Designer benzodiazepines: a report of exposures recorded in the National Poison Data System, 2014–2017

Etizolam: A rapid review on pharmacology, non‐medical use and harms

“…International programs that monitor emerging substances have reported on etizolam use and harms. These include the European Monitoring Centre for Drugs and Drug Addiction , the STRIDA project , the Drug Enforcement Agency National Forensic Laboratory Information System and analysis of US Poisons call centres . All these demonstrate that etizolam use is common, although the STRIDA project reported that, between 2012 and 2016, other designer benzodiazepines had become more common than etizolam .…”

“…The comparative toxicity of etizolam relative to other benzodiazepines, particularly when combined with other drugs, and whether mechanisms of toxicity for etizolam are similar to other benzodiazepines in overdose are unknown. One report on ‘designer benzodiazepine’ toxicity described symptoms that were consistent with a ‘sedative‐hypnotic toxidrome’ (reduced blood pressure, pulse and respiration depressed mental state, hyporeflexia and ataxia ).…”

Designer Benzodiazepines: A Review of Published Data and Public Health Significance

“…7,14 Norflurazepam, also named desalkykflurazepam, is the principal active metabolite of flurazepam, 10,17,18 a BZ hypnotic used in the United States since 1970. 6,[28][29][30][31] In cases of overdose, some designer BZs can be detected with adequate sensitivity by immunoassay-based urine drug screening. 10,21 The principal determinants of elimination 10 This scenario is not difficult to envision if a user is not familiar with a particular compound, or ingests an impure mixture of multiple compounds.…”

“…Clinical toxicity patterns associated with designer BZs have been described in case reports and case series, and are similar to those associated with the traditional BZs: slurred speech, somnolence, lethargy, ataxia, psychomotor impairment, slowed reaction time, and impaired memory. 6,[28][29][30][31] In cases of overdose, some designer BZs can be detected with adequate sensitivity by immunoassay-based urine drug screening. [32][33][34][35] However, not all designer BZs will necessarily cross-react with commercially used immunoassays, and the detectability of many designer BZs remains unknown.…”

“…Case reports suggest that the effects of designer BZs, when taken alone in overdose, are reversible (at least partly) by the BZ antagonist flumazenil. 29,31 In an appropriate patient, empiric administration of flumazenil may be reasonable even if the urine drug screening is negative. As in traditional BZ intoxication, the use of flumazenil carries a theoretical risk of precipitating discontinuation symptoms in highly BZ-tolerant patients.…”