August 1989, p. 117–22 (original not read by us) en.wikipedia.org
  7. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: "Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013", American Journal of Public Health, April 2016, p. 686–8; Commissioner, "Press Announcements - FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use", www.fda.gov; "Extent and appropriateness of benzodiazepine use. Results from an elderly urban community", The British Journal of Psychiatry, November 1998, p. 433–8; "Shou en.wikipedia.org
  8. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: "Drug-related deaths in Scotland, 2018", National Records of Scotland (original not read by us) en.wikipedia.org
  9. Wikipedia, "Benzodiazepine overdose" (CC BY-SA 4.0), which cites: Nelson, "Goldfrank's toxicologic emergencies", McGraw-Hill, 2006, p. 1112–7; Nelson, "Goldfrank's toxicologic emergencies", McGraw-Hill, 2006, p. 1112–7; "Goldfrank's toxicologic emergencies", McGraw-Hill, 2006, p. 929–51; Nelson, "Goldfrank's toxicologic emergencies", McGraw-Hill, 2006, p. 1112–7; "A risk-benefit assessment of flumazenil in the management of benzodiazepine overdose", Drug Safety, September 1997, p. 181–96; "Goldfrank's toxicologic emergencies", McGraw-Hill, 2006, p. 929–51; "Use of Flumazenil in benzodiazepine en.wikipedia.org
  10. Open Library record, ISBN 9780071479141 ("Goldfrank's toxicologic emergencies"). CC0 (metadata); book content not read. openlibrary.org

Each numbered sentence above was checked against the source it cites before publication. Sentences citing Wikipedia adapt text from the English Wikipedia article Benzodiazepine overdose (contributors), used under CC BY-SA 4.0; this entry is available under the same licence. Other sources were used for facts only; no text or images are copied from them.

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