Stressful reactions and panic attacks induced by flumazenil in chronic benzodiazepine users.
The acute effects of flumazenil, a benzodiazepine (BZD) receptor antagonist in long-term BZD users were used as a possible test to detect physiological dependence. Thirty-four subjects (20 females, 14 males) aged 26-48 years (mean + SD, 42.4+/-8.5 years), all chronic users of low doses of diazepam (5-20 mg/day, 14.2+/-4.8 mg/day) for 5 to 28 years (10.5+/-6 years), received a single 1-mg i.v. flumazenil dose or saline, infused slowly under double-blind conditions. Physiological dependence was suggested as all patients receiving flumazenil developed an anxiety reaction while the placebo group did not. Flumazenil triggered a qualitatively different reaction amounting to a panic attack during infusion in nine out of 15 patients. These patients had a diagnosis of panic disorder or a history of panic attacks. Caution should be exercised when giving flumazenil to panic patients who are taking BZDs as maintenance treatment.
Bernik
M A
MA
Ambulatório de Ansiedade, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil. bernikma@ax.apc.org
Gorenstein
C
C
Vieira Filho
A H
AH
D000328:Adult; D014151:Anti-Anxiety Agents / Q000009:adverse effects; D001143:Arousal / Q000187:drug effects*; D003975:Diazepam / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005442:Flumazenil; D018757:GABA Modulators; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010200:Panic / Q000187:drug effects*; D016584:Panic Disorder / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000175:diagnosis*
D014151:Anti-Anxiety Agents; D018757:GABA Modulators; D005442:Flumazenil; D003975:Diazepam