BENZODIAZEPINE WITHDRAWAL Anxiety or Agitation_ Fever and Tremor

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                                                                  High-dose withdrawal

                                                                            High-dose benzodiazepine

                                                                            withdrawal produces signs

                                                                             and symptoms similiar to

                                                                                    alcohol withdrawal.

Anxiety or Agitation, Fever and Tremor

Seizures          Hallucinations      Poor Sleep and
                  or Confusion        Nightmares

Low-dose (therapeutic) withdrawal

Benzodiazepine withdrawal can

continue for weeks and occasionally

months, with low-grade symptoms.

Depression and feeling ‘beside yourself’

Anxiety           Twitching           Extra-sensitive Senses: Smell,
                  Muscles             Sound, Taste, Light, and Touch.

           Developed by The Addictions Program, Mental Health Program, Health Sciences Centre.

What happens to Benzodiazepines in the Body?
·   Benzodiazepines are absorbed through the stomach, muscle, or blood stream, which depends on
    the route they are given. They travel through the body at different speeds until processed out of
    the body through the liver.
·   Benzodiazepines, if given by mouth, can be split into three groups based on how quickly they are
    absorbed: Rapid (30minutes), Intermediate (30minutes-2hours), and Slow (2hours plus). If given
    in the vein by needle, the onset is rapid (15seconds to a few minutes).
·   Some common names of benzodiazepines are: diazepam (Valium), chlordiazepoxide (Librium),
    oxazepam (Serax), lorazepam (Ativan), temazepam (Restoril), alprazolam (Xanax), and clonazepam
    (Rivotril), to name a few.

What are the Short-Term Effects?
·   After taking a benzodiazepine, the person will notice three main effects: 1) muscles relax, 2) decrease
    in level of anxiety, and 3) sleepy or relaxed feeling.
·   If taken in high doses and/or with alcohol, these effects are more intense. The person may lose
    consciousness, slow or stop breathing, and may die.
·   Short-term use of benzodiazepines rarely results in chronic addiction, unless the person has already
    had an addiction to this or other drugs or alcohol in the past.

What are the Long-term effects?
·   Over time, a tolerance to the drug will develop (the same dose of the drug will not have the same
    effect as it used to and the person will need higher doses to achieve the “high” or relaxed effect).
    The person will also become physically dependent on the drug, meaning the person will have
    withdrawal symptoms if they suddenly decrease the dose or stop taking the drug.
·   Caution should be used when thinking about long-term use of a medication in the benzodiazepine
    group, especially if the person has an addiction to these or alcohol/other drugs.

What about tolerance?
·   Tolerance means that when taking the drug over a length of time, the person will notice that he or
    she will need more and more of the drug to feel the same effects from the drug. Tolerance to
    benzodiazepines may occur over a period of roughly 3 weeks to 3 months.

What about withdrawal?
·   There is a benzodiazepine withdrawal syndrome whose symptoms depend on the dosage the
    person was taking and the length of time they were on the drugs. Low-dose benzodiazepine
    withdrawal consists of some or all of these symptoms; extra aware senses (such as hearing or
    vision), anxiety, feeling depressed or sad, the feeling of being ‘outside of yourself’, muscle twitching
    and tremors. High-dose benzodiazepine withdrawal consists of these symptoms: increased vital
    signs (temperature, blood pressure and pulse), tremor, anxiety/agitation, problems sleeping or not
    sleeping at all, nightmares, and sometimes hallucinations, paranoia, and seizures.

                           Developed by The Addictions Program, Mental Health Program, Health Sciences Centre.

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