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Tables for:
Paradoxical Reactions to Benzodiazepines: Literature Review and Treatment Options

[Pharmacotherapy 24(9):1177-1185, 2004. © 2004 Pharmacotherapy Publications]


Table 1. Summary of Paradoxical Reactions in Adults[2-17]


Age (yrs),
Sex
Daily Drug DoseTreatmentOutcomeConcomitant Psychiatric
or Medical Conditions
67, M[2]Midazolam 15 mg i.v.Flumazenil 0.5 mg i.v.Restlessness resolvedCoronary artery disease, atrial fibrillation
66, M[2]Midazolam 3 mg i.v.Flumazenil 0.3 mg i.v.Restlessness resolvedObstructive lung disease, alcoholism
65, M[2]Midazolam 18 mg i.v.Flumazenil 0.4 mg i.v.Body rocking resolvedNone noted
73, M[2]Midazolam 6 mg i.v.Flumazenil 0.4 mg i.v.Restlessness resolvedDiabetes mellitus
70, M[2]Midazolam 6 mg i.v.Flumazenil 0.3 mg i.v.Restlessness, vocalizations resolvedDiabetes mellitus, coronary artery disease
76, M[2]Midazolam 9 mg i.v.Flumazenil 0.3 mg i.v.Restlessness, vocalizations resolvedDiabetes mellitus, atrial fibrillation
28, M
(twins)[3]
Midazolam 12 mg i.v.NoneRestlessness resolved and retained amnesiaNone noted
 Diazepam 10 mg p.o.NoneRestlessness resolved and retained amnesiaNone noted
22, F[4]Midazolam 18 mg i.v.NoneAbusive, belligerent behavior ceased within 24 hrsAlcoholism, anger management issues
32, F[5]Alprazolam 1.5 mg p.o.DiscontinuedRacing thoughts, increased energy resolved in 48-72 hrsDepressive bipolar disease
34, M[5]Alprazolam 3 mg p.o.DiscontinuedRacing thoughts, paranoid feelings resolved in 72 hrsAnxiety, panic attacks
32, F[5]Alprazolam 1 mg p.o.DiscontinuedRacing thoughts and insomnia resolved in 48 hoursPanic attacks
37, M[6]Clonazepam 12 mg p.o.DiscontinuedAggressive behavior ceasedBipolar affective disorder
25, M[6]Clonazepam 4.5 mg p.o.DiscontinuedHyperactivity, belligerence ceasedBipolar affective disorder
19, M[6]Clonazepam 4 mg p.o.DiscontinuedAgitation ceasedBorderline personality disorder
31, M[7]Midazolam 5 mg i.v.Sodium amobarbital
200 mg i.m.
Combative, verbally threatening behavior ceasedAnger management issues
22, F[8]Lorazepam 3 mg p.o.DiscontinuedHostile behavior resolvedPhobia of elevators and escalators
28, F[9]Diazepam 20 mg p.o.DiscontinuedImprovement of hostile, physical abuse in 48-72 hrsDepression, anxiety
30, F[10]Temazepam 30 mg p.o. at bedtimeDiscontinuedAnger and enraged behavior ceasedManic-depression
30, M[10]Temazepam 30 mg p.o. at bedtimeDiscontinuedAnger and agitation resolved, no recollection of eventsChronic insomnia
37, M[10]Temazepam 30 mg p.o. at bedtimeDiscontinuedAnger resolvedSchizophrenia
39, F[10]Temazepam 15-30 mg p.o. at bedtimeDiscontinuedAgitation and restlessness resolvedObsessive-compulsive symptoms
75, F[10]Triazolam 0.5 mg p.o. every other nightDiscontinuedAgitation and nervousness resolvedChronic insomnia
40, M[10]Triazolam 1-1.5 mg p.o. at bedtimeDiscontinuedAnger, panic, visual hallucinations ceasedChronic insomnia
60, F[10]Triazolam 0.5-1 mg p.o. at bedtimeDiscontinuedAnger and argumentative behaviors ceasedChronic insomnia
29, F[10]Triazolam 0.5 mg p.o. at bedtimeDiscontinuedAnxiety and agitation resolvedChronic insomnia
64, F[10]Triazolam 0.5 mg p.o. at bedtimeDiscontinuedBizarre behaviors ceasedChronic insomnia
56, F[10]Triazolam 0.5 mg p.o. at bedtimeDiscontinuedAgitation ceased over 2 daysChronic insomnia
37, M[11]Clonazepam 8 mg p.o.DiscontinuedIrritability, hyperactivity ceasedManic episodes, panic attacks
50, M[12]Midazolam 6 mg i.v.Haloperidol 10 mg i.v.Patient calmed, retained amnesiaCoronary artery disease
49, F[13]Midazolam 12 mg i.v.Flumazenil 0.5 mg i.v.Aggressive behavior ceased, retained amnesiaNone noted
71, M[14]Midazolam 4 mg i.v.Flumazenil 0.2 mg i.v.Patient calmed, retained amnesiaAnger management issues
27, M[15]Midazolam 7 mg i.v.Flumazenil 0.3 mg i.v.Patient calmed, retained amnesiaNone noted
62, M[16]Midazolam 5 mg i.v.Flumazenil 0.5 mg i.v.Patient calmed, retained amnesiaAlcoholism
58, F[16]Midazolam 7.5 mg i.v.Flumazenil 0.5 mg i.v.Patient calmed, retained amnesiaAlcoholism
26, M[16]Midazolam 10 mg i.v.Flumazenil 0.5 mg i.v.Patient calmed, retained amnesiaNone noted
19, F[17]Midazolam 5 mg i.v.Flumazenil 0.2 mg i.v.Crying ceased, retained amnesiaNone noted
21, F[17]Midazolam 7 mg i.v.Flumazenil 0.4 mg i.v.Crying ceased, retained amnesiaNone noted

Table 2. Summary of Paradoxical Reactions in Pediatric Patients[18-22]


No. of
Patients
Age
(yrs)
SexDrug, Maximum DoseTreatmentOutcome
14[18]2-7NRMidazolama 0.35 mg/kg (n=4)
Midazolama 0.45 mg/kg (n=10)
NoneAgitation, restlessness resolved
1[19]26 mosFMidazolam 0.5 mg/kg p.o.Morphine sulfate 0.1 mg/kg i.v.Calmed, ceased crying
1[20]11MMidazolam 17.5 mg p.o.Flumazenil 0.15 mg i.v.Confusion, screaming ceased, amnesia retained
36[21]1-1719 M
17 F
Midazolam 0.1-0.5 mg/kg i.v.
Meperidine 1-2 mg/kg i.v.
Flumazenil 0.01 mg/kg i.v. (n=30)
Physostigmine i.v. (dose unknown, n=6)
Inconsolable crying, restlessness resolved
25[22]2.5-18NRMidazolam 0.1-0.3 mg/kg i.v.
Meperidine 1-2 mg/kg i.v.
Flumazenil 0.01 mg/kg i.v. i.v. (n=2)Agitation resolved

NR = not reported.
aRoute of administration was per rectum.