Clinical Management of Designer Benzodiazepine Intoxication: A Systematic Review

Area of Science:

• Toxicology
• Pharmacology
• Emergency Medicine

Background:

• Designer benzodiazepines (DBDs), potent novel psychoactive substances (NPS), are increasingly prevalent.
• These compounds, stronger than prescription benzodiazepines, can cause profound sedation.
• Clinicians face challenges managing patients with DBD intoxication or withdrawal.

Approach:

• A systematic literature review was conducted using MeSH terms and permutations.
• The PICOS search algorithm was employed to refine the systematic review.
• Twenty-seven articles comprising 35 patient cases were included.

Key Points:

• The average patient age was 27.14 years, with a male-to-female ratio of 3.38:1.
• Over half of cases involved DBDs alone; 45.71% involved co-ingestions.
• Altered mental status and tachycardia were the most frequent signs and vital sign abnormalities.

Conclusions:

• Management of acute DBD intoxication is variable and severity-dependent.
• Guidance is provided for sedation-predominant, withdrawal-predominant, and mixed toxidromes.
• DBDs pose significant risks and clinical challenges, necessitating further research.