Management overview for benzodiazepine poisoning

Benzodiazepines are commonly prescribed sedative-hypnotic and anxiolytic drugs. Many benzodiazepine drugs are available in Australia including alprazolam, bromazepam, clobazam, clonazepam, diazepam, flunitrazepam, lorazepam, midazolam, nitrazepam, oxazepam and temazepam. There is a high risk of self-medication, polydrug use and addiction with these drugs.

Newer illicit designer benzodiazepines are becoming more prevalent among recreational drug users. They are inexpensive and available in oral and injectable forms. Examples include etizolam, clonazolam and flubromazolam.

Most benzodiazepine poisonings cause central nervous system (CNS) depression; however, except for alprazolam, they rarely cause coma. The risk of coma is higher in the elderly and children, in people naive to benzodiazepines, and if benzodiazepines are co-ingested with other sedative drugs.

Most patients with benzodiazepine poisoning recover with close observation of their Glasgow Coma Scale (GCS) score and supportive care. The antidote flumazenil is usually not recommended in benzodiazepine poisoning as it can precipitate seizures.

Zolpidem and zopiclone are hypnotic drugs that have similar toxic effects to benzodiazepines, and poisonings can be managed in the same way.