title: Role of Benzodiazepines in the management of agitation due to inappropriate use of naltrexone.
abstract: BACKGROUND
  Agitation is an early symptom of the acute opioid withdrawal syndrome in addicts that may start by inappropriate use of naltrexone. The current drug interventions are not efficient or need critical care as well. This study compares the clinical role of midazolam and diazepam for the management of agitation due to inappropriate use of naltrexone.
  
  
  METHODS
  In this double-blind randomized controlled clinical trial, 44 agitated addicts, who did not use any type of benzodiazepine, not on systematic central nervous system depressant drugs, without any known hypersensitivity to diazepam, midazolam, or any other component of their formulation and had no evidence for the need of critical care, were enrolled. An i.v. stat dose of 0.1 mg/kg diazepam and 0.1 mg/kg stat dose of midazolam and a 0.1 mg/kg/h infusion of these drugs were administered for different groups of patients, respectively. Agitation scores were recorded at 30, 60, 120 min after the start of drug administration using Richmond Agitation Sedation Scale score.
  
  
  RESULTS
  A significant difference between the mean onset of agitation control in midazolam group (at 67 min) and diazepam group (at 81 min) was recorded. The difference of mean agitation score in the midazolam and diazepam group was only significant at 120 min. There was a negative correlation between agitation score and time elapsed from naltrexone administration to admission.
  
  
  CONCLUSIONS
  Midazolam and diazepam may not be considered suitable and perfect pharmacologic agents for the initial controlling of agitation induced by naltrexone.
authors.affiliation: Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ali Mohammad
authors.initials: AM
authors.lastname: Sabzghabaee
authors.forename: Nastaran
authors.initials: N
authors.lastname: Eizadi-Mood
authors.forename: Farzad
authors.initials: F
authors.lastname: Gheshlaghi
authors.forename: Azam
authors.initials: A
authors.lastname: Javani
authors.forename: Shahin
authors.initials: S
authors.lastname: Shirani
authors.forename: Safieh
authors.initials: S
authors.lastname: Aghaabdollahian
keywords: Benzodiazepines; naltrexone; psychomotor agitation; substance withdrawal syndrome