Reversal of a Paradoxical Reaction to Midazolam with Flumazenil

Thurston, Timothy A.; Williams, Courtney; Foshee, Sarah L.

doi:10.1213/00000539-199607000-00036

Cited by 36 publications

(11 citation statements)

References 2 publications

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“…We believe that the poor results of haloperidol plus midazolam were due to two factors: its short halflife and the paradoxical reaction of midazolam. This last reaction was observed in previous reports [27][28][29][30] and may have been exacerbated by the anticholinergic effects of promethazine (haloperidol plus promethazine was the standard option for additional medication in this study).…”

Section: Discussionsupporting

confidence: 67%

Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone

Baldaçara

Sanches

Cordeiro

et al. 2011

Rev. Bras. Psiquiatr.

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OBJECTIVE: To compare the effectiveness of intramuscular olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone as the first medication(s) used to treat patients with agitation and aggressive behavior. METHOD: One hundred fifty patients with agitation caused by psychotic or bipolar disorder were randomly assigned under double-blind conditions to receive olanzapine, ziprasidone, haloperidol plus midazolam, haloperidol plus promethazine or haloperidol alone. The Overt Agitation Severity Scale, Overt Aggression Scale and Ramsay Sedation Scale were applied within 12 hours after the first dosage. RESULTS: All medications produced a calming effect within one hour of administration, but only olanzapine and haloperidol reduced agitation by less than 10 points, and only olanzapine reduced aggression by less than four points in the first hour. After twelve hours, only patients treated with haloperidol plus midazolam had high levels of agitation and aggression and also more side effects. Ziprasidone, olanzapine and haloperidol alone had more stable results for agitation control, while ziprasidone, haloperidol plus promethazine and olanzapine had stable results for aggression control. CONCLUSION: Olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol were effective in controlling agitation and aggression caused by mental illness over 12 hours. Although all the drugs had advantages and disadvantages, haloperidol plus midazolam was associated with the worst results in all the observed parameters.

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Section: Discussionsupporting

confidence: 67%

Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone

Baldaçara

Sanches

Cordeiro

et al. 2011

Rev. Bras. Psiquiatr.

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“…It is estimated that less than 1% of patients experience atypical responses to benzodiazepines [ 1 ]. Though rare, the case report literature includes observations of atypical response to nearly every agent in the benzodiazepine family, with intravenous midazolam being the most represented [ 1 – 4 ]. Interestingly, despite an association between risk factors and advanced age, the authors observed more reports of atypical responses in pediatric populations than in geriatric populations [ 1 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Paradoxical Reaction to Alprazolam in an Elderly Woman with a History of Anxiety, Mood Disorders, and Hypothyroidism

Kirkpatrick

Smith

Kerfeld

et al. 2016

Case Reports in Psychiatry

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With less than 1% of patients who use benzodiazepines being affected, paradoxical responses to benzodiazepines are rare. In this case report, we outline the course of an 80-year-old female who developed a paradoxical response to benzodiazepines. Significant medical and psychiatric history includes anxiety, mood disorder, hypothyroidism, bilateral mastectomy, goiter removal, and triple bypass. The patient presented with mental status changes, anxiety, motor restlessness, and paranoia. Over time, a temporal relationship between the severity of the patient's motor agitation and intake of alprazolam was observed. As doses of alprazolam were decreased, her motor agitation became less severe. In addition to motor agitation, the patient also demonstrated increased aggressiveness, a subjective feeling of restlessness, and increased talkativeness. As her dose of alprazolam decreased, many of the patient's symptoms were observed to decrease. This case report also discusses theories regarding the pathophysiology of paradoxical reactions to benzodiazepines, known risk factors, and appropriate treatment.

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“…Paradoxical responses to midazolam include symptoms of agitation, restlessness, uncontrollable shaking, and stiffening and jerking of the arms and legs unexpectedly [ 8 ]. This paradoxical excitement occurs in less than 1% of all patients who receive midazolam, and it can be reversed with flumazenil [ 9 , 10 ]. In contrast, irritability during CSE refers to an irritable behavioral response to endoscopic stimuli after adequate sedation, which seems not to be uncommon; however, there are currently no epidemiologic data available on this topic.…”

Section: Introductionmentioning

confidence: 99%

Are Histrionic Personality Traits Associated with Irritability during Conscious Sedation Endoscopy?

Lee

Kim

Park

2015

Gastroenterology Research and Practice

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Aim. We aimed to evaluate whether histrionic personality traits are associated with irritability during conscious sedation endoscopy (CSE). Materials and Methods. A prospective cross-sectional study was planned. Irritability during CSE was classified into five grades: 0, no response; I, minimal movement; II, moderate movement; III, severe movement; IV, fighting against procedure. Patients in grades III and IV were defined as the irritable group. Participants were required to complete questionnaire sheet assessing the extent of histrionic personality traits, extraversion-introversion, and current psychological status. The present authors also collected basic sociodemographic data including alcohol use history. Results. A total of 32 irritable patients and 32 stable patients were analyzed. The histrionic personality trait score of the irritable group was higher than that of the stable group (9.5 ± 3.1 versus 6.9 ± 2.9; P = 0.001), as was the anxiety score (52.8 ± 8.6 versus 46.1 ± 9.6; P = 0.004). Heavy alcohol use was more frequently observed in the irritable group (65.6% versus 28.1%; P = 0.003). In multivariate analysis, all these three factors were independently correlated with irritability during CSE. Conclusion. This study revealed that histrionic personality traits, anxiety, and heavy alcohol use can affect irritability during CSE.

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Reversal of a Paradoxical Reaction to Midazolam with Flumazenil

Cited by 36 publications

References 2 publications

Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone

Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone

Paradoxical Reaction to Alprazolam in an Elderly Woman with a History of Anxiety, Mood Disorders, and Hypothyroidism

Are Histrionic Personality Traits Associated with Irritability during Conscious Sedation Endoscopy?

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