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[67] [78] [79] [80] Some antipsychotic agents may be riskier than others during withdrawal, 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. [81]
Medications that lower seizure threshold include the antidepressant and nicotinic antagonist bupropion, the atypical opioid analgesics tramadol and tapentadol, reserpine, [1] theophylline, [2] antibiotics (fluoroquinolones, imipenem, penicillins, cephalosporins, metronidazole, isoniazid) and volatile anesthetics. So can other factors, including:
Tramadol increases the risk for seizures by lowering the seizure threshold. Using other medications that lower seizure threshold - such as antipsychotic medications , bupropion (an anti-depressant and smoking cessation drug), and amphetamines - can further increase this risk.
The protracted withdrawal syndrome from benzodiazepines, opioids, alcohol and other addictive substances can produce symptoms identical to generalized anxiety disorder as well as panic disorder. Due to the sometimes prolonged nature and severity of benzodiazepine, opioid and alcohol withdrawal, abrupt cessation is not advised.
Antipsychotics are not recommended for benzodiazepine 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. [148]
Individuals who have had more withdrawal episodes are at an increased risk of very severe withdrawal symptoms, up to and including seizures and death. Long-term activation of the GABA receptor by sedative–hypnotic drugs causes chronic GABA receptor downregulation as well as glutamate overactivity, which can lead to drug and neurotransmitter ...
Some medicinal and recreational drugs can dose-dependently precipitate seizures in withdrawal, especially when withdrawing from high doses and/or chronic use. Examples include drugs that affect GABAergic and/or glutamatergic systems, such as alcohol (see alcohol withdrawal), [19] benzodiazepines, barbiturates, and anesthetics, among others.
The treatment of withdrawal in people with opioid use disorder also relies on symptomatic management and tapering with medications that replace typical opioids, including buprenorphine and methadone. The principle of managing the syndrome is to allow the concentration of drugs in blood to fall to near zero and reverse physiological adaptation.