35th AM (2024) - Poster Session-Unique Challenges in Alprazolam Withdrawal - Success with a Combined Tapering Strategy

Unique Challenges in Alprazolam Withdrawal - Success with a Combined Tapering Strategy

Pdf Summary

The case study presented describes the detoxification process of a 59-year-old male patient with Generalized Anxiety Disorder (GAD) admitted for detoxification from alprazolam. Initially using alprazolam at 0.75 mg daily, he escalated to 4 mg daily, developing dependence. Prior to admission, his symptoms mimicked a stroke but were due to benzodiazepine (BZD) withdrawal, including hallucinations and autonomic instability. Standard treatment with chlordiazepoxide failed, prompting a combined tapering approach with alprazolam and chlordiazepoxide, successfully managing his symptoms.<br /><br />Alprazolam is noted for high misuse and dependence potential among BZDs. It belongs to the triazolobenzodiazepine (TBZD) subgroup, characterized by a triazole ring that may lead to unpredictable withdrawal symptoms. Its pharmacokinetic properties, such as rapid absorption and metabolism, contribute to its potency and atypical withdrawal. Alprazolam uniquely affects dopaminergic function in the striatum, similar to stimulants, linking it to neural reward circuitry and severe withdrawal symptoms, including delirium and psychosis.<br /><br />Alprazolam withdrawal requires careful management due to its divergence from other BZD withdrawal syndromes, often involving neuropsychiatric complications. It may evade typical urine toxicology screens, necessitating comprehensive substance use histories and monitoring through Prescription Drug Monitoring Programs.<br /><br />There remains a need for more research to establish treatment guidelines for alprazolam withdrawal, exploring TBZD augmentation or monotherapy options. In the absence of standardized guidelines, clinicians might consider supplementing BZD tapers with low doses of alprazolam to address withdrawal challenges effectively.

Keywords

detoxification

Generalized Anxiety Disorder

alprazolam dependence

benzodiazepine withdrawal

chlordiazepoxide

triazolobenzodiazepine

neuropsychiatric complications

dopaminergic function

withdrawal management

treatment guidelines

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