Case Report
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World J Crit Care Med. Feb 4, 2014; 3(1): 42-44
Published online Feb 4, 2014. doi: 10.5492/wjccm.v3.i1.42
Failure of lorazepam to treat alprazolam withdrawal in a critically ill patient
Gaurav Sachdev, Gail Gesin, A Britton Christmas, Ronald F Sing
Gaurav Sachdev, Gail Gesin, A Britton Christmas, Ronald F Sing, The F H Sammy Ross, Jr Trauma Center, Department of Pharmacy, Carolinas Medical Center, Charlotte, NC 28023, United States
Ronald F Sing, Department of Surgery/MEB 601, Carolinas Medical Center, Charlotte, NC 28203, United States
Author contributions: Sing RF planned the study and was responsible for the design, collection of data, and initial draft of the manuscript; Sachdev G was responsible for author coordination, data interpretation, and final drafting of the manuscript; Gesin G and Christmas AB helped draft the manuscript; all authors read and approved the final manuscript.
Correspondence to: Ronald F Sing, DO, Department of Surgery/MEB 601, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, United States. ron.sing@carolinashealthcare.org
Telephone: +1-704-3553176 Fax: +1-704-3555619
Received: May 10, 2013
Revised: October 12, 2013
Accepted: November 15, 2013
Published online: February 4, 2014
Processing time: 282 Days and 7.2 Hours
Abstract

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.

Keywords: Alpralazom; Lorazepam; Withdrawal; Pharmacokinetics; Pharmacodynamics

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.