Paradoxical reactions to benzodiazepines: literature review and treatment options
Open accessAbstract
Benzodiazepines frequently are administered to patients to induce sedation. Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients. The exact mechanism of paradoxical reactions remains unclear. Most cases are idiosyncratic; however, some evidence suggests that these reactions may occur secondary to a genetic link, history of alcohol abuse, or psychological disturbances. This review evaluates the numerous cases of paradoxical reactions to benzodiazepines in adult and pediatric patients that have been reported in the biomedical literature. It also explores the advantages and disadvantages of the various available treatment options.
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Persistent post-withdrawal tardive dyskinesia has been documented in a non-psychiatric patient after 4-month treatment with a gastric preparation containing trifluoperazine and an anticholinergic drug, with irreversible severe movements 7 weeks after termination.
“in a non-psychiatric patient after a 4-month treatment with a gastric preparation containing trifluoperazine and an anticholinergic drug. In the latter case, 7 weeks after the termination of the treatment, continuous movements of the patient's face, lips, and tongue appeared; they were irreversible and extremely severe [165].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [165]
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Experimental — accuracy not yet measuredChildren and elderly patients, patients with a history of alcohol abuse, and individuals with a history of aggressive behavior or anger may be more likely to experience paradoxical excitement effects than other patients.
“Children and elderly patients, patients with a history of alcohol abuse and individuals with a history of aggressive behavior ⁄ anger may be more likely to experience paradoxical excitement effects than are other patients (172).”
From Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics (2008) · cites this paper as [172]
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- Authors
- Mancuso, C. E., Tanzi, M. G., & Gabay, M.
- Affiliations
- University of Illinois Chicago (US)
- Corresponding author
- Mancuso, Carissa E.
- ORCID
- Gabay, Michael
- Venue
- Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
- Publisher
- Wiley
- Published
- 2004-09
- Volume
- 24
- Issue
- 9
- Pages
- 1177-1185
- ISSN
- 0277-0008 (ISSN-L)
- 1875-9114
- OpenAlex
- W2115910406
- Cited by
- 298
- References
- 30
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 13 · 2023: 25 · 2022: 28 · 2021: 25 · 2020: 14 · 2019: 27 · 2018: 13 · 2017: 11 · 2016: 12 · 2015: 15 · 2014: 17 · 2013: 9 · 2012: 18
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Keywords
- paradoxical reaction, benzodiazepines, sedation, idiosyncratic drug reactions, genetic susceptibility, alcohol abuse, mental illness, pediatric patients, treatment options
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Benzodiazepines, Child, Child, Preschool, Female, Humans, Infant, Male, Middle Aged, Anti-Anxiety Agents, Randomized Controlled Trials as Topic
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