II. Class
III. Preparations: Medical Uses
- See Benzodiazepines
IV. Precautions: Fake Xanax
- Fake Xanax contains Fentanyl and Etizolam (Benzodiazepine analog)
- Presents as opiod Overdose with sedation and respiratory depression (Rhabdomyolysis was also associated)
- Management
- Naloxone 0.4 mg
- Supportive care
- Consult poison control
- References
- Swadron and Nordt in Herbert (2017) EM:Rap 17(2):18
- ThePoisonReview.com
VI. Signs: BenzodiazepineIntoxication
- Classic presentation is Altered Level of Consciousness with normal Vital Signs
- Cardiopulmonary effects
- Respiratory Depression (esp. when combined with other substances, e.g. Alcohol)
- Hypotension
- Rarely lethal alone, but dangerous with Alcohol
- Neurologic effects
- Anterograde Amnesia
- Ataxia (esp. young children)
- Confusion
- Slurred Speech
- Miosis
- Spectrum of Decreased Level of Consciousness
- Drowsiness
- Lethargy
- Sedation
- Coma
VII. Differential Diagnosis
- See Unknown Ingestion
- May present in similar fashion to Diabetic Ketoacidosis
VIII. Management: Toxicity
-
Benzodiazepines Overdoses in isolation generally have good outcomes
- CNS Depression (and apnea) increases when combined with other agents (e.g. Opioids)
- Coingestion is common
- Supportive care with airway management for CNS Depression
-
Flumazenil (Romazicon)
- Avoid in patients with chronic use (risks of severe withdrawal including Seizures)
- Most toxicology guidelines do not recommend Flumazenil in Overdose
- Potential harms appear to outweigh benefits in most cases
- Penningo (2016) Basic Clin Pharmacol Toxicol 118(1): 37-44 +PMID:26096314 [PubMed]
- May be indicated for acute Benzodiazepine Overdose (non-chronic use) with cardiopulmonary depression
- Read Flumazenil contraindications carefully
- Avoid in patients with chronic use (risks of severe withdrawal including Seizures)