ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences
Emergency: requires immediate attention
Benzodiazepine withdrawal syndrome
Print
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Benzodiazepine withdrawal syndrome

Print Images (1)
Contributors: Michael W. Winter MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Benzodiazepines are commonly prescribed hypnotic and anxiolytic medications. Long-term use leads to tolerance and dependence. Patients who are dependent on benzodiazepines can develop withdrawal symptoms with abrupt discontinuation, similar to the withdrawal seen from ethanol. This occurs due to conformational changes of the GABA receptors in the setting of chronic benzodiazepine use, resulting in decreased GABA activity and a pro-excitatory baseline state. In patients still using benzodiazepines, this results in a "normal" baseline excitatory state. Benzodiazepine cessation results in a pro-excitatory baseline in which withdrawal symptoms present. These manifestations of benzodiazepine withdrawal are broad but typically include agitation, anorexia, tremors, dysphoria, and, in some instances, psychosis or seizures.

Patients with benzodiazepine use disorder are at highest risk for benzodiazepine withdrawal syndrome. These can include patients in the inpatient setting on benzodiazepines for sedation, patients in the outpatient setting dependent on benzodiazepines for a variety of medical conditions, or patients in the community using benzodiazepines as a drug of abuse.

Patients who abuse shorter-acting benzodiazepines are most susceptible to acute withdrawal symptoms. Conversely, patients who gradually wean their dose of benzodiazepines are less likely to develop withdrawal symptoms.

Related topic: Benzodiazepine use disorder

Codes

ICD10CM:
F13.239 – Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified

SNOMEDCT:
703849002 – Benzodiazepine withdrawal

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required

References

Subscription Required

Last Reviewed: 03/28/2019
Last Updated: 05/20/2019
Copyright © 2019 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Benzodiazepine withdrawal syndrome
Print 1 Images
Benzodiazepine withdrawal syndrome : Agitation, Seizures, Anxiety, Insomnia, Diaphoresis, Tremor, HR increased, BP increased, Psychosis
Copyright © 2019 VisualDx®. All rights reserved.