A Retrospective Review of Morbidity and Mortality Associated with Acute Benzodiazepine Withdrawal at a Midwestern Academic Medical Center

Acute Benzodiazepine Withdrawal

Abstract

Introduction. There is concern that acute benzodiazepine (BZP) withdrawal may result in morbidity and mortality. However, there is a paucity of medical literature regarding clinical characteristics and outcomes of acute BZP withdrawal. We sought to characterize acute BZP withdrawal at a midwestern academic medical center.

Methods. This was a retrospective study. The medical records of the University of Kansas Hospital, a tertiary academic medical center, were queried for patients with a diagnosis of BZP withdrawal, drug withdrawal, sedative-hypnotic withdrawal or withdrawal-NOS from 1/1/2009 to 1/1/2016. Data collected included: age, sex, month/year of encounter, initial vital signs, type of drug withdrawal (alcohol, opioid, BZP or other), type of BZP withdrawing from, disposition, duration of hospitalization, seizures, endotracheal intubation, mortality and pharmacological treatment.

Results. 82 cases of were identified. Cases per year increased over the study period. Thirty-one (38%) cases involved concurrent drug withdrawal with opioids most common (n=25). Alprazolam (n=32) was the most common BZP implicated in BZP withdrawal. Thirty-nine cases (47%) were admitted including 7 to the ICU. Seizures were reported in 8 (10%) cases. Endotracheal intubation occurred in 3 (3.6%). Sixty-seven patients (81%) were treated with a BZP with lorazepam (n=42) most commonly used. There were no deaths. Upon discharge 40 (49%) patients received a prescription for a benzodiazepine.

Conclusions. Cases of acute BZP withdrawal increased over the study period but were associated with only occasional morbidity and no mortality. Further multi-center studies are warranted to better characterize the incidence and characteristics of acute BZP withdrawal.