Treatment of high dose of intravenous midazolam abuse: a case report.

IF 2.1 3区 医学 Q3 PHARMACOLOGY & PHARMACY International Clinical Psychopharmacology Pub Date : 2024-05-01 Epub Date: 2023-08-09 DOI:10.1097/YIC.0000000000000486
Yeganeh Ramazani, Ahmad Nemati, Mohammad Moshiri, Mahdi Talebi, Mohammad Dadkhah, Leila Etemad
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Abstract

This study reports a rare case of high-dose midazolam abuse and Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral midazolam. She had mimicked the symptoms of Crohn's disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral methadone to 30 mg/day of intravenous midazolam. She also had several skin lesions on injection sites that she considered pyoderma gangrenosum. When the total daily dose of intravenous midazolam was switched to oral bioequivalence of clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received midazolam again as a continuous intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of clonazepam. She was also treated with carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of midazolam could be treated by tapering off the long-acting benzodiazepine.

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大剂量咪达唑仑静脉注射滥用的治疗:病例报告。
本研究报告了一例罕见的大剂量咪达唑仑滥用和孟乔森综合症病例。一名 48 岁的女医生因每天禁用 300 毫克肠外咪达唑仑而被精神科医生转介到伊玛目礼萨医院毒理学部。她曾模仿克罗恩病的症状,因此接受了 15 次结肠镜检查和 40 次核磁共振成像或 CT 扫描,结果均正常。六个月前,她将口服美沙酮改为每天 30 毫克的咪达唑仑静脉注射。她的注射部位也有几处皮肤损伤,她认为是脓皮病。当静脉注射咪达唑仑的每日总剂量改为口服氯硝西泮的生物等效剂量时,她无法耐受戒断(临床研究所戒断评估量表-苯二氮卓=68)。因此,她再次接受咪达唑仑持续静脉注射。在 7 天内,整个剂量被生物等效的氯硝西泮口服剂量所取代。她还接受了卡马西平和认知行为疗法的治疗。之后,她被转到精神科病房接受进一步的精神治疗。对大剂量咪达唑仑的依赖可以通过减少长效苯二氮卓类药物来治疗。
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来源期刊
CiteScore
4.40
自引率
23.10%
发文量
97
审稿时长
>12 weeks
期刊介绍: International Clinical Psychopharmacology provides an essential link between research and clinical practice throughout psychopharmacology. It reports on studies in human subjects, both healthy volunteers and patients, which relate the effects of drugs on psychological processes. A major objective of the journal is to publish fully refereed papers which throw light on the ways in which the study of psychotropic drugs can increase our understanding of psychopharmacology. To this end the journal publishes results of early Phase I and II studies, as well as those of controlled clinical trials of psychotropic drugs in Phase II and IV. Other topics covered include the epidemiology of psychotropic drug prescribing and drug taking, the sociology of psychotropic drugs including compliance, and research into the safety and adverse effects of these compounds.
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