Benzodiazepine overdose

Benzodiazepines (BZDs) are the most commonly prescribed drugs for anxiety, sedation, and sleep. Overdose can be intentional in suicidal patients; accidental in combination with other central nervous system (CNS) depressants, such as alcohol and opioids, and in older people; and occasionally by error. Older people, who commonly have diminished drug clearance and polypharmacy, are at especially high risk of overdose.

The key feature is excessive sedation with unremarkable vital signs and anterograde amnesia. Larger doses can cause coma and respiratory depression.

Treatment of overdose is by symptom management, not by quantitative assay. Acute management consists of maintaining airway, respiration, and hemodynamic support while excluding other diagnoses. Assisted ventilation may be necessary.

Death is uncommon. Most deaths from BZD overdose are from respiratory depression as a result of mixed overdoses with BZD and other respiratory depressants, particularly alcohol and opioids.

The BZD antagonist flumazenil can be effective in select patients with respiratory depression or respiratory arrest caused by pure BZD poisoning who do not have contraindications; however, the risks of flumazenil often outweigh the benefits and its use is inappropriate for most patients presenting to the emergency department with BZD toxicity.

BZD overdose occurs when excessive amounts of BZDs are taken. Commonly known as minor tranquilizers or sleeping pills, BZDs are prescribed for sedative, anxiolytic, hypnotic, and anticonvulsant purposes. BZDs are also widely misused. Acute overdose is characterized by excessive sedation with impaired mental status, and diminished postural stability and reflexes. Although BZDs are relatively safe drugs, acute overdose may induce respiratory depression resulting in coma and, uncommonly, death.[1]Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001161 http://www.ncbi.nlm.nih.gov/pubmed/37721023?tool=bestpractice.com Diagnosis is suggested by the history and by exclusion of other etiologies. Chronic overuse increases the risk of many other pathologies.