Özkıyım amaçlı yüksek doz alprazolam entoksikasyonu

Alprazolam (Xanax) başlıca anksiyolitik ve antidepresan olarak kullanılan bir triazolobenzodiazepin deriveridir, ama ayrıca agorofobi, panikatak ve panik rahatsızlıkların tedavisinde de etkilidir. Anksiyete tedavisinde 0.75-4 mg /gün etkinken ; fobik ve panik rahatsızlıklarda 6-9 mg/gün etkindir. Yüksek dozdaki benzodiazepinler genellikle bradikardiye neden olurlar. Ayrıca, benzodiazepinlerin miyokardiyal kontraktiliteyi azaltıp, miyokarda kan akımını arttırdığı bilinir: Miyokardiyal fonksiyonların azalması hemodinamik durumu düzeltebilir. Biz bu çalışmada, yüksek doz alprazolam alan olguların santral sinir sistemi ve kardiak etkileri sonucu morbid seyreden olgularımızı literature ışığı altında irdelemeyi amaçladık. Burda biz yüksek doz alprazolam entoksikasyonu üç olguyu sunuyoruz.

Anahtar Kelimeler:

Doz aşımı, Benzodiazepinler, Merkezi sinir sistemi, Zehirlenme, İntihar etme, Alprazolam

The overdose entoxication of alprazolam, purposing suicide

Alprazolam (Xanax) is a triazolobenzodiazepine derivative, mainly used as an anxiolytic and antidepressant, but also efficient in the treatment of agoraphobia, panic attacks and panic disorders. Daily doses of 0.75-4 mg are effective for generalized anxiety, while daily doses of 6-9 mg have been used for phobic and panic disorders. High-dose benzodiazepines classically induce bradicardia in heart. And also, benzodiazepines are known to reduce myocardial contractility and increase myocardial blood flow: a reduced myocardial function may compromise the hemodynamic status even further. In this study we tried to investigate the central nervous system and cardiac effects that has been seen in high doses alprazolam intoxication cases with the help of the literatures. Here in, we presented three cases of high doses alprazolam intoxication.

Keywords:

Overdose, Benzodiazepines, Central Nervous System, Poisoning, Suicide, Alprazolam,

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1. Schulz M, Schmoldt A, Therapeutic and toxic blood concentrations of more than 500 drugs, Pharmazie 1997; 12: 895–910.
2. Kayaalp, S.O. Rasyonel Tedavi Yönünden Tıbbi Farmakoloji. 4th.edn. Ankara. Feryal Matbaası, 1989: 1798-1799.
3. Gelpin E, Bonne O, Peri T, Brandes D, and Shalev AY. Treatment of recent traumasurvivors with benzodiazepines: a prospective study. J Clin Psychiatry 1996; 57: 390-394
4. Rossetti E, Fragasso G, Xuereb RG, Xuereb M, Margonato A, Chierchia SL. Antiischemic effects of intravenous diazepam in patients with coronary artery disease. J Cardiovasc Pharmacol 1994; 24:55-58.
5. Guadreault P, Guay J, Thivierge RL, Verdy L. Benzodiazepine poisoning: Clinical and pharmacologic considerations and treatment. Drug Safety 1991; 6:297.
6. Bosse GM. Benzodiazepines. In: Tinthinalli J E, editors. Emergency medicine. 5th edn. New York. The McGraw-Hill Companies, 2000: 1096
7. Michaud K, Augsburger M, Giroud C, Mangin P. Fatal overdose of tramadol and alprazolam. Forensic Sci Int 1999; 105:185- 189.
8. Christiaens F, Lessire H, Dellers I, Denis B, Vankeerberghen L, Verborgh C. Successful prolonged cardiopulmonary resuscitation after a combined intoxication with a tricyclic antidepressant, a benzodiazepine and a neuroleptic. Eur J Emerg Med 2000;7:229-236.
9. Tulen JH, Bussmana HB, Van steenis HG, Pepplinkhuizen L, and Man in’t Veld AJ. A novel tool to quantify physical activites: ambulatory accelerometry in psychopharmacology. J Clin Psychopharmaco. 1997; 17: 202-207
10. van den Berg F, Tulen JH, Boomsma F, Noten JB, Moleman P, and Pepplinkhuizen L. Effects of alprazolam and lorzepam on catecholaminergic and cardiovasculer activity during dupine rest, mental load and orthostatic challenge. Psychopharmacol. Berl 1996; 128:21-30
11. McCormick SR., Nielsen J, and Jatlow PI, Alprazolam overdose: clinical findings and serum concentrations in two cases. J Clin Psychiatry 1985; 46: 247–248.
12. Jenkins AJ, Levine B, Locke JL, Smialek JE. A fatality due to alprazolam intoxication. J Anal Toxicol. 1997; 21: 218- 220.
13. Leeuwin RS, Zeegers A, van Hamme J, van Wilgenburg H. Modification of cardiac actions of RO 05-4864 by PK 11195 and flumazenil in the perfused rat heart. Life Sci. 1997; 61:1631-1642.
14. Richard AN, Douglas AR. Psychotropic medications. In: Tinthinalli J E, editors. Emergency medicine. 5th edn. New York: The McGraw-Hill Companies, 2000. 1921.