Clinical Management of Designer Benzodiazepine Intoxication: A Systematic Review

A subset of novel psychoactive substances (NPS), designer benzodiazepines, are rising in popularity. These compounds are more potent derivatives of prescription benzodiazepines and can lead to profound sedation. Therefore, clinicians are challenged with caring for patients who present with designer benzodiazepine intoxication or withdrawal. We conducted a systematic review of the literature for designer benzodiazepine overdoses with a focus on patient presentation and clinical management.

We conducted a systematic literature search in multiple databases using Medical Subject Headings (MeSH) terms "designer benzodiazepine(s)" and "case report" along with additional permutations of search terms. We used the PICOS search algorithm to enhance reporting of systematic reviews' findings.

A total of 27 articles were selected for inclusion in our systematic review, comprising 35 patient cases. The average patient age was 27.14 years (SD = 9.86), and the male-to-female ratio was 3.38:1. More than half (54.29%) of cases involved designer benzodiazepines alone, whereas 45.71% of cases involved co-ingestions. The most frequent presenting sign was altered mental status. The most frequent abnormal vital sign was tachycardia.

Management of patients presenting with acute designer benzodiazepine intoxication was highly variable, depending on the severity. We include practical clinical management guidance based on 3 designer benzodiazepine toxidromes including sedation-predominant, withdrawal-predominant, or mixed-sedation with rebound agitation.

Designer benzodiazepines are highly potent compounds that present a significant risk to patients and pose a clinical management challenge to clinicians. More research is needed to fully understand the effects of designer benzodiazepines in humans.