Barbiturate dependence

Barbiturate dependence
Classification and external resources
Specialty psychiatry
ICD-10 F13.2
ICD-9-CM 304.1

Barbiturate dependence develops with regular use of barbiturates. This in turn may lead to a need for increasing doses of the drug to get the original desired pharmacological or therapeutic effect.[1] Barbiturate use can lead to both addiction and physical dependence, and as such they have a high potential for abuse.[2] Management of barbiturate dependence involves considering the affected person's age, comorbidity and the pharmacological pathways of barbiturates.[3] Psychological addiction to barbiturates can develop quickly. The GABAA receptor, one of barbiturates' main sites of action, is thought to play a pivotal role in the development of tolerance to and dependence on barbiturates, as well as the euphoric "high" that results from their abuse.[2] The mechanism by which barbiturate tolerance develops is believed to be different from that of ethanol or benzodiazepines, even though these drugs have been shown to exhibit cross-tolerance with each other.[4] The management of a physical dependence on barbiturates is stabilisation on the long-acting barbiturate phenobarbital followed by a gradual titration down of dose. The slowly eliminated phenobarbital lessens the severity of the withdrawal syndrome and reduces the chances of serious barbiturate withdrawal effects such as seizures.[5] Antipsychotics are not recommended for barbiturate withdrawal (or other CNS depressant withdrawal states) especially clozapine, olanzapine or low potency phenothiazines e.g. chlorpromazine as they lower the seizure threshold and can worsen withdrawal effects; if used extreme caution is required.[6]

References

  1. ↑ Zapantis A, Leung S (September 2005). "Tolerance and withdrawal issues with sedation". Crit Care Nurs Clin North Am. 17 (3): 211–23. PMID 16115529. doi:10.1016/j.ccell.2005.04.011.
  2. 1 2 Takehiko Ito; Toshihito Suzuki; Susan E. Wellman; Ing Kang Ho (June 1996). "Pharmacology of barbiturate tolerance/dependence: GABAA receptors and molecular aspects". Life Sciences. 59 (3): 169–95. PMID 8699929. doi:10.1016/0024-3205(96)00199-3.
  3. ↑ Santos C, Olmedo RE (2017). "Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition And Treatment". Emerg Med Pract. 19 (3): 1–20. PMID 28186869.
  4. ↑ Allan AM, Zhang X, Baier LD (August 1992). "Barbiturate tolerance: effects on GABA-operated chloride channel function". Brain Res. 588 (2): 255–60. PMID 1382810. doi:10.1016/0006-8993(92)91583-Z.
  5. ↑ Tyrer, Peter; Silk, Kenneth R., eds. (24 January 2008). Cambridge Textbook of Effective Treatments in Psychiatry (1st ed.). Cambridge University Press. p. 406. ISBN 978-0-521-84228-0.
  6. ↑ Ebadi, Manuchair (23 October 2007). "Alphabetical presentation of drugs". Desk Reference for Clinical Pharmacology (2nd ed.). USA: CRC Press. p. 512. ISBN 978-1-4200-4743-1.


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