Published online Feb 4, 2014. doi: 10.5492/wjccm.v3.i1.42
Revised: October 12, 2013
Accepted: November 15, 2013
Published online: February 4, 2014
Management of sedation in the critical care unit is an ongoing challenge. Benzodiazepines have been commonly used as sedatives in critically ill patients. The pharmacokinetic and pharmacodynamic properties that make benzodiazepines effective and safe in critical care sedation include rapid onset of action and decreased respiratory depression. Alprazolam is a commonly used benzodiazepine that is prescribed for anxiety and panic disorders. It is frequently prescribed in the outpatient setting. Its use has been reported to result in a relatively high rate of dependence and subsequent withdrawal symptoms. Symptoms of alprazolam withdrawal can be difficult to recognize and treat in the critical care setting. In addition, other benzodiazepines may also be ineffective in treating alprazolam withdrawal. We present a case of alprazolam withdrawal in a critically ill trauma patient who failed treatment with lorazepam and haloperidol. Subsequent replacement with alprazolam resulted in significant improvement in the patient’s medication use and clinical status.
Core tip: Withdrawal from drugs and alcohol is a common phenomenon in the intensive care unit. Benzodiazepines are commonly used for both alcohol and benzodiazepine withdrawal. The pharmacokinetics and pharmacodynamics among drugs within this class vary. The failure of lorazepam to treat withdrawal of alprazolam is demonstrated in this case study.