D.Sedative–hypnotic drugs

•Acute intoxication: For supportive management, flumazenil is the specific antidote for benzodiazepines but can precipitate seizures or withdrawal in patients with chronic abuse.

•Chronic intoxication/withdrawal:

Barbiturates: The equivalent dose of phenobarbitone for a period, which depends on the duration of action of the abused drug for withdrawl effect flumazenil can cause seizure in chronic intoxication of barbiturates.

Benzodiazepines: Long-acting like chlordiazepoxide (Librium) orally/Ryle’s tube maximum up to 25 mg, three to four times a day, or lorazepam 1–2 mg three to four times a day

Alcohol: Same as benzodiazepines

E.Stimulant drugs

•Acute intoxication: Benzodiazepines (lorazepam) are the drug of choice.

•Chronic abuse: Bromocriptine and/or desipramine can be given orally.

Suggested Reading

1.Cohagan A, Worthington R, Krause RS. Alcohol and substance abuse evaluation. 2009. emedicine.medscape.com.

This article discusses the various aspects of alcohol and other substance abuse in the emergency department.

2.Mausner KL. Sedatives and hypnotics. In: Ma OJ, Cline DM, editors. Emergency medicine manual. 6th ed. New York: McGraw-Hill; 2004. pp. 489–93.

This chapter discusses the various aspects of sedative and hypnotic drug abuse.

3.Chang G, Kosten TR. Detoxification. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, editors. Substance abuse: A comprehensive textbook. 4th ed. Baltimore: Lippincott, Williams & Wilkins; 2004. pp. 579–86.

The handbook provides all the information to diagnose and treat addictive disorders and associated medical conditions.

4.Giannini AJ. An approach to drug abuse, intoxication and withdrawal. Am Fam Physician. 2000; 61:2763–74.

This review discusses the symptomatic effects of drug abuse that are a result of alterations in the functioning of the various neurotransmitters. This can accurately determine the drug class and intervene appropriately to counteract drug-induced effects.

5.Weinbroum AA, Flaishon R, Sorkine P, et al. A risk-benefit assessment of flumazenil in the management of benzodiazepine overdose. Drug Saf. 1997;17:181–96.

This article reviews the indications, dosage, and effectiveness of flumazenil in different groups of patients with benzodiazepine overdose.

6.Giannini AJ, Baumgartel P, DiMarzio LR. Bromocriptine therapy in cocaine withdrawal. J Clin Pharmacol. 1987;27:267–70.

Significant relief with bromocriptine was seen almost immediately and continued throughout the detoxification period in cocaine withdrawal.

7.Giannini AJ, Malone DA, Giannini MC, Price WA, Loiselle RH. Treatment of depression in chronic cocaine and phencyclidine abuse with desipramine. J Clin Pharmacol. 1986;26:211.

Subjects who received desipramine showed a decrease in depressive symptoms after a 20to 40-day period regardless of whether they abused PCP or cocaine.