Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Withdrawal-induced delirium associated with a benzodiazepine switch: a case report. | Bosshart Journal of Medical Case Reports 2011 5 207 http content 5 1 207 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Withdrawal-induced delirium associated with a benzodiazepine switch a case report Herbert Bosshart Abstract Introduction Introduced in the early 1960s diazepam remains among the most frequently prescribed benzodiazepine-type sedatives and hypnotics. Patients with chronic use of short-acting benzodiazepines are frequently switched to diazepam because the accumulating long-acting metabolite N-desmethyl-diazepam prevents benzodiazepine-associated withdrawal symptoms which can occur during trough plasma levels of shortacting benzodiazepines. Although mild to moderate withdrawal symptoms are frequently observed during benzodiazepine switching to diazepam severe medical complications associated with this treatment approach have thus far not been reported. Case presentation A 64-year-old female Caucasian with major depression alcohol dependence and benzodiazepine dependence was successfully treated for depression and after lorazepam-assisted alcohol detoxification was switched from lorazepam to diazepam to facilitate benzodiazepine discontinuation. Subsequent to the benzodiazepine switch our patient unexpectedly developed an acute delirious state which quickly remitted after re-administration of lorazepam. A newly diagnosed early form of mixed dementia combining both vascular and Alzheimer-type lesions was found as a likely contributing factor for the observed vulnerability to benzodiazepine-induced withdrawal symptoms. Conclusion Chronic use of benzodiazepines is common in the elderly and a switch to diazepam often precedes benzodiazepine discontinuation trials. However contrary to common clinical practice benzodiazepine switching to diazepam may require cross-titration with slow tapering of the first benzodiazepine to allow for the build-up of N-desmethyl-diazepam in order to safely prevent severe withdrawal .
