Benzodiazepine tolerance, dependency, and withdrawal syndromes and interactions with fluoroquinolone antimicrobials

McConnell, J. G.

doi:10.3399/bjgp08x280317

Cited by 5 publications

(1 citation statement)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transient or rarely long-lasting tinnitus can be a part of a sedative withdrawal syndrome, 30 which in the case of benzodiazepines can be precipitated by fluoroquinolones because these antibiotics compete directly with benzodiazepines for the benzodiazepine receptor site displacing benzodiazepines and thereby precipitating benzodiazepine withdrawal. 31 Always Unilateral-Never with Vestibular Symptoms…”

Section: Central Nervous System Disorder: Rostral To Trapezoid Bodymentioning

confidence: 99%

Tinnitus: Diagnostic Approach Leading to Treatment

Levine

2013

Semin Neurol

View full text Add to dashboard Cite

Optimal care for a patient with tinnitus begins with identifying the cause of the tinnitus. Once the cause has been identified then an appropriate treatment plan can be initiated. In this article, the author reviews how to identify the tinnitus etiology and its treatment.The workup begins with the patient's description of the percept because in some cases, the quality of the tinnitus will make the diagnosis (e.g., clicking, which is readily suppressed pharmacologically); in other cases, it will give direction in the diagnostic evaluation (e.g., pulsatile). With the exception of a small dural arteriovenous malformation, the source of objective pulsatile tinnitus can be determined without conventional cerebral angiography. If the diagnostic workup is unrevealing and the pulsations are not suppressed with somatic testing, then eighth nerve vascular compression becomes the likely etiology, especially if there is some clicking also heard, no matter how minor.The two major causes of tinnitus are hearing loss and myofascial disorders of the head and neck. Moreover, the two can combine and cause tinnitus even though either condition alone would not have caused tinnitus. Although the tinnitus of hearing loss is not easily treatable, the tinnitus from myofascial disorders is often responsive to an optimized myofascial treatment program. Hyperacusis, a frequent accompaniment of tinnitus, and its treatment are discussed.

show abstract

Section: Central Nervous System Disorder: Rostral To Trapezoid Bodymentioning

confidence: 99%

Tinnitus: Diagnostic Approach Leading to Treatment

Levine

2013

Semin Neurol

View full text Add to dashboard Cite

show abstract

Safe Deprescribing of Benzodiazepines and Z‐drugs

2024

The Maudsley Deprescribing Guidelines – Antidepressants, Benzodiazepines, Gabapentinoids and Z‐drugs

View full text Add to dashboard Cite

Most guidelines recommend that benzodiazepines and z‐drugs used continuously for more than 4 weeks should be withdrawn, if the patient is agreeable, because of the unfavourable balance of harms (including physical dependence, addiction, tolerance and withdrawal effects) and benefits. Withdrawal effects arise due to adaptation to chronic use of benzodiazepines and z‐drugs – often termed physical dependence, distinct from addiction. Addiction is an issue only for a small minority of benzodiazepine users whilst withdrawal effects and physical dependence affect a much larger group of patients taking medication as prescribed. Withdrawal effects can manifest as either physical or psychological symptoms and can often be mistaken for a return of an underlying condition or onset of a new physical or mental health condition. The most severe withdrawal effects are suicidality, akathisia and protracted withdrawal syndromes which can last for months or years and can sometimes be debilitating. Careful tapering can minimise these effects. After long‐term use tapering should be gradual (months or years), and adjusted to a rate that the individual can tolerate. Dose reduction should be conducted in a hyperbolic pattern (so that decrements become smaller and smaller as the total dose gets lower) to reflect the hyperbolic relationship between dose and receptor occupancy. In order to facilitate gradual hyperbolic tapering sometimes formulations other than widely available tablets will be required, including liquid versions, compounded versions or off‐label use of existing formulations. Switching from one benzodiazepine to a longer‐acting drug like diazepam can sometimes be helpful.

show abstract

Safe Deprescribing of Gabapentinoids

2024

The Maudsley Deprescribing Guidelines – Antidepressants, Benzodiazepines, Gabapentinoids and Z‐drugs

View full text Add to dashboard Cite

Gabapentinoids are widely used off‐label for conditions for which the balance of harms and benefits is uncertain or unfavourable. Long‐term use of gabapentinoids in mental health conditions is affected by issues such as physical dependence, addiction, tolerance and withdrawal effects. Harms include numerous cognitive, physical and emotional effects, and spiking rates of accidental overdoses (especially when used with opioids). Withdrawal effects arise due to adaptation to chronic use of gabapentinoids – often termed physical dependence, distinct from addiction. Addiction is an issue for a minority of gabapentinoid users whilst withdrawal effects and physical dependence affect a larger group of patients taking medication as prescribed. Withdrawal effects can manifest as either physical or psychological symptoms and can be mistaken for a return of an underlying condition or onset of a new physical or mental health condition. The most severe withdrawal effects are suicidality, akathisia and protracted withdrawal syndromes which can last for months or years and can sometimes be debilitating. Careful tapering can minimise these effects. After long‐term use tapering should be gradual (months or years), and adjusted to a rate that the individual can tolerate. Dose reduction should be conducted in a hyperbolic pattern (so that decrements become smaller and smaller as the total dose gets lower) to reflect the hyperbolic relationship between dose and receptor occupancy (and clinical effects), as dictated by the law of mass action. In order to facilitate gradual hyperbolic tapering sometimes formulations other than widely available tablets or capsules will be required.

show abstract

Benzodiazepine tolerance, dependency, and withdrawal syndromes and interactions with fluoroquinolone antimicrobials

Cited by 5 publications

References 4 publications

Tinnitus: Diagnostic Approach Leading to Treatment

Tinnitus: Diagnostic Approach Leading to Treatment

Safe Deprescribing of Benzodiazepines and Z‐drugs

Safe Deprescribing of Gabapentinoids

Contact Info

Product

Resources

About