Case report: A Delirious Abstinence Syndrome associated with Clorazepate (Tranxilen^R)

Abstract

A 30-year-old woman with a previous history of diazepam dependence was admitted due to delirium following high doses of ctorazepate ( Tranxiten). She was detoxified with clomethiazole without complications.

Drug Abuse and Dependence in Psychiatric Inpatients

“…In lhe literature withdrawa! fits (12,25) and withdrawal psychoses (15,16) are rather rarely reported for therapeutic doses, but in correspondence with our findings were usually found for an increase in dose (1,10,21).…”

Benzodiazepine Abuse and Dependence in Psychiatric Inpatients

“…There are different opinions concerning the effect of dosage on the severity ofthe withdrawal syndrome. While Petursson (43) points out that abstinence phenomena may be qualitatively and quantitatively the same in low-dose and high-dose dependence, other authors (2,15,22,26) emphasize that "major" withdrawal syndromes develop preponderantly after high doses. The present study confirms both opinions to some extent, as it shows that "minor" withdrawal symptoms are almost identical in low-dose and high-dose dependence, whereas "major" withdrawal syndromes develop predominantly in patients dependent on high doses.…”

Benzodiazepine Dependence

“…Several reports indicate that on such doses physical dependence can develop within 2-3 weeks [12, 40], and certainly within four months [41]. In the majority of cases, however, the drugs have been taken for much longer, usually a few years [35,42,43,44,45,46,47,48,49,50]. Finally, two reports have described apparent withdrawal symptoms in neonates following maternal exposure to benzodiazepines [51,52].…”

“…The fully-developed benzodiazepine withdrawal syndrome has been described as a severe sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, profuse sweating, difficulty in concentration, dry retching and nausea, weight loss, palpitations, and muscular pains and stiffness. Instances are also reported of more serious developments such as epileptic fits [19,24,38,59,60,63,98], psychotic reactions [19,38,49,50,57,59,62,64,66,98] and even death [40].…”