Paradoxical Reactions to Benzodiazepines: Literature Review and Treatment Options

@article{Mancuso2004ParadoxicalRT,
  title={Paradoxical Reactions to Benzodiazepines: Literature Review and Treatment Options},
  author={Carissa E. Mancuso and Maria G. Tanzi and Michael P. Gabay},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
  year={2004},
  volume={24}
}
Benzodiazepines frequently are administered to patients to induce sedation. Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients. The exact mechanism of paradoxical reactions remains unclear. Most cases are idiosyncratic; however, some evidence suggests that these reactions may occur secondary to a genetic link, history of alcohol abuse, or… 
Paradoxical Excitation Following Intravenous Lorazepam Administration for Alcohol Withdrawal - A Case Presentation and Literature Review.
TLDR
This rare presentation of paradoxical excitation with the use of lorazepam in a 50-year-old male being treated for alcohol withdrawal is reported and the underlying pathophysiology, pharmacology, and current literature are reviewed.
Paradoxical Reaction to Alprazolam in an Elderly Woman with a History of Anxiety, Mood Disorders, and Hypothyroidism
TLDR
An 80-year-old female who developed a paradoxical response to benzodiazepines presented with mental status changes, anxiety, motor restlessness, and paranoia, and as her dose of alprazolam decreased, many of the patient's symptoms were observed to decrease.
Paradoxical reaction following administration of a benzodiazepine.
  • W. McKenzie, M. Rosenberg
  • Psychology, Medicine
    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
  • 2010
Reversal of a Suspected Paradoxical Reaction to Zopiclone with Flumazenil
TLDR
It is indicated that zopiclone induced behavioral changes resembling a paradoxical reaction to benzodiazepines and these symptoms may be treated with flumazenil.
Benzodiazepines Remain Important Therapeutic Options in Psychiatric Practice.
TLDR
Data presented in this article support the use of benzodiazepines as treatments of choice for acute situational anxiety, chronic anxiety disorders, insomnia, alcohol withdrawal syndromes, and catatonia.
Paradoxical Reaction to Midazolam in Preterm Neonates: A Case Series
  • M. K. Gupta, J. Mondkar, D. Hegde
  • Medicine
    Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
  • 2018
TLDR
Two newborns in the Neonatal Unit are reported, who developed myoclonic seizure after the administration of midazolam, both of these neonates were preterm, and require multiple invasive and noninvasive investigations which leads to parent and clinician stress.
Safety and Tolerability of Anxiolytics/Sedative-Hypnotics
TLDR
Emerging evidence indicates that pregabalin, a pharmacological agent approved for the treatment of generalized anxiety disorder, also has the potential to lead to abuse and dependence, and is still valuable in the management of anxiety disorders and transient insomnia.
Paradoxical reaction to midazolam in children
  • Y. Moon
  • Medicine
    Korean journal of anesthesiology
  • 2013
TLDR
A study about paradoxical reactions to midazolam in preschool aged children and the incidence of paradoxical reaction was found to be related to younger age (odds ratio [OR] = 5.3) and higher dose of midazlam (OR = 3.0).
Paradoxical Reaction to Hypnotics in Intensive Care Unit
TLDR
The present case is unique, with severe PR not only to midazolam but also to propofol, and this etiology, with difficult withdrawal, should be considered after ruling out all classical etiologies for refractory agitation.
...
...

References

SHOWING 1-10 OF 35 REFERENCES
Paradoxical reactions to benzodiazepines in intravenous sedation: a report of 2 cases and review of the literature.
TLDR
Two cases of paradoxical reactions associated with the use of intravenous midazolam are presented, and the management of this complication and its different etiologies are reviewed.
Paradoxical Reactions to Benzodiazepines — A Genetically Determined Phenomenon?
TLDR
Patients are observed who become restless, with spontaneous muscle movements rather than displaying the relaxation and sedation typical of benzodiazepine action, and a pair of monozygotic twins who exhibited this atypical response are reported.
Treatment of a paradoxical reaction to midazolam with haloperidol.
TLDR
In a patient who had an intraaortic balloon pump in place and was awaiting coronary artery bypass graft (CABG) surgery, this work successfully treated a paradoxical reaction to midazolam with small doses of IV haloperidol.
Agitation observed during treatment with newer hypnotic drugs.
Side effects involving agitation, e.g., sleepwalking, anger, and panic, were observed in 10 insomniac patients treated with temazepam or triazolam but not other benzodiazepines. Each patient
Paradoxical reaction to a new minor tranquilizer.
  • R. Goldney
  • Psychology
    The Medical journal of Australia
  • 1977
This case report demonstrates that paradoxical reactions to the benzodiazepine class of minor tranquilizer can occur, and that lorazepam, a new derivative, is not free from this effect. It also lends
Flumazenil Reverses Paradoxical Reaction to Midazolam in a Child
TLDR
A case of a paradoxical reaction in a child following the oral administration of midazolam which was treated successfully with intravenous flumazenil is reported.
Paradoxical Reactions in Children Associated with Midazolam Use During Endoscopy
All 2,617 children who received midazolam and meperidine for a variety of endoscopic procedures were monitored for the development of adverse behavioral problems. Thirty-six (1.4%) of the children
Physostigmine reversal of drug-induced paradoxical excitement.
The midazolam-induced paradox phenomenon is reversible by flumazenil. Epidemiology, patient characteristics and review of the literature
TLDR
Flumazenil completely reverses midazolam-induced paradoxical reactions and they are more frequent in older patients.
Completion of upper endoscopic procedures despite paradoxical reaction to midazolam: a role for flumazenil?
TLDR
It is suggested that flumazenil may have greater utility in the management of this particular problem than is considered at present and three cases in which paradoxical reactions to midazolam responded so well to flumZenil administration that the procedure was successfully completed in each instance.
...
...