Paradoxical Reactions to Benzodiazepines: Literature Review and Treatment Options

Carissa E. Mancuso, PharmD; Maria G. Tanzi, PharmD; Michael Gabay, PharmD


Pharmacotherapy. 2004;24(9) 


Paradoxical reactions to benzodiazepines are relatively uncommon and occur in less than 1% of patients. The exact mechanism of paradoxical reactions remains unclear. Most cases are idiosyncratic; however, there is some evidence that these reactions may occur secondary to young or advanced age, a genetic link, history of alcohol abuse, or psychological disturbances, particularly those associated with a history of anger and aggressive behavior. The excitatory reactions that may occur, including excessive talkativeness, movement, and emotional release, can prevent the performance of such procedures as gastrointestinal endoscopy. Reactions have occurred in both adults and children; however, clinical data have not identified differences in the presentation or treatment of these reactions between the two populations. Flumazenil, a benzodiazepine antagonist, has been shown to manage these reactions successfully with minimal adverse effects. As more information is learned regarding the mechanism of paradoxical reactions to benzodiazepines, better treatment options may become available.