CBD and Xanax

One of the more common benzodiazepine prescriptions for those who struggle with conditions like panic disorder or anxiety is called Xanax, also known as Alprazolam (with a chemical name of 8-Chloro-1-methyl-6-phenyl-4H-1,2,4- -triazolo(4,3-a) 1,4) benzodiazepine, molecular formula of C17H13ClN4, and molecular weight of 308.8). This medication is quite potent and has many drug interactions, making it one of the more worrisome anxiety medications on the market. As an alternative to benzos like this, many people have considered trying CBD or cannabidiol. The effects of this natural substance are similar in potency, but there are fewer worries about how it could harm someone or interact with other medications. It gives people who are allergic to these types of medications an alternative that can provide relief as well. It could be the best possible option for those who struggle with anxiety, whether they have ever been medicated or not. 

Understanding Xanax

Xanax is a type of medication called a benzodiazepine that comes in a white to off-white color. It is a solid crystal described as Virtually insoluble in water; soluble in alcohol; sparingly soluble in acetone; freely soluble in chloroform; slightly soluble in ethyl acetate. It alters the chemicals within the brain by forcing it to try and rebalance itself. 

Some people can tolerate this substance, but many also struggle with the effects that can be incredibly strong. There are also many people who cannot take this medication for one reason or another.

These people include: 

  • Anyone with narrow-angle glaucoma
  • Anyone taking itraconazole 
  • Anyone taking ketoconazole 
  • Anyone allergic to the following medications: Librium, Serax, Klonopin, Ativan, Tranxene, or Valium 
  • Anyone under 18 years of age 

Some people must find out first from their doctors if this medication is safe for them to take, and these people include: 

  • Anyone who has seizures or has been diagnosed with epilepsy 
  • Anyone taking narcotic pain medications 
  • Anyone with liver or kidney disease, especially if the disease was caused by alcohol or drugs
  • Anyone who struggles with depression
  • Anyone that is currently showing suicidal ideations or behaviors 
  • Anyone with any type of breathing disorder, such as asthma 

There are also several side effects that come along with using Xanax. These include: 

  • An overwhelming feeling of exhaustion or falling asleep 
  • Less balance than is normal as falls are more common with people on this medication 
  • Feeling anxious when first waking up in the morning, but this subsides as the day goes on
  • Trouble remembering things or staying focused on a task at hand 
  • Thoughts that race and are hard to stay focused on 
  • An increase in energy 
  • Behavior that changes to include risks that someone would not normally take 
  • Feeling agitated or becoming hostile 

Rarer side effects can happen, and if they are noticed, a doctor should be notified immediately. These include the following: 

  • Hallucinations
  • Increased heart rate
  • Fluttering of the heart
  • Depressed mood
  • Thinking about suicide
  • Tremors
  • Uncontrolled movement or twitches in the muscles
  • Seizures
  • Eye problems
  • Reproductive issues
  • The inability to remain awake
  • Trouble breathing
  • Hives
  • Renal trouble
  • Swelling of the head in any form (lips, throat, face, tongue, etc.)

Other effects that are possible with Xanax include: 

  • Hypothermia
  • Allergic reactions
  • Poisoning

Dangers of Xanax

One of the most important dangers that come along with taking this medication is the fact that it can lead to addiction. The body becomes reliant on it to relax or sleep, making the body act in such a way that it makes the user seek more. Abuse has been known to happen, so these prescriptions need to be doled out only to those who truly need the medication and monitored very closely. Anyone who develops withdrawal symptoms before the next dose needs to speak to his or her doctor right away. This is what happens when the body becomes dependent on the medication. In this case, another medication or type of relief needs to be sought out.

Safer Alternatives to Anxiety Medications

Many options can be used instead of medications when someone struggles with conditions like panic or anxiety disorder or social anxiety. Some people need to change how they do things, while others need an actual substance to help them with the overwhelming feelings that arise. For those that can change habits and feel better, some options include: 

  • Regularly exercising can help ease anxiety by allowing the body to move around actively. Plus, exercise releases endorphins, which are mood enhancers in their own right. Exercise has the benefit of also helping with self-esteem and self-confidence, plus it allows people to gain bonds with others who partake in similar activities in a safe manner. 
  • Eating healthy foods that vary can also help when anxiety is a common issue. The more nutrient-dense a diet is, the more the body can naturally pull items out of the foods that it needs. This type of diet also helps get plenty of fiber into the body, which helps scrape out any toxins left that may lead to physical or mental struggles. 
  • Spending time with positive people can help keep the negativity away, which can reduce the anxiety that someone feels. Ideally, these people should be close friends or family members who can make the anxious person feel happy, silly, or calm. If these are not an option, then seeking out time with a pet could also provide social relief. 
  • Avoiding sugar and caffeine can help when someone is struggling with anxiety as there is no up and then down in a person’s focus or mood. When people regularly consume sugar or caffeine, the mood and focus lift because of the stimulant. Then when it wears off, the effect brings the mood and ability to focus back down, often below where it started. 
  • Volunteering is a great way to reduce anxiety. Being able to help someone else can be very uplifting, plus it can also help people feel less isolated, which can exacerbate anxiety. It can also help to see that there are other people out there who struggle in their own ways, allowing the person with anxiety to feel more accepted. 
  • Ensuring that people get plenty of sleep can help them alleviate a lot of anxiety. It is very important to allow the body to heal during sleep, which does not happen if sleep is interrupted or is not enough. Plus, sleep deprivation also leads to more anxiety instead of helping it get better. A solid eight hours can help with the symptoms of anxiety, along with any health-related issues that came from a lack of sleep.
  • Getting outside now and again can help with anxiety. The natural benefits from sunlight (vitamin D) and fresh air can improve someone’s mood and make them naturally more relaxed. Plus, it can allow someone who may feel isolated by his or her anxiety to feel a bit more open about what he or she is feeling. 
  • Meditation is a great way to avoid anxiety. It should be full of positive imagery so that the person meditating can foresee positive things happening in his or her life. This can be done one longer time each day, or even in small, three-minute increments, whatever allows the person to get the most benefit out of the time spent. 
  • Alcohol brings moods down, no matter how good or bad a mood one has to begin with. If alcohol is consumed regularly, it can add to feelings of depression or anxiety. Cutting this out of the diet can help improve the health of the person and his or her mood. Plus, then there is no worry about developing issues related to the consumption of alcohol. 
  • Focusing on the positive helps people notice good things around them instead of feeling like something is always going to go wrong. Anxiety often starts from a negative emotion or thought and grows from there. By focusing on positive thinking, feeling grateful, or looking back at a happier memory, it can improve someone’s resiliency and allow that person to feel calm instead of anxious. 
  • Being forgiving can go a long way towards decreasing anxiety. Holding on to something negative can bring one’s mood down or make someone feel anxious about a situation that is days, weeks, months, or even years old. By forgiving, it allows the person to move on without the weight of that event. Even if the person does not share that he or she forgave those who wronged them, the effect can help the anxious party. 
  • Stress almost always leads to increased anxiety. The stress may have nothing to do with the anxiety, but usually, the two are related. The best way to remove the anxiety that comes from stress is to reduce or remove the stress itself. Start by identifying the stressors and then come up with solutions. The more proactive someone is, the more he or she typically benefits from the practice.
  • Looking for a reason to feel good is sometimes enough. When people feel as though they do not fit in, it can increase anxiety exponentially. By finding a reason to get up, get out, or to go somewhere that he or she fits in, it can bring down how much anxiety he or she feels and can also give that person the strength to fight back against whatever is causing the anxiety. 

For those who need some type of substance to help them feel better, one of the best options available is CBD oil. It brings about a sense of peace and calm without the side effects of medications. Plus, CBD helps almost immediately. Other medications can also work. However, they each carry their own risks and chances of interaction with other medications that someone may be taking or bringing out a negative emotion as an effect. 

How Does CBD Help with Anxiety? 

In order to understand how CBD has the potential to help with anxiety, it is best to understand first where it comes from. There are two species of a cannabis plant, the one that gets people high, and one that does not. The species of cannabis that gets people high is marijuana, and it gets people high because it contains THC. The species of cannabis that does not get people high is hemp, and it contains CBD. THC gets people high because it has a psychoactive compound that reacts with the brain. CBD is a similar compound, called cannabinoid, but it has no psychoactive component in it. It simply relaxes the body and helps improve the overall function of the body. 

One of the most common side effects of using CBD products of any sort is the ability to relax the central nervous system. This does not depress the system. Instead, it allows it to slow down and function properly. Many people with anxiety have so much going on; every part of their body is trying to move at super high speeds. The ability to slow down allows the body and brain to catch up and then sync back up. This means every part of the body works more efficiently, and people feel as though they are more in control. That simple change can be the start of someone being less overwhelmed by his or her anxiety.

Whenever a product containing CBD is consumed, the product works its way through the endocannabinoid system. This is the pathway of the brain that reads signals being sent from the various parts of the body. There are CB receptors all over the body, but there are many of them along this system. These receptors are supposed to open up when a message is sent, accept the message, read what is going on, and respond accordingly. In some instances, these receptors do not open. By adding CBD, these receptors recognize that they should be opening, and they start to receive messages again, all through natural means. It allows the body to begin regulating itself the way it was meant to, and it allows people with anxiety to feel like they are back in control, at least to some degree. 

The FDA had already recognized that CBD could help with some medical ailments when in 2018, it approved a CBD-based medicine to help with seizure disorders. Studies are already underway that are showing how CBD can help with other issues, like: 

  • Anxiety, depression, and PTSD 
  • Parkinson’s patients 
  • MS patients who have chronic pain 
  • Glaucoma patients who struggle with inner-ocular pressure 
  • Cardiac patients 
  • Numerous types of cancer 
  • Alcohol and drug withdrawals
  • Schizophrenic patients 
  • Patients with high blood pressure 

How Does Someone Get CBD? 

There are many places people can buy CBD products since they are legal. Online buying is one of the easiest because it is easy to research the quality before purchasing anything from a vendor. However, it does mean that some research should still be done prior to buying about what method of ingestion the anxious party is going to want to use. There are quite a few methods to choose from. They include: 

  • Drops: Oil drops are called a tincture. These drops are put under the tongue and allowed to sit for about 30 seconds before the person swallows. These drops are able to enter the bloodstream quickly and start becoming effective in minutes. 
  • Vape: Vaping or smoking CBD oil allows the person to inhale the effects, getting the CBD into the system in seconds. However, these tend to wear off more quickly than drops, and the person vaping or smoking needs to buy the device to smoke the oil with. 
  • Edibles: There are several edibles available with CBD in them, including food additives, gummies, and even lollipops. These take a few minutes to get into the system in some instances, or they may take a little longer if mixed with a meal. 
  • Skin: Many different CBD options are out there if someone wants to absorb CBD through the skin. There are lotions, balms, sprays, and ointments that can be rubbed over larger areas of the body. Plus, there are also dabbers if just one small area hurts as the oil can be dabbed directly on the sore part of the body. 

Does CBD Come with Any Risks? 

There are a few side effects that could come with taking CBD. However, nearly all of them are short-term problems that stop once the body adjusts to the new substance, or the right dosage is found. These issues include minor problems like: 

  • Occasionally feeling a bit more tired. This is usually a very limited problem that stops within a short time of starting a CBD regimen. 
  • Having a dry mouth is common for those taking CBD. It is usually easy to overcome with an increase in how much water someone drinks each day. 
  • Some people feel dizzy after taking CBD, but that is typically only because of how it can reduce blood pressure. Once the body gets used to the new substance, this goes away. 
  • Occasionally, people notice some diarrhea when they first start with CBD, but once the correct dose for a person’s size is found, this also disappears. 

The best way to avoid any of these effects is to start by taking small doses or using it sparingly, then increasing in small increments. Then, if any of these effects start to happen, the dose can slowly be lowered again until the right amount is found. Starting with a higher dose is likely going to cause stomach upset or diarrhea, but once the dose is brought back down, nearly all of these effects permanently stop. 

When it comes to getting the best quality CBD, that takes a little bit of research. It should only be purchased from a vendor that can show results on the product itself. Tests should be run to show the CBD came from hemp that does not contain problematic levels of the psychoactive chemical in the plant. That way, the buyer can ensure the highest quantity of CBD as possible. It is important to research the finest CBD around before buying because that allows the buyer to have the best chances of getting the relief he or she was looking for in the first place. 

More Information on Xanax

Xanax belongs to the group ATC classification index, Psycholeptics (N05)/  Anxiolytics (N05B)/Benzodiazepine derivatives (N05BA). Target organ is the central nervous system, causing depression of respiration and consciousness.

Summary of Clinical Effects

Central nervous system (CNS) depression and coma, or paradoxical excitation, but deaths are rare when  benzodiazepines are taken alone. Deep coma and other manifestations of severe CNS depression are rare. Sedation, somnolence, diplopia, dysarthria, ataxia and intellectual impairment are the most common adverse effects of benzodiazepines. Overdose in adults frequently involves co-ingestion of other CNS depressants, which act synergistically to increase toxicity. Elderly and very young children are more susceptible to the CNS depressant action. Intravenous administration of even therapeutic doses of benzodiazepines may produce apnoea and hypotension.

Dependence may develop with regular use of benzodiazepines, even in therapeutic doses for short periods. If benzodiazepines are discontinued abruptly after regular use, withdrawal symptoms may develop.  The amnesia produced by benzodiazepines can have medico-legal consequences.

Diagnosis

The clinical diagnosis is based upon the history of benzodiazepine overdose and the presence of the clinical signs of benzodiazepine intoxication. Benzodiazepines can be detected or measured in blood and urine using standard analytical methods. This information may confirm the diagnosis but is not useful in the clinical management of the patient.

A clinical response to flumazenil, a specific benzodiazepine antagonist, also confirms the diagnosis of benzodiazepine overdose, but the administration of this drug is rarely  justified.

First Aid Measures and Management Principles

Most benzodiazepine poisonings require only clinical observation and supportive care. It should be remembered that benzodiazepine ingestions by adults commonly involve co-ingestion of other CNS depressants and other drugs. Activated charcoal normally provides adequate gastrointestinal decontamination. Gastric lavage is not routinely indicated.

Emesis is contraindicated. The use of flumazenil is reserved for cases with severe respiratory or cardiovascular complications and should not replace the basic management of the airway and respiration. The routine use of flumazenil is contraindicated because of potential complications, including seizures.  Renal and extracorporeal methods of enhanced elimination are not effective.

Overall Interpretation of All Toxicological Analyses and Toxicological Investigations

For toxicological analyses: whole blood 10 mL; urine 25 mL and gastric contents 25 mL.

Biomedical analysis: Blood gases, serum electrolytes, blood glucose and hepatic enzymes when necessary in severe cases.

Toxicological analysis: Qualitative testing for benzodiazepines is helpful to confirm their presence, but quantitative levels are not clinically useful. More advanced analyses are not necessary for the treatment of the poisoned patient due to the lack of correlation between blood concentrations and clinical severity (Jatlow et al., 1979; MacCormick et al., 1985; Minder, 1989). 

TLC and EMIT: These provide data on the presence of benzodiazepines, their metabolites and possible associations with other drugs.

GC or HPLC: These permit identification and quantification of the benzodiazepine which caused the poisoning and its metabolites in blood and urine.

Acute Poisoning Through Ingestion

The onset of impairment of consciousness is relatively rapid in benzodiazepine poisoning.  Onset is more rapid following larger doses and with agents of shorter duration of action. The most common and initial symptom is somnolence.  This may progress to coma Grade I or Grade II (see below) following very large ingestions. Reed Classification of Coma (Reed et al., 1952)

Coma Grade I:   Depressed level of consciousness, response to painful stimuli. Deep tendon reflexes and vital signs intact.

Coma Grade II:  Depressed level of consciousness, no response to painful stimuli. Deep tendon reflexes and vital signs intact.

Coma Grade III: Depressed level of consciousness, no response to painful stimuli. Deep tendon reflexes absent. Vital signs intact.

Coma Grade IV:  Coma grade III plus respiratory and circulatory collapse.

 

Acute Poisoning Through Parenteral Exposure

Overdose by the intravenous route results in symptoms similar to those associated with ingestion, but they appear immediately after the infusion, and the progression of central nervous system (CNS) depression is more rapid. Acute intentional poisoning by this route is uncommon and most cases are iatrogenic. Rapid intravenous infusion may cause hypotension, respiratory depression and apnoea.

Chronic Poisoning Through Ingestion

Toxic effects associated with chronic exposure are secondary to the presence of the drug and metabolites and include depressed mental status, ataxia, vertigo, dizziness, fatigue, impaired motor co-ordination, confusion, disorientation and anterograde amnesia. Paradoxical effects of psychomotor excitation, delirium and aggressiveness also occur. These chronic effects are more common in the elderly, children and patients with renal or  hepatic disease.

Administration of therapeutic doses of benzodiazepines for 6 weeks or longer can result in physical dependence, characterized by a withdrawal syndrome when the drug is discontinued. With larger doses, the physical dependence develops more rapidly.

Chronic Poisoning Through Parenteral Exposure

The chronic parenteral administration of benzodiazepines may produce thrombophlebitis and tissue.

Course, Prognosis, and Cause of Death 

Benzodiazepines are relatively safe drugs even in overdose. The clinical course is determined by the progression of the neurological symptoms. Deep coma or other manifestations of severe central nervous system (CNS) depression are rare with benzodiazepines alone.  Concomitant ingestion of other CNS depressants may result in a more severe CNS depression of longer duration.

The therapeutic index of the benzodiazepines is high and the mortality rate associated with poisoning due to benzodiazepines alone is very low. Complications in severe poisoning include respiratory depression and aspiration pneumonia. Death is due to respiratory arrest.

Systematic Description of Clinical Effects

Cardiovascular: Hypotension, bradycardia and tachycardia have been reported with overdose (Greenblatt et al., 1977; Meredith & Vale 1985). Hypotension is more frequent when benzodiazepines are ingested in association with  other drugs (Hojer et al., 1989). Rapid intravenous injection is also associated with hypotension.

Respiratory: Respiratory depression may occur in benzodiazepine overdose and the severity depends on dose ingested, amount absorbed, type of benzodiazepine and co-ingestants. Respiratory depression requiring ventilatory support has occurred in benzodiazepine overdoses (Sullivan, 1989; Hojer et al.,1989). The dose-response for respiratory depression varies between individuals.  Respiratory depression or respiratory arrest may rarely occur with therapeutic doses. Benzodiazepines may affect the control of ventilation during sleep and may worsen sleep apnoea or other sleep-related breathing disorders, especially in patients with chronic obstructive pulmonary disease or cardiac failure (Guilleminault, 1990).

Neurological: Central nervous system (CNS) depression is less marked than that produced by other CNS depressant agents (Meredith & Vale, 1985). Even in large overdoses, benzodiazepines usually produce only mild symptoms and this distinguishes them from other sedative-hypnotic agents. Sedation, somnolence, weakness, diplopia, dysarthria, ataxia and intellectual impairment are the most common neurological effects. The clinical effects of severe poisoning are sleepiness, ataxia and coma Grade I to Grade II (Reed). The presence of more severe coma suggests the possibility of co-ingested drugs. Certain of the newer short-acting benzodiazepines (temazepam, alprazolam and triazolam) have been associated with several fatalities and it is  possible that they may have greater acute toxicity (Forrest et al., 1986). The elderly and very young children are more susceptible to the CNS depressant action of benzodiazepines.

The benzodiazepines may cause paradoxical CNS effects, including excitement, delirium and hallucinations. Triazolam has been reported to produce delirium, toxic psychosis, memory impairment and transient global amnesia (Shader & Dimascio, 1970; Bixler et al, 1991). Flurazepam has been associated with nightmares and hallucinations.There are a few reports of extrapyramidal symptoms and dyskinesias in patients taking benzodiazepines (Kaplan & Murkafsky, 1978; Sandyk, 1986).

The muscle relaxation caused by benzodiazepines is of CNS origin and manifests as dysarthria, incoordination and difficulty standing and walking. Oral benzodiazepine poisoning will produce minimal effects on the gastrointestinal tract (GI) tract but can occasionally cause nausea or vomiting (Shader & Dimascio, 1970). A case of cholestatic jaundice due focal hepatic necrosis was associated with the administration of diazepam (Tedesco & Mills, 1982).

 Vesical hypotonia and urinary retention has been reported in association with diazepam poisoning (Chadduck et al.,1973). As for the endocrine and reproductive systems, galactorrhoea with normal serum prolactin concentrations has been noted in 4 women taking benzodiazepines (Kleinberg et al., 1977). Gynaecomastia has been reported in men taking high  doses of diazepam (Moerck & Majelung, 1979). Raised serum concentrations of oestrodiol were observed in men taking diazepam 10 to 20 mg da 9.4.8 Dermatological

Bullae have been reported following overdose with nitrazepam and oxazepam (Ridley, 1971; Moshkowitz et al., 1990). Allergic skin reactions were attributed to diazepam at a rate of 0.4 per 1000 patients (Brigby, 1986).  For eye, ear, nose, throat, local effects include brown opacification of the lens that occurred in 2 patients who used diazepam for several years (Pau Braune, 1985).

Allergic Reactions

Hypersensitivity reactions including anaphylaxis are very rare (Brigby, 1986). Reactions have been attributed to the vehicle used for some parenteral diazepam formulations (Huttel et al., 1980). There is also a report of a type I hypersensitivity reaction to a lipid emulsion of diazepam (Deardon, 1987). Hypothermia was reported in 15% of cases in one series. (Martin, 1985; Hojer et al., 1989). 

Special Risks on Pregnancy

Passage of benzodiazepines across the placenta depends on the degree of protein binding in mother and fetus, which is influenced by factors such as stage of pregnancy and plasma concentrations of free fatty acids in mother and fetus (Lee et al., 1982). Adverse effects may persist in the neonate for several days after birth because of immature drug metabolising  enzymes. Competition between diazepam and bilirubin for protein binding sites could result in hyperbilirubinemia in the neonate (Notarianni, 1990).

 The abuse of benzodiazepines by pregnant women can cause withdrawal syndrome in the neonate. The administration of benzodiazepines during childbirth can produce hypotonia, hyporeflexia, hypothermia and respiratory depression in the newborn. Benzodiazepines have been used in pregnant patients and early reports associated diazepam and chlordiazepoxide with some fetal malformations, but these were not supported by later studies (Laegreid et al., 1987; McElhatton, 1994).

Special Risks on Breastfeeding

Benzodiazepines are excreted in breast milk in significant amounts and may result in lethargy and poor feeding in neonates.  Benzodiazepines should be avoided in nursing mothers (Brodie, 1981; Reynolds, 1996).

Dependence and Withdrawal

Benzodiazepines have a significant potential for abuse and can cause physical and psychological dependence. Abrupt cessation after prolonged use causes a withdrawal syndrome (Ashton, 1989). The mechanism of dependence is probably related to functional deficiency of GABA activity. Withdrawal symptoms include anxiety, insomnia, headache, dizziness, tinnitus, anorexia, vomiting, nausea, tremor, weakness, perspiration, irritability, hypersensitivity to visual and auditory stimuli, palpitations, tachycardia and postural hypotension. In severe and rare cases of withdrawal from high doses, patients may develop affective disorders or motor dysfunction: seizures, psychosis, agitation, confusion, and hallucinations (Einarson, 1981; Hindmarch et al, 1990; Reynolds, 1996).

The time of onset of the withdrawal syndrome depends on the half-life of the drug and its active metabolites; the symptoms occur earlier and may be more severe with short-acting benzodiazepines. Others risk factors for withdrawal syndrome include prolonged use of the drug, higher dosage and abrupt cessation of the drug.

Abuse

Benzodiazepines, particularly temazepam, have been abused both orally and intravenously (Stark et al., 1987; Funderburk et al, 1988).

Criminal Uses

The amnesic effects of benzodiazepines have been used for criminal purposes with medicolegal consequences (Ferner, 1996).

Management

Most benzodiazepine poisonings require only clinical observation and supportive care. It should be remembered that benzodiazepine ingestions by adults commonly include other drugs and other CNS depressants. Activated charcoal normally provides adequate gastrointestinal decontamination. Gastric lavage is not routinely indicated. Emesis is contraindicated. The use of flumazenil is reserved for cases with severe respiratory or cardiovascular complications and should not replace the basic management of the airway and respiration. Renal and extracorporeal elimination methods are not effective.

Life Supportive Procedures and Symptomatic/Specific Treatment

The patient should be evaluated to determine adequacy of airway, breathing and circulation. Continue clinical observation until evidence of toxicity has resolved. Intravenous access should be available for administration of fluid. Endotracheal intubation, assisted ventilation and supplemental oxygen may be required on rare occasions, more commonly when benzodiazepines are ingested in large amounts or with other CNS depressants.

Decontamination

Gastric lavage is not routinely indicated following benzodiazepine overdose. Emesis is contraindicated because of the potential for CNS depression. Activated charcoal can be given orally.

Antidote Treatment for Adults

Flumazenil, a specific benzodiazepine antagonist at central GABA-ergic receptors is available. Although it effectively reverses the CNS effects of benzodiazepine overdose, its use in clinical practice is rarely indicated. Use of Flumazenil is specifically contraindicated when there is history of co-ingestion of tricyclic antidepressants or other drugs capable of producing seizures (including aminophylline and cocaine),   benzodiazepine dependence, or in patients taking benzodiazepines as an anticonvulsant agent. In such situations, administration of Flumazenil may precipitate seizures (Lopez, 1990; Mordel et al., 1992).

Adverse effects associated with Flumazenil include hypertension, tachycardia, anxiety, nausea, vomiting and benzodiazepine withdrawal syndrome. The initial intravenous dose of 0.3 to 1.0 mg may be followed by further doses if necessary. The absence of clinical response to 2 mg of flumazenil within 5 to 10 minutes indicates that  benzodiazepine poisoning is not the major cause of CNS depression or coma. The patient regains consciousness within 15 to 30 seconds after injection of flumazenil, but since it is metabolised more rapidly than the benzodiazepines, recurrence of toxicity and CNS depression can occur and the patient should be carefully monitored after  initial response to flumazenil therapy. If toxicity recurs, further bolus doses may be administered or an infusion commenced at a dose of 0.3 to 1.0 mg/hour (Meredith et al., 1993).

Antidote Treatment for Children

The initial intravenous dose of 0.1 mg should be repeated each minute until the child is awake. Continuous intravenous infusion should be administered at a rate of 0.1 to 0.2 mg/hour (Meredith et al., 1993).

Most benzodiazepine poisonings require only clinical observation and supportive care. Flumazenil is the specific antagonist of the effects of benzodiazepines, but the routine use for the treatment of benzodiazepine overdosage is not recommended. The use of Flumazenil should only be considered where severe CNS depression is observed. This situation rarely occurs, except in cases of mixed ingestion. The administration of flumazenil may improve respiratory and cardiovascular function enough to decrease the need for intubation and mechanical ventilation, but should never replace basic management principles.

Flumazenil is an imidazobenzodiazepine and has been shown to reverse the sedative, anti-convulsant and muscle-relaxant effects of benzodiazepines. In controlled clinical trials, flumazenil significantly antagonizes benzodiazepine-induced coma arising from anaesthesia or acute overdose. However, the use of flumazenil has not been shown to reduce mortality or sequelae in such cases. The administration of flumazenil is more effective in reversing the effects of benzodiazepines when they are the only drugs producing CNS toxicity. Flumazenil does not reverse the CNS depressant effects of non-benzodiazepine drugs, including alcohol. The diagnostic use of flumazenil in patients presenting with coma of unknown origin can be justified by its high therapeutic index and the fact that this may limit the use of other diagnostic procedures (CT scan, lumbar puncture, etc). Flumazenil is a relatively expensive drug and this may also influence its use, especially in areas with limited resources.

Conclusion

While no medication should ever be taken without medical advice, CBD is a slightly different product. It can interact with some drugs, but very few, especially when compared to drugs like Xanax, which have several interaction warnings. There are times where a type of medication is the best method for getting relief. However, when a more natural alternative is giving people as good, if not better results, it is at least worth considering. For anyone who has struggled with the overwhelming emotions that come with anxiety or who is allergic to many of the medications used to treat anxiety, CBD could be the best option for natural relief. It could be the one thing that brings about a sense of normality while also providing numerous other medical benefits. Instead of allowing anxiety to dictate how to live life, take back control. Give CBD oil or one of the other amazing products that contain CBD a try and see if that makes things just a little bit easier. 

Susan Lindeman

Susan is a young mother and writer, passionate about cooking and blogging. She makes CBD-infused foods, like cookies and candies, to help her cope with anxiety and perform her daily tasks better.
Susan Lindeman

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