Detoxification Methods of Benzodiazepines Mono-Dependence: Application and Comparison

Document Type : Original Article

Authors

1 Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University. Tanta, Egypt.

2 Psychiatry and Neurology, Faculty of Medicine, Tanta University, Egypt.

3 Departments of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Egypt.

Abstract

Benzodiazepines are common drugs of abuse in Egypt and  produce severe suffering during withdrawal which magnifies the need to develop treatment strategies for discontinuing these medications. The study aimed to evaluate different detoxification procedures that have been followed to manage benzodiazepines dependence and to assess their efficiency in controlling withdrawal symptoms and relapse rates. This study had been conducted in the center of Psychiatry, Neurology and Neurosurgery, Faculty of Medicine, Tanta University, Egypt.  It lasted for 45 days and was divided into three phases; pretreatment phase (7 days), detoxification phase (8 days) and follow-up phase (30 days). Three different methods of detoxification of benzodiazepines dependence were applied during the detoxification phase and included 1) slow flumazenil infusion (1mg/500ml saline twice daily) as the main line of treatment with low doses of oxazepam given orally during the first three nights of detoxification phase 2) gradual tapering using oxazepam and 3) abrupt discontinuation of benzodiazepines with symptomatic treatment. Withdrawal symptoms were assessed by psychometric scales BWSQ, HAM-A, HAM-D scores and craving was assessed by VAS scores emerged in the three studied groups during the detoxification phase. The study revealed that flumazenil infusion with low doses of oxazepam was associated with the least intensity of withdrawal symptoms and craving. Also, relapse rates were decreased in patients treated with flumazenil than those treated by oxazepam tapering or abrupt discontinuation with symptomatic treatment. It can be concluded that slow flumazenil infusion with low doses of oxazepam appeared to be the most effective in controlling withdrawal symptoms, reducing craving and relapse rate after benzodiazepine discontinuation.

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