BZD overdose often occurs in association with other substances. Chloride channel opening results in membrane hyperpolarization, which inhibits cellular excitation. Enhanced GABA neurotransmission results in sedation, striated muscle relaxation, anxiolysis, and anticonvulsant effects. These changes could have the potential to alter tissue perfusion. The rate of BZD onset of action is determined by its ability to cross the blood-brain barrier.
The relatively lipophilic BZDs eg, diazepam usually have a faster onset of effect than the relatively water-soluble BZDs eg, lorazepam. BZD effects can be potentiated when ethanol is present as a coingestant. Peak blood concentrations of most agents occur within hours. After a single dose, the lipophilic agents can have a shorter duration of action shorter CNS effect than water-soluble agents because rapid redistribution from the CNS to peripheral sites eg, adipose tissue ; thus, lorazepam has a longer CNS duration of action than diazepam.
However, diazepam metabolizes to active intermediates with prolonged half-lives, which extend its therapeutic effects. Most BZDs are broken down into pharmacologically active metabolites, which may have longer half-lives than the parent compounds. However, no short-term increases were noted between and Records did not always specify the BZD involved, but alprazolam was indicated in about a third of these ED visits, and in approximately a third of BZD-related suicide attempts [ 3 ].
DAWN was discontinued in ED data from the new data collection system are expected in Of these, 1. Although BZDs taken alone are relatively safe in overdose, the combination of BZDs and opioid analgesics can produce significant respiratory depression. In particular, the combination of alprazolam with opioids may be fatal. Deaths attributed to BZDs increased fivefold from to During to , death rates from alprazolam increased Similarly, an Australian study reported that alprazolam-positive cases of sudden or unnatural death increased from three cases in to 86 cases in The increase was driven mostly by accidental toxicity in people with known drug and alcohol problems.
Drugs other than alprazolam and its metabolites were present in The most commonly detected drugs, in order of decreasing frequency, were opioids, other BZDs, and alcohol. The most reported BZD use is in persons older than 19 years. Elderly individuals and very young persons are more susceptible to the CNS depressant effects of BZDs than people in other age groups. Oral benzodiazepine BZD overdoses, without co-ingestions, rarely result in significant morbidity eg, aspiration pneumonia, rhabdomyolysis or mortality, although in mixed overdoses they can potentiate the effect of alcohol or other sedative-hypnotics.
Overdose of ultrashort-acting BZDs eg, triazolam [Halcion] is also more likely to result in apnea and death than overdose with longer-acting BZDs. Of individual BZDs, alprazolam is relatively more toxic than others in overdose. Antidotes for toxicological emergencies: Am J Health Syst Pharm. Drug Abuse Warning Network, April 4, ; Accessed: Characteristics of alprazolam-related deaths compiled by a centralized state medical examiner.
Circumstances and toxicology of sudden or unnatural deaths involving alprazolam. Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol. Treatment of patients with substance use disorders, second edition. Signs and symptoms of an overdose may include 3, Slowed or stopped breathing. Coma loss of consciousness. Don't let another day pass by without treatment.
Benzodiazepines, such as clonazepam, should be prescribed only for short periods of time. If you use the drug for longer than prescribed, then, it may be easier to fall into a pattern of drug abuse. The more clonazepam you use over time, the more tolerance can develop. Eventually, your body can become dependent on having the drug in the system and need it just to feel normal. If you have stopped using clonazepam for a while, your tolerance will likely decrease.
Yet this can be a dangerous time because if you begin to use again and take the same amount of the drug that you were used to taking, you could quickly overdose. It is not recommended that you take clonazepam with an opioid medication since this combination can more easily lead to loss of consciousness, respiratory depression, and overdose death. Similarly, drinking alcohol while taking the medication is also extremely dangerous and can result in accidental overdose 4.
According to the FDA, when benzodiazepines are taken in combination with opioid medications or alcohol, adverse reactions may include Some individuals may be more at risk than others when it comes to the potential dangers associated with benzodiazepine use. Given the risk for overdose, you will want to make sure that both your medical and mental health histories are fully disclosed before receiving a prescription.
Be sure to discuss the following important issues with your health provider If you have suicidal thoughts or thoughts of harming yourself. Any psychiatric or medical problems you may have including obstructive sleep apnea. All other medications you are taking. If you drink alcohol or use recreational drugs. If you are breastfeeding, speak to your medical provider because clonazepam may pass into your breast milk.
If you or a loved one is struggling with an addiction to clonazepam, give us a call today at Who Answers? If you know someone who has overdosed, here are some important steps to take Luckily, there are medications that can help reverse the effects of a clonazepam overdose. For example, flumazenil is a medication that is administered during a benzodiazepine overdose.
Flumazenil works by preventing benzodiazepines from binding to the GABA receptor to halt its inhibitory effects. While clonazepam can be an effective medication when used as directed, heavy use can produce dependence. Physical dependence can develop in as little as 2 weeks of daily use. Dependence often begets patterns of compulsive abuse and, eventually, addiction.
The often-escalated dosing and repeated use seen in addicted individuals precipitates dangerous overdose situations. It follows that a direct intervention towards preventing clonazepam overdose is in treating clonazepam addiction. Addiction is a complex, chronic condition and many people need to access formal treatment to stop using drugs.
Treatment can help you do this, stay drug-free, and regain a sense of purpose so that you can be productive in your family, at work, and in other social relationships. This can be a desirable form of treatment, especially if your addiction is relatively severe or if you struggle with co-occurring disorders. Outpatient treatment is a great choice if you prefer to live at home while you receive treatment. These facilities offer a variety of programs that you can choose from.
With each option, you will meet with a behavioral health counselor on a regular schedule. As the initial period of benzodiazepine withdrawal can be dangerous, the type of treatment sought should ultimately be arrived at with the help of a physician or other addiction treatment professional. In all forms of addiction treatment, you may engage in a number of different types of therapies to help address the underlying reasons for your addiction, including This type of therapy is offered at most drug addiction treatment centers.
CBT can help you understand and respond to situations that will trigger you to use clonazepam so that you feel confident and ready as you transition out of treatment. The family unit can be one of the biggest sources of support throughout your treatment, but they can also be the people who have been the most hurt or affected by your drug abuse. In family therapy, you will work with a therapist to address issues that will help you and your family resolve conflict and effectively communicate with one another.
This type of therapy can help you realize your own goals and move toward them. In the end, you are the only person who can change your behavior and turn your life around. Motivational interviewing is a great tool to help you advance your own self-efficacy.