Overdosing on Alprazolam

slackboxed said:

It's not like we can taper her off, she just ate all of the fucking alprazolam. If she develops a super-tolerance from this, she's fucked because she actually does have panic disorders. Is there a step up on the benzo chain or any way to taper her off this shit with out having any more alprazolam? She is still prescribed valium.

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Valium said:

poor girl...


so stop writing all of this garbage...whats the point. you know its a lie. we know it too.

what DO YOU REALLY WANT to know? and WHY ask it here? are you that,....

nevermind. je m'exscuse.

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Alprazolam is relatively more toxic than other benzodiazepines in overdose

Dr Geoffrey K. Isbister, Emergency Department, Newcastle Mater Hospital, Edith St, Waratah

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.

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slackboxed said:

Recently, SWIM ate about 200mgs of (pure powdered) alprazolam one night, drank with it, and then four days later she ate about 20 gel tab hits of lsd and while she was tripping she ate around 500mgs of alprazolam all at once. She is prescribed benzos so she had a little bit of a tolerance, but holy shit I have never seen anyone so fucked up on benzos before in my entire life! She actually drank beer an hour into it. I read up on erowid that it takes about ~330mgs-2000mgs to kill lab rats with alprazolam.

How much alprazolam do you think it would take to kill a 120lb girl with a slight benzo tolerance (she is prescribed 5mg valiums 4x a day)? We're talking some pure powder here, supposidely 98-99% pure unadulterated but who the hell knows now a days ya know?

Oh the dumbass girl is alright. No serious injuries occured somehow.

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haribo1 said:

Is their a ceiling effect for benzos? After all, once all those GABA receptors are full, more won't do anything...

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mugabe said:

I found a study that says that alprazolam is more toxic in overdose than other benzos, it even mentions deaths from alprazolam alone, heres that abstract;

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Benzodiazepines have a relatively high therapeutic index. Death after admission is rare and due to respiratory depression with aspiration of gastric contents. Over 10 years in the United Kingdom, however, 1512 fatal poisonings have been attributed to benzodiazepines with or without alcohol. These were compared with prescription data to establish a fatal toxicity index (deaths per million prescriptions) for each benzodiazepine. Similar indices have been derived for antidepressants and barbiturates. There were clear differences between benzodiazepines. Of drugs frequently prescribed, temazepam by far had the highest number of deaths per million prescriptions at 11.9 (95% confidence interval 10.9 to 12.; above that of some tricyclic antidepressants. In contrast, oxazepam had an index of 2.3 (1.2 to 3.4 ), and the average index for all benzodiazepines combined was 5.7.

Although there are potential sources of error in these studies, a bias that would lead to differences between compounds was not identified. Clinical studies can adjust for potential confounders which studies that use coronial data are unable to take into account. If differences between the benzodiazepines are supported by data from clinical studies this also adds credence to the fatal toxicity index which first noted these findings.

The aim was therefore to determine if temazepam caused more sedation and oxazepam less sedation than other benzodiazepines.

During 1991-3, 542 patients with benzodiazepine poisoning presented to the hospital, 239 of these patients, however, had ingested either more than one benzodiazepine or co-ingested other sedating drugs. The drugs ingested by the remainder were temazepam (64 ), oxazepam (45 ), diazepam (113), clonazepam (24 ), flunitrazepam (21 ), nitrazepam (1, others (1.

Details of coma scores and odds ratios of the benzodiazepines ingested showed that temazepam was significantly more toxic than most other benzodiazepines. Two out of the 45 subjects (4 who ingested oxazepam were stuporous or comatose, 38 out of the 194 subjects (19 who ingested other benzodiazepines (clonazepam, diazepam, flunitrazepam, nitrazepam and others) were stuporous or comatose, while 16 out of the 64 subjects (25 who ingested temazepam were stuporous or comatose. None of the oxazepam subjects were comatose, 16 out of the 194 subjects (8 who ingested other benzodiazepines were fully comatose, and 9 out of 64 subjects (14 who ingested temazepam were fully comatose.

The results show that there are differences between temazepam, oxazepam, and other benzodiazepines in the degree of sedation they cause in overdose, and the observed differences are not due to confounding by age, sex, dose ingested, co-ingestion of alcohol, chronic benzodiazepine use, or history of drug or alcohol abuse. This provides a plausible explanation why temazepam and oxazepam have different fatal toxicity indices from other benzodiazepines.

The sedation produced by benzodiazepines in therapeutic doses and overdose has a poor correlation with measured drug concentration but is increased with rapid absorption. Temazepam is more rapidly absorbed and oxazepam is more slowly absorbed than other benzodiazepines. Further research is required to determine if the rate of absorption is different in overdose and is sufficient to explain the differences in sedation. Slowing the rate of absorption may reduce toxicity, but this would also reduce their sedative effect in therapeutic doses. Drug regulatory authorities should be aware that changes in formulation of benzodiazepines may affect toxicity in overdose.

Pharmacodynamic factors such as benzodiazepine receptor affinity and potency may also be important. Because of the wide variations in half life, adjustments for dose by conversion into defined daily doses or diazepam equivalents is imperfect. These are designed to compare use rather than potency. Though they correlate reasonably well with sizes of prescriptions and tablets, they may not account for potency per tablet taken in overdose.

SOURCES:

Gaudreault P, Guay J, Thivierge RL, Verdy I (1991). "Benzodiazepine poisoning. Clinical and pharmacological considerations and treatment". Drug Saf 6 (4): 247–65. PMID 1888441.

Höjer J, Baehrendtz S, Gustafsson L (1989). "Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14-year period". J. Intern. Med 226 (2): 117–22. PMID 2769176.

Serfaty M, Masterton G (1993). "Fatal poisonings attributed to benzodiazepines in Britain during the 1980s". Br J Psychiatry 163: 386–93. PMID 8104653.

Cassidy S, Henry J (1987). "Fatal toxicity of antidepressant drugs in overdose". Br Med J (Clin Res Ed) 295 (6605): 1021–4. PMID 3690249.

Johns MW (1977). "Self-poisoning with barbiturates in England and Wales during 1959-74". Br Med J 1 (6069): 1128–30. PMID 861497.

Dwyer PS, Jones IF (1984). "Fatal self-poisoning in the UK and the paracetamol/dextropropoxyphene combination". Hum Toxicol 3 Suppl: 145S–174S.

Serfaty M, Masterton G (1993). "Fatal poisonings attributed to benzodiazepines in Britain during the 1980s". Br J Psychiatry 163: 386–93.

Buckley NA, Dawson AH, Whyte IM, O'Connell DL (1995). "Relative toxicity of benzodiazepines in overdose". BMJ 310 (6974): 219–21.

Serfaty M, Masterton G (1993). "Fatal poisonings attributed to benzodiazepines in Britain during the 1980s". Br J Psychiatry 163: 386–93.

Gaudreault P, Guay J, Thivierge RL, Verdy I (1991). "Benzodiazepine poisoning. Clinical and pharmacological considerations and treatment". Drug Saf 6 (4): 247–65.

Busto U, Kaplan HL, Sellers EM (1980). "Benzodiazepine-associated emergencies in Toronto". Am J Psychiatry 137 (2): 224–7.

Fuccella LM, Bolcioni G, Tamassia V, Ferrario L, Tognoni G (1977). "Human pharmacokinetics and bioavailability of temazepam administered in soft gelatin capsules". Eur. J. Clin. Pharmacol 12 (5): 383–6.

Greenblatt DJ, Harmatz JS, Engelhardt N, Shader RI (1989). "Pharmacokinetic determinants of dynamic differences among three benzodiazepine hypnotics. Flurazepam, temazepam, and triazolam". Arch. Gen. Psychiatry 46 (4): 326–32.

Gaudreault P, Guay J, Thivierge RL, Verdy I (1991). "Benzodiazepine poisoning. Clinical and pharmacological considerations and treatment". Drug Saf 6 (4): 247–65.

Busto U, Kaplan HL, Sellers EM (1980). "Benzodiazepine-associated emergencies in Toronto". Am J Psychiatry 137 (2): 224–7.

Fuccella LM, Bolcioni G, Tamassia V, Ferrario L, Tognoni G (1977). "Human pharmacokinetics and bioavailability of temazepam administered in soft gelatin capsules". Eur. J. Clin. Pharmacol 12 (5): 383–6.
Greenblatt DJ, Harmatz JS, Engelhardt N, Shader RI (1989). "Pharmacokinetic determinants of dynamic differences among three benzodiazepine hypnotics. Flurazepam, temazepam, and triazolam". Arch. Gen. Psychiatry 46 (4): 326–32.

Mitler MM (1981). "Evaluation of temazepam as a hypnotic". Pharmacotherapy 1 (1): 3–13.
Fuccella LM, Bolcioni G, Tamassia V, Ferrario L, Tognoni G (1977). "Human pharmacokinetics and bioavailability of temazepam administered in soft gelatin capsules". Eur. J. Clin. Pharmacol 12 (5): 383–6.

Alexander B, Perry PJ (1991). "Detoxification from temazepam: schedules and strategies". J Subst Abuse Treat 8 (1-2): 9–17.

Serfaty M, Masterton G (1993). "Fatal poisonings attributed to temazepam in Britain during the 1980s". Br J Psychiatry 163: 386–93.

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Temazepam is a drug which is very frequently involved in drug intoxication, including overdose. Overdose of temazepam may result in excessive sedation, impairment of balance and speech. This may progress in severe overdoses to respiratory depression or coma and possibly death. The risk of overdose is increased if temazepam is taken in combination with alcohol, opiates or other CNS depressants. Temazepam overdose responds to the benzodiazepine receptor antagonist flumazenil.

Benzodiazepines were implicated in 39% of suicides by drug poisoning in Sweden, with temazepam, nitrazepam and flunitrazepam accounting for 90% of benzodiazepine implicated suicides, in the elderly over a period of 2 decades. In three quarters of cases death was due to drowning, typically in the bath. Benzodiazepines were the predominant drug class used in suicides in this review of Swedish death certificates with 72% of benzodiazepine overdoses showing that benzodiazepines were the sole drug used in deaths by overdose. Benzodiazepines and in particular temazepam, nitrazepam and flunitrazepam should therefore be prescribed with caution in the elderly. Nitrazepam, and especially temazepam were the benzodiazepines most commonly detected in overdose related drug deaths in an Australian study of drug deaths. The two benzodiazepines were found to be the sole cause of death in one third of cases.

In a retrospective study of deaths, when benzodiazepines were implicated in the deaths, the benzodiazepines flunitrazepam, temazepam and nitrazepam were the most common benzodiazepines involved. Benzodiazepines were a factor in all deaths caused by drug addiction in the study. Temazepam, nitrazepam and flunitrazepam were significantly more commonly implicated in suicide related deaths than natural deaths. In four of the cases benzodiazepines alone were the only cause of death. It was concluded that flunitrazepam, nitrazepam, and temazepam were significantly more toxic than other benzodiazepines.

From a research perspective, there are several data acquired through scientific research that suggest temazepam is more frequently involved in drug-related deaths than are all other benzodiazepines. Temazepam is also the benzodiazepine that is by far the most commonly targeted in pharmacy burglaries and prescription forgeries.

SOURCES:

Zevzikovas A, Kiliuviene G, Ivanauskas L, Dirse V (2002). "[Analysis of benzodiazepine derivative mixture by gas-liquid chromatography]" (in Lithuanian). Medicina (Kaunas) 38 (3): 316–20.

Carlsten, A; Waern M, Holmgren P, Allebeck P (2003). "The role of benzodiazepines in elderly suicides". Scand J Public Health 31 (3): 224-8.

Drummer OH; Ranson DL (Dec 1996). "Sudden death and benzodiazepines". Am J Forensic Med Pathol 17 (4): 336-42.

Ericsson HR, Holmgren P, Jakobsson SW, Lafolie P, De Rees B (1993). "[Benzodiazepine findings in autopsy material. A study shows interacting factors in fatal cases]" (in Swedish). Lakartidningen 90 (45): 3954–7.

Injecting Temazepam -- Temazepam Injection and Diversion. Victorian Governmant Health Information (29 March, 2007).

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Benzodiazepines have always been regarded as remarkably non-toxic drugs. However, they are not completely safe. They are involved in up to 40% of all self poisoning incidents. Between 1980 and 1989 there were 1512 suicides attributed to benzodiazepine overdose. In 2/3 of these cases the drug was taken alone, in 1/3 with alcohol.

Temazepam, the commonest hypnotic used today, turned out to be the most toxic. The risk of a fatal outcome form benzodiazepine overdosage is greatly increased in the elderly and in people with lung disease, and benzodiazepines increase the risks of fatality if taken with many other drugs not included in this analysis. The combination of benzodiazepines with opiates causes almost 100 deaths each year among drug abusers in Glasgow alone. The cause of benzodiazepine fatalities is depression of respiration: They impair function in brain centres vital for breathing.

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Her whole weekend was a blur and then on tuesday night she consumes 500mgs. She sipped and killed maybe a beer to herself while she was fucked up/barred outter her mind.

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haribo1 said:

Is their a ceiling effect for benzos? After all, once all those GABA receptors are full, more won't do anything...

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biggerstronger said:

IMPOSSIBLE. That girl would be knocked out/blacked out for several days at the very least. She takes 20mg of valium per day! The story you tell is just not possible unless she is also shooting grams and grams of meth to keep her up along with it and is a walking zombie. Even then I would not believe it. Say she took 100mg of actual alprazolam instead of the 700mg that you said she would still be blacked out for a few of days.

700mg of alprazolam within a 2 day period alongside alcohol/lsd would have her on her death bed. Toxicity vs actual effect are two very different things. Although the dose may not be toxic to her body she would still have extreme effects from the huge dose including death if mixed with enough other drugs or alcohol. I believe this is a trolling attack people. lol.

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