More often than not, a patient who inadvertently takes more than the prescribed dose will simply feel drowsy and fall asleep for a few hours.

īenzodiazepines have a wide therapeutic index and taken alone in overdose rarely cause severe complications or fatalities. The bottom line represents benzodiazepine deaths that did not involve opioids. The top line represents the number of benzodiazepine deaths that also involved opioids in the US. Hypotonia may also occur in severe cases. The symptoms of an overdose such as sleepiness, agitation and ataxia occur much more frequently and severely in children. In most cases of fatal overdose it is likely that lack of opioid tolerance combined with the depressant effects of benzodiazepines is the cause of death. The majority of drug-related deaths involve misuse of heroin or other opioids in combination with benzodiazepines or other CNS depressant drugs. The duration of symptoms following overdose is usually between 12 and 36 hours in the majority of cases. Significant toxicity may result following recreation drug misuse in conjunction with other CNS depressants such as opioids or alcohol. Severe consequences are rare following overdose of benzodiazepines alone but the severity of overdose is increased significantly if benzodiazepines are taken in overdose in combination with other medications. Ĭases of severe overdose have been reported and symptoms displayed might include prolonged deep coma or deep cyclic coma, apnea, respiratory depression, hypoxemia, hypothermia, hypotension, bradycardia, cardiac arrest, and pulmonary aspiration, with the possibility of death. Gastrointestinal symptoms such as nausea and vomiting have also been occasionally reported. Paradoxical reactions such as anxiety, delirium, combativeness, hallucinations, and aggression can also occur following benzodiazepine overdose. Most patients with pure benzodiazepine overdose will usually only exhibit these mild CNS symptoms.

Initial signs and symptoms include intoxication, somnolence, diplopia, impaired balance, impaired motor function, anterograde amnesia, ataxia, and slurred speech. Patients initially present with mild to moderate impairment of central nervous system function. Signs and symptoms įollowing an acute overdose of a benzodiazepine the onset of symptoms is typically rapid with most developing symptoms within 4 hours. An Australian (1995) study found oxazepam less toxic and less sedative, and temazepam more toxic and more sedative, than most benzodiazepines in overdose. Temazepam was shown to be more toxic than the majority of benzodiazepines. Over 10 years in the United Kingdom, 1512 fatal poisonings have been attributed to benzodiazepines with or without alcohol. Benzodiazepines are one of the most highly prescribed classes of drugs, and they are commonly used in self-poisoning. The US Food and Drug Administration (FDA) has subsequently issued a black box warning regarding concurrent use of benzodiazepines and opioids. In 2013, benzodiazepines were involved in 31% of the estimated 22,767 deaths from prescription drug overdose in the United States. However, combinations of high doses of benzodiazepines with alcohol, barbiturates, opioids or tricyclic antidepressants are particularly dangerous, and may lead to severe complications such as coma or death. ĭeaths from single-drug benzodiazepine overdoses occur infrequently, particularly after the point of hospital admission. There is an antidote, flumazenil, but its use is controversial. Supportive care is the mainstay of treatment of benzodiazepine overdose. Severe symptoms include coma and respiratory depression. The most common symptoms of overdose include central nervous system (CNS) depression, impaired balance, ataxia, and slurred speech. Benzodiazepine overdose describes the ingestion of one of the drugs in the benzodiazepine class in quantities greater than are recommended or generally practiced.

Diazepam antidote