Barbiturate dependence

Barbiturate dependence develops with regular use of barbiturates. This in turn may lead to a need for increasing doses of the drug to get the original desired pharmacological or therapeutic effect.[1] Barbiturate use can lead to both addiction and physical dependence, and as such they have a high potential for excess or non-medical use,[2] however, it does not affect all users. Management of barbiturate dependence involves considering the affected person's age, comorbidity and the pharmacological pathways of barbiturates.[3]

Psychological addiction to barbiturates can develop quickly. The patients will then have a strong desire to take any barbiturate-like drug. The chronic use of barbiturates leads to moderate degradation of the personality with narrowing of interests, passivity and loss of volition. The somatic signs include hypomimia, problems articulating, weakening of reflexes, and ataxia.[4]

The GABAA receptor, one of barbiturates' main sites of action, is thought to play a pivotal role in the development of tolerance to and dependence on barbiturates, as well as the euphoric "high" that results from their use.[2] The mechanism by which barbiturate tolerance develops is believed to be different from that of ethanol or benzodiazepines, even though these drugs have been shown to exhibit cross-tolerance with each other[5] and poly drug administration of barbiturates and alcohol used to be common.

The management of a physical dependence on barbiturates is stabilisation on the long-acting barbiturate phenobarbital followed by a gradual titration down of dose. People who use barbiturates tend to prefer rapid-acting barbiturates (amobarbital, pentobarbital, secobarbital) rather than long-acting barbiturates (barbital, phenobarbital).[6] The slowly eliminated phenobarbital lessens the severity of the withdrawal syndrome and reduces the chances of serious barbiturate withdrawal effects such as seizures.[7] A cold turkey withdrawal can in some cases lead to death. Antipsychotics are not recommended for barbiturate withdrawal (or other CNS depressant withdrawal states) especially clozapine, olanzapine or low potency phenothiazines e.g. chlorpromazine as they lower the seizure threshold and can worsen withdrawal effects; if used extreme caution is required.[8] The withdrawal symptoms after ending barbiturate consumption are quite severe and last from 4 to 7 days.

## References

1. ↑ "Tolerance and withdrawal issues with sedation". Crit Care Nurs Clin North Am 17 (3): 211–23. September 2005. doi:10.1016/j.ccell.2005.04.011. PMID 16115529.
2. ↑ 2.0 2.1 Takehiko Ito; Toshihito Suzuki; Susan E. Wellman; Ing Kang Ho (June 1996). "Pharmacology of barbiturate tolerance/dependence: GABAA receptors and molecular aspects". Life Sciences 59 (3): 169–95. doi:10.1016/0024-3205(96)00199-3. PMID 8699929.
3. ↑ "Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition And Treatment". Emerg Med Pract 19 (3): 1–20. 2017. PMID 28186869.
4. ↑ Jüri Saarma "Kliiniline psühhiaatria". Tallinn, 1980. P. 139.
5. ↑ "Barbiturate tolerance: effects on GABA-operated chloride channel function". Brain Res. 588 (2): 255–60. August 1992. doi:10.1016/0006-8993(92)91583-Z. PMID 1382810.
6. ↑ Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants By Donald G. Barceloux. P. 469
7. ↑ Tyrer, Peter; Silk, Kenneth R., eds (24 January 2008). Cambridge Textbook of Effective Treatments in Psychiatry (1st ed.). Cambridge University Press. pp. 406. ISBN 978-0-521-84228-0. https://books.google.com/books?id=HLPXELjTgdEC.
8. ↑ Ebadi, Manuchair (23 October 2007). "Alphabetical presentation of drugs". Desk Reference for Clinical Pharmacology (2nd ed.). USA: CRC Press. p. 512. ISBN 978-1-4200-4743-1. https://books.google.com/books?id=ihxyHbnj3qYC.

## External links

Classification|

* ICD-10: F13.2
* ICD-9-CM: 304.1

|

* v
* t
* e

Psychoactive substance-related disorder (F10–F19, 291–292; 303–305)

General|

* SID
* Substance intoxication / Drug overdose
* Substance-induced psychosis
* Withdrawal:
* Craving
* Neonatal withdrawal
* Post-acute-withdrawal syndrome (PAWS)
* SUD
* Substance abuse / Substance-related disorders
* Physical dependence / Psychological dependence / Substance dependence

Combined
substance use|

* SUD
* Polysubstance dependence
* SID
* Combined drug intoxication (CDI)

Alcohol|

| SID|

| Cardiovascular diseases|

* Alcoholic cardiomyopathy
* Alcohol flush reaction

|

Gastrointestinal diseases|

* Alcoholic liver disease (ALD):
* Alcoholic hepatitis
* Auto-brewery syndrome

Endocrine diseases|

* Alcoholic ketoacidosis (AKA)

Nervous
system diseases|

* Alcohol-related dementia (ARD)
* Alcohol intoxication
* Hangover

Neurological
disorders|

* Alcoholic hallucinosis
* Alcoholic polyneuropathy
* Alcohol-related brain damage
* Alcohol withdrawal syndrome:
* Alcoholic hallucinosis
* Delirium tremens (DTs)
* Fetal alcohol spectrum disorder (FASD)
* Fetal alcohol syndrome (FAS)
* Korsakoff syndrome
* Korsakoff psychosis
* Positional alcohol nystagmus (PAN)
* Wernicke–Korsakoff syndrome (WKS)
* Wernicke encephalopathy (WE)

Respiratory tract diseases|

* Alcohol-induced respiratory reactions
* Alcoholic lung disease

SUD|

* Alcoholism (alcohol use disorder (AUD))
* Binge drinking

Caffeine|

* SID
* Caffeine-induced anxiety disorder
* Caffeine-induced sleep disorder
* Caffeinism
* SUD
* Caffeine dependence

Cannabis|

* SID
* Cannabinoid hyperemesis syndrome (CHS)
* SUD
* Amotivational syndrome
* Cannabis use disorder (CUD)
* Synthetic cannabinoid use disorder

Cocaine|

* SID
* Cocaine intoxication
* Prenatal cocaine exposure (PCE)
* SUD
* Cocaine dependence

Hallucinogen|

* SID
* Acute intoxication from hallucinogens (bad trip)
* Hallucinogen persisting perception disorder (HPPD)

Nicotine|

* SID
* Nicotine poisoning
* Nicotine withdrawal
* SUD
* Nicotine dependence

Opioids|

* SID
* Opioid overdose
* SUD
* Opioid use disorder (OUD)

Sedative /
hypnotic|

* SID
* Kindling (sedative–hypnotic withdrawal)
* benzodiazepine: SID
* Benzodiazepine overdose
* Benzodiazepine withdrawal
* SUD
* Benzodiazepine use disorder (BUD)
* Benzodiazepine dependence
* barbiturate: SID
* Barbiturate overdose
* SUD
* Barbiturate dependence

Stimulants|

* SID
* Stimulant psychosis
* amphetamine: SUD
* Amphetamine dependence

Volatile
solvent|

* SID
* Sudden sniffing death syndrome (SSDS)
* Toluene toxicity
* SUD
* Inhalant abuse

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