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Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose
BACKGROUND: The availability of nonapproved psychoactive substances with addiction potential from internet sources poses a significant threat to public health. Polysubstance abuse or inadvertent contamination of preparations may result in clinically challenging intoxication and withdrawal syndromes....
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Association of Psychiatric Pharmacists
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819137/ https://www.ncbi.nlm.nih.gov/pubmed/36644586 http://dx.doi.org/10.9740/mhc.2022.12.356 |
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author | Markovic, Marija Niwash, Dania |
author_facet | Markovic, Marija Niwash, Dania |
author_sort | Markovic, Marija |
collection | PubMed |
description | BACKGROUND: The availability of nonapproved psychoactive substances with addiction potential from internet sources poses a significant threat to public health. Polysubstance abuse or inadvertent contamination of preparations may result in clinically challenging intoxication and withdrawal syndromes. CASE REPORT: We report a case of a 32-year-old male with an approximate 2-year history of taking internet-obtained etizolam and tianeptine who presented to the hospital following an overdose. He experienced subsequent withdrawal symptoms consistent with benzodiazepine and opioid withdrawal. Initial attempts at managing symptoms with chlordiazepoxide 25 mg every 6 hours did not relieve his symptoms. On day 3 of admission, addiction medicine was consulted and his regimen was changed to diazepam 80 mg daily with additional as-needed diazepam based on etizolam equivalence. He also received a 5-day methadone taper with plans to transition to buprenorphine in the outpatient setting. Upon discharge he was referred to an addiction medicine specialist who was willing to continue a slow diazepam taper and initiate medications for opioid use disorder to manage both substance use disorders. DISCUSSION: This case report demonstrates the effectiveness of diazepam in managing benzodiazepine withdrawal from etizolam while concurrently using methadone to manage opioid withdrawal symptoms from tianeptine in a hospitalized patient following overdose. We highlight the importance of a warm handoff in considering the outpatient discharge plan. |
format | Online Article Text |
id | pubmed-9819137 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Association of Psychiatric Pharmacists |
record_format | MEDLINE/PubMed |
spelling | pubmed-98191372023-01-13 Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose Markovic, Marija Niwash, Dania Ment Health Clin Case Report BACKGROUND: The availability of nonapproved psychoactive substances with addiction potential from internet sources poses a significant threat to public health. Polysubstance abuse or inadvertent contamination of preparations may result in clinically challenging intoxication and withdrawal syndromes. CASE REPORT: We report a case of a 32-year-old male with an approximate 2-year history of taking internet-obtained etizolam and tianeptine who presented to the hospital following an overdose. He experienced subsequent withdrawal symptoms consistent with benzodiazepine and opioid withdrawal. Initial attempts at managing symptoms with chlordiazepoxide 25 mg every 6 hours did not relieve his symptoms. On day 3 of admission, addiction medicine was consulted and his regimen was changed to diazepam 80 mg daily with additional as-needed diazepam based on etizolam equivalence. He also received a 5-day methadone taper with plans to transition to buprenorphine in the outpatient setting. Upon discharge he was referred to an addiction medicine specialist who was willing to continue a slow diazepam taper and initiate medications for opioid use disorder to manage both substance use disorders. DISCUSSION: This case report demonstrates the effectiveness of diazepam in managing benzodiazepine withdrawal from etizolam while concurrently using methadone to manage opioid withdrawal symptoms from tianeptine in a hospitalized patient following overdose. We highlight the importance of a warm handoff in considering the outpatient discharge plan. American Association of Psychiatric Pharmacists 2023-01-05 /pmc/articles/PMC9819137/ /pubmed/36644586 http://dx.doi.org/10.9740/mhc.2022.12.356 Text en © 2022 AAPP. The Mental Health Clinician is a publication of the American Association of Psychiatric Pharmacists. https://creativecommons.org/licenses/by-nc/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Markovic, Marija Niwash, Dania Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose |
title | Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose |
title_full | Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose |
title_fullStr | Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose |
title_full_unstemmed | Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose |
title_short | Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose |
title_sort | treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819137/ https://www.ncbi.nlm.nih.gov/pubmed/36644586 http://dx.doi.org/10.9740/mhc.2022.12.356 |
work_keys_str_mv | AT markovicmarija treatmentofconcurrentetizolamandtianeptinewithdrawalfollowingaccidentaloverdose AT niwashdania treatmentofconcurrentetizolamandtianeptinewithdrawalfollowingaccidentaloverdose |