Diazapam/Valium question

[nomofica]

A contraindication for Diazapam is obvious ETOH, so I've got a question...

During the spring I had a sinus tach episode with HR @ ~180-190 strong/reg resting (cause being consumption of a stimulant and depressant... Redbull and alcohol). To bring my HR down, I was given Valium (diazapam) via IV, although I was intoxicated at the time.

I'm curious as to why I'd be given Valium if I have an obvious contraindication to any benzodiazapines. Anybody have any ideas?

[Smash]

ETOH use is not a contraindication for diazepam.

Severe hepatic dysfunction maybe, and obviously you would be cautious with any level of hepatic dysfunction or respiratory impairment, but ETOH use on it's own is not contrindicated.

[exodus]

Hoping this is a typo? But you were ETOH at the time?

[dmiracco]

Benzos as well as narcs are not absolutely contraindicated in people who are ETOH. You want to use caution and perhaps give a less than normal dose secondary to hemodynamics. Youre assessment is key here as to the decision to give a benzo to a patient who has been drinking.

[VentMedic]

Just like you mixing the alcohol and Red Bull to get a desired affect, mixing Valium and alcohol can also give a desired or undesired affect. It may increase drowsiness which to some may be a desired effect who knowingly (just as you did with the ETOH and Red Bull) do the combination but to others it can become a complication as it appears your experience with the ETOH/Red Bull mixture did.

In the hospital for ETOH withdrawal, the patient may be given up to 120 mg/day of Valium but there is a desired effect under observation and he/she won't be driving or doing other tasks that can cause harm to oneself or others. Thus, the need for warnings on the medication. Unfortunately, the manufacturers of Red Bull knew what their product could do and there have been voluntary advisories on it. They just didn't plan on people doing stupid things like mixing their product with another product such as ETOH to get another "desired" effect. Thus, the need for another med such as Valium to calm the effects of the other combination.

[mycrofft]

WE customarily gave Ativan, later Valium, for ETOH withdrawl, often starting the loading doses when the pt's were still a little inebriated. Since they were locked up they weren't going driving or handling nuclear waste.
HOWEVER:
We saw a trend in pt's with evidence of liver damage or so called "stunned livers" due to chemical insult; the Valium would have less than the anticipated effect. If we redoubled our dosing based on effects (vital signs, tremor) and not on body weight, after a few days the pt would suddenly become severely obtunded because the benzo's active metabolites were suddenly available once the liver could stop fighting for it's life and get back to processing and eliminating.
Despite the HOUSE, MD episode, Valium does NOT cause seizures; it also is not a big threat to depress respirations (versus phenobarb and some others).

[VentMedic]

Originally Posted by mycrofft

WE customarily gave Ativan, later Valium, for ETOH withdrawl, often starting the loading doses when the pt's were still a little inebriated.

Is Librium still an option in the treatment pathway?

[maxwell]

If you weren't breathing, I'd hold the benzos, but, I routinely give ativan (and yes, sometimes versed!) to my friendly drunks. EtOH + Benzos (of course, in moderation) together really aren't that dangerous (yes yes be monitored etc). It's commonly done to chill 'em out. You sounded hemodynamically stable (and do those who are gonna b*tch and moan about the heart rate...I offer to you that the cause isn't cardiogenic) - and sometimes the HR of 180 is just due to drunken tomfoolery --> anxiety. So, sure, some of mother's little helper is nice. Especially if you're a mean drunk.

Now, the problem comes when we mix benzos with narcos. THEN you can run the risk of RR depression - which is why with CS we have to be careful playing with versed and fentanyl . However, I've learned that with a sober(ish) patient you can give as much benzo as you wish, but when you add just a whiff of narcotics, you can run into trouble.

Drink up!!

[maxwell]

Originally Posted by VentMedic

Is Librium still an option in the treatment pathway?

Usually not. I see it less and less. What I see more and more and have some very good results with (and is biochemically fascinating!):

http://www.ncbi.nlm.nih.gov/pubmed/3327372

[VentMedic]

We still have it as an option in the hospital pathway for treating alcohol withdrawal as not all patients are the same and can follow the same recipe.

http://www.ncbi.nlm.nih.gov/pubmed/3327372

There is more recent data on it since 22 years is like two lifetimes in medicine.