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Alprazolam is relatively more toxic than other benzodiazepines in overdose

Isbister, GK, O'Regan, L, Sibbritt, D and Whyte, IM (2004). Alprazolam is relatively more toxic than other benzodiazepines in overdose. British Journal of Clinical Pharmacology,58(1):88-95.

Document type: Journal Article
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Title Alprazolam is relatively more toxic than other benzodiazepines in overdose
Author Isbister, GK
O'Regan, L
Sibbritt, D
Whyte, IM
Journal Name British Journal of Clinical Pharmacology
Publication Date 2004
Volume Number 58
Issue Number 1
ISSN 1365-2125   (check CDU catalogue open catalogue search in new window)
Start Page 88
End Page 95
Total Pages 8
Place of Publication London
Publisher Blackwell Science
Field of Research 1115 - Pharmacology and Pharmaceutical Sciences
HERDC Category C1 - Journal Article (DEST)
Abstract AIMS: To describe alprazolam poisoning and the relative toxicity of alprazolam compared with other benzodiazepines. METHODS: A database of consecutive poisoning admissions to a regional toxicology service was searched to identify consecutive benzodiazepine deliberate self poisonings, which were coded as alprazolam, diazepam or other benzodiazepine. Major outcomes used were length of stay (LOS), intensive care (ICU) admission, coma (GCS > 9), flumazenil administration and requirement for mechanical ventilation. Prescription data were obtained for benzodiazepines for the study period. RESULTS: There were 2063 single benzodiazepine overdose admissions: 131 alprazolam overdoses, 823 diazepam overdoses and 1109 other benzodiazepine overdoses. The median LOS for alprazolam overdoses was 19 h which was 1.27 (95% CI 1.04, 1.54) times longer compared with other benzodiazepines by multiple linear regression. For patients with alprazolam overdoses, 22% were admitted to ICU which was 2.06 (95% CI 1.27, 3.33) times more likely compared with other benzodiazepines after multivariate analysis adjusting for age, dose, gender, time to ingestion and co-ingested drugs. Flumazenil was administered to 14% of alprazolam patients and 16% were ventilated, which was significantly more than for other benzodiazepine overdoses (8% and 11%, respectively). Twelve percent of alprazolam overdoses had a GCS > 9 compared with 10% for other benzodiazepines. From benzodiazepine prescription data, total alprazolam prescriptions in Australia increased from 0.13 million in 1992 to 0.41 million in 2001. Eighty five percent of prescriptions were for panic disorder, anxiety, depression or mixed anxiety/depression. CONCLUSIONS: Alprazolam was significantly more toxic than other benzodiazepines. The increased prescription of alprazolam to groups with an increased risk of deliberate self poisoning is concerning and needs review.
Keywords Alprazolam
benzodiazepines
overdose
toxic
DOI http://dx.doi.org/10.1111/j.1365-2125.2004.02089.x   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes 3767 (Journal) DA - 20040621IS - 0306-5251 (Print)LA - engPT - Journal ArticlePT - ReviewRN - 0 (Anti-Anxiety Agents)RN - 0 (Benzodiazepines)RN - 12794-10-4 (benzodiazepine)RN - 28981-97-7 (Alprazolam)RN - 439-14-5 (Diazepam)SB - IM
 
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Created: Mon, 17 Dec 2007, 09:02:11 CST